良性终末期肝病肝移植术后肺部医院感染的危险因素分析

Risk factors of nosocomial pulmonary nosocomial infection in adult patients with benign end-stage liver disease after liver transplantation

目的分析并探讨良性终末期肝病肝移植术后肺部医院感染的危险因素,为临床治疗提供参考意见。方法选取2014年1月至2017年12月本院收治的因良性终末期肝病而接受肝移植的86例患者为研究对象,通过对感染部位标本的培养和鉴定,探讨肺部医院感染的病原学特点。回顾性分析患者的临床病历资料,采用单因素及多因素Logistic回归分析探讨影响良性终末期肝病肝移植患者术后肺部医院感染的危险因素。结果培养并鉴定出病原菌29株,其中革兰阴性菌21株(72.41%),革兰阳性菌8株(27.58%)。单因素分析显示,肝功能低下、合并低蛋白血症(<30 g/L)、ICU留观时间长、术中输注大量血制品、有创机械通气时间长的良性终末期肝病肝移植患者术后更易发生肺部医院感染(P_均<0.05)。Logistic回归分析表明肝功能Child-Pugh评分≥9分、合并低蛋白血症(<30 g/L)、ICU留观时间≥7天、术中输注血制品>4 L、有创机械通气时间≥48小时均为良性终末期肝病肝移植患者术后肺部医院感染的独立危险因素(P_均<0.05)。结论良性终末期肝病肝移植患者术后肺部医院感染主要与合并低蛋白血症(<30 g/L)、术中输注大量血制品、ICU留观时间≥7天、有创机械通气时间≥48小时有关,临床上应针对上述危险因素采取相应的预防措施。

Objective To analyze and explore the risk factors of pulmonary nosocomial infection after liver transplantation in benign end-stage liver disease, and provide reference for clinical treatment. Method 86 patients with benign end-stage liver disease undergoing liver transplantation in our hospital from January 2014 to December 2017 were selected as research objects. The etiological characteristics of pulmonary nosocomial infection were studied by culturing and identifying the infected parts. The clinical data of patients were retrospectively analyzed, to explore the risk factors of pulmonary nosocomial infection after liver transplantation for benign end-stage liver disease by univariate and multivariate Logistic regression analysis. Result 29 strains of pathogenic microorganisms were cultured and identified. The results showed that there were 21 strains of Gram-negative bacteria accounting for 72.41% and 8 strains of Gram-positive bacteria accounting for 27.58%. Univariate results showed that patients with low liver function, combined with hypoproteinemia（ 30 g/L）, longer ICU length of stay, intraoperative infusion of large quantities of blood products, and invasive mechanical ventilation were more likely to develop pulmonary nosocomial infections（Pall〈 0.05）. Logistic regression analysis showed that patients with Child-Pugh score ≥ 9 scores, combined with hypoproteinemia（ 30 g/L）, ICU length of stay ≥ 7 d,intraoperative transfusion of blood products〉 4 L and invasive mechanical ventilation time ≥ 48 h were independent risk factors of pulmonary nosocomial infection（Pall〈 0.05）. Conclusion The incidence of pulmonary nosocomial infection after liver transplantation in patients with benign end-stage liver disease is mainly related to hypoalbuminemia（ 30 g/L）, intraoperative transfusion of blood products 4 L, ICU length of stay ≥ 7 d and invasive mechanical ventilation time ≥ 48 h, and corresponding preventive measures should be taken for the above-mentioned high-risk factors.