肾移植术后肺部感染的高危因素分析

Analysis on risk factors of pulmonary infection after renal transplantation

目的探讨肾移植手术后患者发生肺部感染的高危因素。方法回顾性分析184例在本院2014年12月至2017年4月做肾移植术的患者及92例对应供者的临床资料。其中肾移植术后发生肺部感染的受者53例(对应供者33例)作为感染组,未发生肺部感染者131例(对应供者59例)为未感染组。分析两组的临床资料,包括供者的性别、年龄、呼吸机应用时间、是否行心肺复苏、误吸史,受者的性别、年龄、吸烟史、糖尿病史、依从性、术前透析时间、有无肾功能延迟恢复、围术期降钙素原(procalcitonin,PCT)水平及(1,3)-β-D葡聚糖试验[(1,3)-β-D glucan test,G试验]水平、静脉营养使用时间,分析受者术后发生肺部感染的高危因素。结果感染组9例发生重症肺部感染而死亡。供者呼吸机应用时间(95%CI:3.161～48.238,P=0.002)、误吸史(95%CI:2.384～43.891,P=0.036),受者糖尿病史(95%CI:1.923～33.271,P=0.029)、依从性(95%CI:2.015～39.338,P=0.009)、肾功能延迟恢复(95%CI:3.045～38.945,P=0.013)、围术期G试验水平(95%CI:2.147～44.125,P=0.006)是患者术后发生肺部感染的独立危险因素。结论供者的呼吸机应用时间、误吸史,受者的糖尿病史、依从性、肾功能延迟恢复、围术期G试验水平与肾移植术后发生肺部感染相关。一旦发生重症肺部感染,死亡率极高,故应对高危因素做好筛查和预防工作,以降低肺部感染发病率。

Objective To investigate the risk factors of pulmonary infection after renal transplantation. Method Clinical data of 92donors and 184 recipients admitted to Organ Transplantation Center, from December 2014 to April 2017 were retrospectively analyzed.All recipients were divided into the pulmonary infection group A (n=53) and non-pulmonary infection group B (n=131) after renaltransplantation.Risk factors like donor sex, age, perform the ventilator time, whether the history of aspiration,the recipients' age, smokinghistory, diabetes, compliance, preoperative dialysis time, with or without DGF ,perioperative test of PCT and G test, TPN time were subjectto single factor analysis and multi-variate Logistic regression analysis to identify the independent risk factors of pulmonary infection.Result Among 53 patients with pulmonary infection, 9 died due to progression to severe pulmonary infection.The donor's ventilation time(95%CI: 3.161-48.238, P=0.002), the history of aspiration(95%CI: 2.384-43.891, P=0.036), diabetes mellitus (95% CI: 1.923-33.271,P = 0.029), compliance (95% CI: 2.015-39.338, P=0.009), DGF(95%CI: 3.045-38.945, P =0.013), perioperative G test (95% CI: 2.147-44.125, P=0.006) were independent risk factors for pulmonary infection. Conclusion The donor's ventilation time, the history of aspiration,receipients'history of diabetes mellitus,compliance,DGF,elevated perioperative G test were related with pulmonary infection and severepulmonary infection is a major attack to the transplanted kidney. It is necessary to screen and prevent high risk factors and reduce theincidence of pulmonary infection.