儿童活体肝移植术后早期肺部感染危险因素分析

Analysis of potential risk factors for early postoperative pulmonary infection after pediatric living donor liver transplantation

目的分析儿童活体肝移植（LDLT）术后早期（≤30d）肺部感染的危险因素，探讨其防治策略。方法回顾性分析2006年6月至2009年12月在重庆医科大学附属儿童医院接受活体肝移植的36例患儿的临床资料，术前均排除呼吸道感染，分析术后早期肺部感染的发生率、患儿的预后及相关危险因素。对所有相关危险因素先用单因素分析逐一筛选，然后将所有P〈0．05的因素进行非条件Logistic多元回归分析。结果术后早期肺部感染发生率为67％（24／36），病死率17％（4／24）。单因素分析年龄≤1岁、术前高Child—Pugh分级、血红蛋白〈90g／L、先天性心脏病、术中输液量〉150ml／kg、术后呼吸机使用时间〉12h、胃管留置时间〉3d均与术后早期肺部感染相关（均P〈0．05）。Logistic回归分析筛出年龄≤1岁、术中输液量〉150ml／kg、胃管留置时间〉3d是术后早期肺部感染的独立危险因素（均P〈0．05）。结论肺部感染是儿童活体肝移植术后早期常见并发症之一，也是影响近期生存的重要因素，术前积极改善全身状态，术中血流动力学监测下限制性补液，术后加强胃管管理对降低术后肺部感染风险、提高手术成功率有重要意义。

Objective To analyze the potential risk factors of early （ 430 days） postoperative pulmonary infection after pediatric living donor liver transplantation （LDLT） and explore the feasible preventive and therapeutic measures. Methods Without preoperative respiratory disease, the clinical data of 36 cases undergoing LDLT at Children＇s Hospital of Chongqing Medical University between June 2006 and December 2009 were analyzed retrospectively so as to evaluate the incidence, prognosis and risk factors of early postoperative pulmonary infection. Univariate analysis was performed to determine the relative risk factors for postoperative pneumonia. And significant factors （ P 〈 0. 05 ） were then used for multivariate Logistic regression analysis. Results Twenty-four recipients suffered from early postoperative pulmonary infection at an incidence of 67% （24/36）. The mortality rate in the pediatric patients who developed pulmonary infection was 17% （4/24）. In univariate analysis, age ~ 1 year, high Child-Pugh scores, hemoglobin 〈 90 g/L, congenital heart disease, mechanical ventilation 〉 12 hours, intraoperative transfusion 〉 150 ml/kg and indwelling gastric tube 〉 3 days were of statistical significance （ all P 〈 0. 05）. Multivariate Logistic regression analysis showed age ~〈 1 year, intraoperative transfusion 〉 150 ml/kg and indwelling gastric tube 〉 3 days were independent risk factors for post-LDLT pneumonia （ all P 〈 0. 05 ）. Conclusions Pulmonary infection is an important factor of decreasing the survival rate during the early postoperative stage. To reduce the incidence of postoperative pulmonary infection and guarantee a successful transplantation, should improve the preoperative physical condition, restrict intraoperative fluid infusion with stable hemodynamics and strengthen gastric tube management.