肝功能衰竭合并严重感染患者肝移植术后的临床观察

The clinical observation of patients with liver function failure and severity infection undergoing liver transplantation

目的 探讨肝功能衰竭伴严重感染患者行肝移植术的预后及转归.方法 2004年1月至2006年12月对24例肝功能衰竭伴严重感染的患者行肝移植术.对患者术前状况进行评估,并收集肝移植术后患者的临床资料,判断此类患者行肝移植的时机和预后.结果 肝移植术后常见的微生物感染为大肠艾希氏菌、假单胞菌属、肺炎克雷伯杆菌、假丝酵母菌属、烟曲霉菌等.肝功能衰竭合并重症感染的24例接受肝移植的患者均安全度过围手术期,术后平均呼吸机使用时间（97.3±21.4）h,免疫抑制剂在进展性感染得到控制后开始使用,FK506的初始剂量为0.03 mg/（kg·d）,浓度控制在（3～4）ng/ml.没有明显的排斥反应发生,感染最终均被控制. 结论肝功能衰竭合并严重感染的患者,选择合适的时机行肝移植十分重要.早期使用敏感抗生素;推迟或减少免疫抑制剂使用;适当延长呼吸机使用时间以维持肺功能可以治疗术后感染相关并发症.

Objective To discuss the prognosis and turnover of the patients with liver function failure and severity pulmonary infection undergoing liver transplantation. Method A total of 24 patients with liver function failure and severity pulmonary infection had accepted liver transplantation in our center during Jan. 2004 to Dec. 2006. The preoperative conditions of the patients were evaluated, and their postoperative clinical data were collected to decide the appropriate operating time and prognosis. Results The most frequent microorganisms inducing infections after liver transplantation were as follows ： E. coli, Pseudomonas,KlebsieUa pneumoniae, Candida mycoderma, Aspergillus fumigatus. All the 24 patients had passed perioperative time safely,and used respirator at the average of （97.3 ＋ 21.4） h. The immunosup- pressants were used after the controlling of progressive infection, and the initial dose of FKS06 was 0.03 mg/（ kg · day） with the concentration controlled at （3 -4） ng/ml. There was no episode of rejection, and the infections were cured finally. Conclusion It is very important to choose the appropriate time of liver transplantation for patients with liver function failure and severity pulmonary infection. The postoperative infection and relative complications can be treated by using effective antibiotics early, delaying or reducing the use of immunosuppressants and appropriately prolonging the using time of respirator to support the lung function.