儿童活体肝移植术后感染临床特征分析

Clinical Characteristics of Infections after Living Donor Liver Transplantation in Children

目的评估儿童活体肝移植术后感染的临床特征,用以指导术后抗感染治疗方案选择。方法回顾性分析笔者医院2019年6月~2020年6月收治的68例(男患儿36例和女患儿32例)实施活体肝移植术患儿的临床资料,讨论术后感染的发生情况及特点。结果本组68例患儿中54例(79.4%)发生术后感染,感染细菌、真菌、病毒的患儿分别为39例(57.3%)、13例(19.1%)及44例(64.7%)。细菌、真菌感染部位均以呼吸道及腹腔为主,前者以革兰阴性菌(57.8%)多见,后者病原体包括念珠菌及卡氏肺孢子菌,二者感染大多发生于术后30天内[细菌感染10.0(4.5,20.0)天;真菌感染29.8±17.9天]。病毒感染以巨细胞病毒(cytomegalo virus,CMV:43.0%)及EB病毒(Epstein-Barr virus,EBV:39.2%)最为常见。随访期间患儿存活61例,死亡7例,其中4例(57.1%)与感染直接相关。结论儿童活体肝移植术后感染发生率、病死率高,严密监测和感染管理对改善活体肝移植患儿预后至关重要。

Objective To evaluate the clinical characteristics of children living donor liver transplantation infectious complications,to guide prophylactic anti-infection treatment options.Methods A retrospective analysis were performed using data of 68 cases(36 males and 32 females)with the implementation of children living donor liver transplantation clinical in our hospital between June 2013 and June 2014 to discuss the incidence of postoperative infection and characteristics.Results Among 68 children,54(79.4%)had postoperative infection.The number of children infected with bacteria,fungi and viruses were 39(57.3%),13(19.1%)and 44(64.7%),respectively.The infection sites of bacteria and fungi were mainly respiratory tract and abdominal cavity.The former was mainly Gram-negative bacteria(57.8%),and the latter pathogens included Candida and Pneumocystis carinii.Most of the two infections occurred within 30 days after surgery[bacteria 10.0(4.5,20.0)days vs.fungi 29.8±17.9 days].CMV(43.0%)and EBV(39.2%)were the most common viral infections.Among 68 participants,61 patients survived,four of 7deaths(57.1%)was directly related to the infection.Conclusion Children living donor liver transplantation had high incidence of postoperative infection and high mortality.Close monitoring and management of infection in children is crucial to improve the prognosis of living donor liver transplantation.