肝移植术后持续性胸腔积液的危险因素分析

Risk factor analysis of the persistent pleural effusion for thoracocentesis treatment after liver transplantion

目的对肝移植术后需穿刺置管引流治疗的胸腔积液并发症进行原因分析,了解其危险因素,从而有效预防及治疗肝移植术后胸腔积液。方法回顾性分析2015年1月至2016年12月中山市人民医院52例肝移植患者临床资料,单因素分析持续性胸腔积液胸腔置管引流组和未引流组之间的差异,再建立Logistic多元回归模型分析肝移植术后胸腔置管引流的持续性胸腔积液相关危险因素。结果术后48例(92.3%)发生胸腔积液,13例(25.0%)持续性胸腔积液患者需要胸腔置管引流。单因素分析显示术后肺部感染(P=0.005)、胸腔感染(P=0.012)、沙门杆菌感染(P=0.012)、表皮葡萄球菌感染(P=0.013)、白假丝酵母菌感染(P<0.001)、术后胆管并发症(P=0.025)、腹腔置管引流(P=0.003)是术后发生持续性胸腔积液的相关因素。Logistic回归分析显示,肝移植术后肺部感染及腹腔穿刺置管术是患者胸腔穿刺置管引流持续性胸腔积液的危险因素,其中肺部感染患者行胸腔置管引流持续性胸腔积液的风险是无肺部感染患者的7.354倍(P=0.027),术后腹腔置管引流术患者行胸腔置管引流的风险为术后无腹腔置管引流术患者的31.601倍(P=0.012)。结论肝移植术后应密切观察患者病情,积极预防肺部感染,减少腹腔穿刺置管引流,以有效控制持续性胸腔积液的发生。

Objective To analyze the reasons of persistent pleural effusion complications after liver transplantation and to understand the risk factors, so as to effectively prevent and treat pleural effusion after liver transplantation. Methods From January 2015 to December 2016, the clinical data of fiftytwo patients with liver transplantation in Zhongshan City People’s Hospital were retrospectively analyzed. Univariate analysis was carried out for the difference between the continuous pleural effusion group and the non-drainage group after thoracic catheterization. Logistic multiple regression model was established to analyze the risk factors of persistent pleural effusion after thoracic catheterization and drainage after liver transplantation. Results There were 48 cases(92.3%) of pleural effusion after operation, and 13 cases(25.0%) needed thoracic catheter drainage for persistent pleural effusion. Univariate analysis showed that pulmonary infection(P=0.005), thoracic infection(P=0.012), Salmonella infection(P=0.012), Staphylococcus epidermidis infection(P=0.013), Candida albicans infection(P<0.001), postoperative biliary complications(P=0.025), and abdominal catheter drainage(P=0.003) were the related factors of persistent pleural effusion after operation. Logistic regression analysis showed that pulmonary infection(OR=7.354, P=0.027), abdominal puncture and catheterization(OR=31.601, P=0.012) were risk factors for persistent pleural effusion after liver transplantation. Conclusion The occurrence of persistent pleural effusion can be effectively controlled by closely observing the condition after liver transplantation, actively preventing pulmonary infection and reducing abdominal puncture and catheter drainage.