16例心脏移植术后早期感染的防治

Prevention and treatment of infection following cardiac transplantation at early stage in 16 cases

目的 探讨心脏移植术后早期感染发生的相关因素及其防治措施。方法 通过观察16例同种异体原位心脏移植术后的细菌学、病毒学检查及临床表现 ,了解受者感染的发生情况。结果 16例受者术后早期均出现不同程度的亚临床感染 ,其中 9例为临床感染 ,感染发生的最多部位是肺部 ,部分受者为多重感染或多器官、多菌种感染。 16例受者中 ,死亡 5例 ,其中 2例死因与感染直接相关。结论 心脏移植术后早期感染与术前准备、术后隔离条件、大剂量免疫抑制剂的应用等因素直接相关。外科手术切除病灶是治疗霉菌性肺炎的重要方法。

Objectives To explore the cause and management of infection at early stage after heart transplantation.Methods From Aug. 1995 to April 2000, 16 patients with end-stage dilated cardiomyopathy underwent orthotopic heart transplantation, whose infections during operation were diagnosed through bacteriologic and virologic investigation, and manifestations of dissemination to some organs. Results The 16 patient at early stage after transplantation had subclinical infection in various sense. Nine of 16 cases had clinical infection. Infection after transplantation most frequently occurred in lung. Some patients had multi-infectious or multi-organs and multi-organisms infections. Two of 5 dead cases died of infection after transplantation. Eleven patients survived with good quality of life.Conclusions The causes of infection at early stage after heart transplantation is closely associated with preoperative preparation, postoperative protective isolation, large dose of immunosuppresion and son on. Surgical resection of local lesion is very important in the treatment of local aspergillar pneumonia.