肝移植术后并发医院获得性肺炎的危险因素分析

Analysis of risk factors for hospital-acquired pneumonia after liver transplantation

目的探讨肝移植术后并发医院获得性肺炎(Hospital acquired pneumonia,HAP)的危险因素.方法选取安徽医科大学第一附属医院器官移植中心2019年6月1日~2021年6月31日接受肝移植手术的患者临床资料,采集肝移植术后HAP的相关数据,分析导致肝移植术后并发HAP的危险因素,绘制受试者工作特征曲线(ROC),评估相关临床指标对肝移植术后并发HAP的预测价值.结果70例肝移植患者中25例(35.7%)术后并发HAP.HAP组患者在有吸烟史、术中输注红细胞量、机械通气时间、ICU住院时间、并发AKI、术前并发其他部位感染均较非HAP组明显增高,差异具有统计学意义(P<0.05).通过绘制ROC曲线得出,术中输注红细胞量、机械通气时间和ICU住院时间对预测肝移植术后并发HAP的曲线下面积分别为0.669,0.713和0.799;利用cut-off方法,确定术中输红细胞量大于4.25U,机械通气时间大于24.75h和ICU住院时间超过31.5h为预测肝移植术后并发HAP的阈值.结论肝移植术后并发HAP较为常见,吸烟、术中输注红细胞量、机械通气时间及ICU住院时间均是并发HAP的危险因素.并发HAP可导致住院时间更长,预后更差.

Objective To investigate the risk factors of Hospital acquired pneumonia(HAP)after liver transplantation.Methods The clinical data of patients who received liver transplantation from June 1,2019 to June 31,2021 in the Organ Transplant Center of the First Affiliated Hospital of Anhui Medical University were selected to collect the data related to HAP after liver transplantation.Data related to HAP after liver transplantation were collected,the risk factors leading to HAP after liver transplantation were analyzed,and the receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of related clinical indicators on HAP after liver transplantation.Result HAP was found in 25 of 70 liver transplantation patients,accounting for 35.7%of all liver transplants.Smoking history,intraoperative erythrocyte infusion volume,duration of mechanical ventilation,length of ICU stay,complication of AKI and complication of other site infection in HAP patients were significantly higher than those in the non-HAP group,and the differences were statistically significant.ROC curve was drawn to show that the areas under the curve of intraoperative erythrocyte infusion volume,mechanical ventilation duration and ICU stay for predicting HAP after liver transplantation were 0.669,0.713 and 0.799,respectively.The cut-off method was used to determine the threshold value of intraoperative erythrocyte transfusion volume greater than 4.25U,mechanical ventilation time greater than 24.75h and ICU stay time greater than 31.5h for predicting HAP after liver transplantation.Conclusion HAP is more common after liver transplantation.Smoking,intraoperative blood transfusion,mechanical ventilation time and ICU stay are all risk factors for HAP.Concomitant HAP can lead to longer hospital stays and worse prognosis.