19例肺移植单中心围术期抗感染方案回顾性分析

Retrospective analysis of single center perioperative anti-infection strategy in 19 cases of lung transplantation

目的:总结本院肺移植中心围术期的抗感染方案。方法:回顾性分析2016年12月至2020年12月我院19例肺移植受体的围术期临床资料,其中行双肺移植12例,单肺移植7例。观察肺移植受体的围术期抗感染方案情况。结果:12例双肺肺移植的手术时间为(509±78)min,7例单肺移植的手术时间为(431±131)min,术前肺平均动脉压力为(38±22) mmHg,术后ICU平均停留时间为(4.6±2.2)d,其中围术期体外膜肺氧合(ECMO)辅助9例,平均辅助时间为(3.0±1.2)d,其中3例死亡(原发性移植物失功、术后感染、术后大出血),2例放弃出院(术后大出血和术后感染),平均住院时间为(30.0±24.8)d。本院19例肺移植受体术前抗感染方案:4例为三代头孢菌素,14例为头孢哌酮舒巴坦,1例为多黏菌素联合头孢他啶阿维巴坦。术后抗感染方案为亚胺培南西司他丁钠、万古霉素、更昔洛韦、米卡芬净或伏立康唑静脉注射,异烟肼联合两性霉素B雾化,并动态监测降钙素原含量、痰培养、1,3-β-D葡聚糖检测(G试验)/半乳甘露聚糖(GM)试验、细胞免疫功能及他克莫司的浓度。结论:肺移植围术期管理中,术前受者感染风险评估,术后主动感染指标监测,及时调整抗感染方案对于肺移植患者平稳渡过围术期感染关具有重要意义。

Objective:To summarize the anti-infection strategy of perioperative lung transplantation in our hospital.Methods:We retrospectively analyzed the clinical data of 19 lung transplant recipients in our hospital from December 2016 to December 2020, and of the 19 cases, 12 received bilateral lung transplantation and 7 received single lung transplantation.We reviewed the anti-infection strategy of lung transplantation recipients during perioperative period.Results:The operation time of 12 cases of bilateral lung transplantion were(509±78) min, and the operation time of 5 cases of single lung transplantation were(431±131)min, the pulmonary arterial pressure before operation were(38±22) mmHg,the average ICU stay after transplantation operation were(4.6±2.2)d, 9 cases used extracorporeal membrane oxygenation(ECMO) support during the perioperative period, and the average support time were(3.0±1.2)d.Three cases died of primary graft dysfunction, major postoperative bleeding and severe infections, respectively, and 2 cases gave up because of major postoperative bleeding and postoperative infection.The average length of hospital stay was(30.0±24.8)d.Four cases before operation adopted the third generation cephalosporin and 14 cases used cefoperazone and sulbactam,and one case used polymyxin combined with ceftazidime and averbactam.The postoperative anti-infection strategy included intravenous injection of imipenem cilastatin sodium, vancomycin, ganciclovir, micafungin or voriconazole, atomization of isoniazid combined with amphotericin B, and dynamic monitoring of procalcitonin, sputum culture, G test/GM test, cellular immune function and tacrolimus concentration.Conclusion:In the perioperative management of lung transplantation, preoperative infection risk assessment of recipients, active screening infection status after operation and timely adjustment of anti-infection strategy are the corestone for lung transplantation patients to get through the perioperative infection stage.