肝移植术后肺部感染的临床分析

Clinical analysis of pulmonary infection after liver transplantation

目的探讨肝移植术后肺部感染的影响囤素晨防治措施。方法回顾70例成人肝移植病例资料，分析患者肺部感染的影响因素及防治措施。结果70例中31例患者出现肺部感染，且均于术后1个月内发生，24例肺部感染发生于术后1周，3例发生于术后8～14d，3例发生于术后15—21d，1例发生于术后22～30d。肺部感染的发生与术前肝功能Child-Pugh分级、血肌酐水平、有无吸烟史、术中输液量、手术时间、术后气管插管时间、术后第1天总胆红素水平有关。肺部感染组与无肺部感染组中的差异有统计学意义（P〈0．05）。结论肝移植术前积极改善肝功能、降低血肌酐水平，戒烟并行肺功能锻炼，术中尽量控制液体输入量，缩短手术时间，术后尽快拔除气管插管、积极改善高胆红素血症是预防肝移植术后肺部感染的重要因素。

Objective To investigate influencing factors and prevention methods for pulmonary infection after liver transplantation. Methods Seventy adult patients who underwent liver transplantation were retrospectively analyzed for the influencing factors and prevention methods of pulmonary infection. Results Thirty-one patients occurred pulmonary infection in one month after liver transplantation, 24 cases occurred in the first week after surgery, 3 cases occurred in 8 - 14 days after surgery, 3 cases occurred in 15 - 21 days after surgery, 1 case occurred in 22 - 30 days after surgery. Lung infection were realated with preoperative liver function Child-Pugh classification, serum reatinine levels, with or without a history of smoking, amount of intraoperative transfusion, operative time, postoperative intubation time, one day after total bilirubin levelrelated. The differences was statistically significant （P 〈 0.05 ） between lung fection group and without lung infection group. Conclusions Actively improve liver function before liver transplantation, lower serum creatinine levels, quit smoking and had lung function exercise, control the amount of liquid intraoperatively, shorten operative time, postoperative extubation as soon as possible, and actively improve hyperbilirubinemia are important factors for prevention of pulmonary infection after liver transplantation.