脑死亡器官捐献者合并感染的回顾性分析

Retrospective Analysis of Organ Donors After Brain Death Complicated with Infection

目的总结脑死亡器官捐献者感染发生部位,病原菌种类,耐药性以及外周血T淋巴细胞亚群的变化,为控制供体感染提供依据。方法回顾性分析深圳市第三人民医院重症医学科2016年5月至2018年12月完成的31例脑死亡器官捐献者与感染相关的临床资料,其中20例作为观察组,对照组为同期住院20例轻型颅脑损伤(GCS 14～15分)患者,比较两组在发病1周内外周血T淋巴细胞亚群的差异。结果 31例供者中27例合并感染,发生率为87.1%),感染部位以下呼吸道最常见,占96.3%,两个及以上部位发生感染7例,占25.9%,共检出病原菌35株,其中革兰阴性菌28株,占80%,革兰阳性菌4株,占11.4%,真菌3株,占8.6%,多重耐药菌14株,占40.0%。与对照组相比,观察组CD_4,CD_4/CD_8下降,CD_8上升,差异有统计学意义。结论脑死亡器官捐献者感染发生率高,下呼吸道为最常见感染部位,革兰阴性菌以及多重耐药菌检出率高,免疫功能降低可能是感染的易发因素之一。

Objective To summarize infection site, pathogen species, drug resistance and changes of peripheral blood T lymphocyte subsets in cases of donation after brain death. To provide evidence for infection control of organ donors. Methods The infection-related clinical data of 31 cases of donation after brain death completed in the intensive care department of the Third People's Hospital of Shenzhen from May 2016 to December 2018 were retrospectively analyzed. Among them, 20 cases were treated as the observation group, and the control group was 20 cases of mild craniocerebral injury (GCS 14-15 points) patients hospitalized at the same time, and the difference of peripheral blood T lymphocyte subsets between the two groups within 1 week after the onset was compared. Results There were 27 cases of these 31 donators with infection is 87.1%. The most common infection site was lower respiratory tract 96.3%. In 7 cases with two or more infection sites, accounting for 25.9%. 35 strains of pathogenic bacteria were detected. There were 28 strains of gram-negative bacteria, accounting for 80%, 4 strains of gram-positive bacteria, accounting for 11.4%, 3 fungal strains, accounting for 8.6%. 14 multi-resistant bacteria strains, accounting for 40.0%.Compared with the control group, CD4, CD4/CD8 decreased and CD8 increased in the observation group, and the difference was statistically significant. Conclusion The infection rate of organ donors after brain death is high. The lower respiratory tract is the most common infection site. The detection rate of gram-negative bacteria and multi-drug resistant bacteria is high, and the reduced immune function may be one of the risk factors for infection.