摘要
目的 探讨原位肝移植术后 1个月内感染的诊断、预防。方法 回顾分析 3 8例次原位肝移植的临床资料 ,对可能导致感染的危险因素进行分析。结果 全组 18例患者出现 2 9例次感染 ,感染率为 47.4% (18/3 8)。所有感染均出现在术后 3d以后 ,感染部位肺部占 3 7.9% (11/2 9) ,腹腔 2 4.1% (7/2 9) ,血液 17.2 % (5 /2 9) ,胆道 13 .8% (4 /2 9) ,泌尿系统 3 .4% (1/2 9) ,肝脏3 .4% (1/2 9)。感染菌株中阴沟肠杆菌占 2 7.6% (8/2 9) ,大肠埃希菌 2 4.1% (7/2 9) ,金黄色葡萄球菌 2 0 .7% (6/2 9) ,表皮葡萄球菌 10 .3 % (3 /2 9) ,肺炎克雷伯菌 6.9% (2 /2 9) ,白色念株菌 6.9%(2 /2 9) ,粪肠球菌 3 .4% (1/2 9)。感染病死率 3 8.9% (7/18)。上腹部手术史、手术持续时间、输血量、胆道重建方式、术后肠道功能恢复延迟、术后持续高血糖是感染的主要危险因素 ,围术期肠道去污治疗是预防感染的保护因素。结论 感染是影响肝移植生存率的重要因素之一 ,减少各种危险因素及围术期肠道去污治疗有助于降低感染的发生率。
Objective To study the diagnosis and prophylaxis of postoperative infections within 1 month after orthotopic liver transplantation(OLT). Methods Clinical date of 38 consecutive patients who underwent OLT at our institution from 2001 to 2003 were retrospectively reviewed. Result Eighteen patients( 47.4% ) developed twenty-nine times infection after operation .Respiratory tract and peritoneum were the common infectious sites(37.9% and 24.1%). Enterobacter cloacae(8 of 29, 27.6%) , Escherichia coli(7 of 29, 24.1%),staphylococcus aureus(6 of 29, 20.7%) were the commonest bacterial.The mortality of infection was 38.9%(7/18). Identified risk factors for infection including: previous transplantation ; duration of operation; transfusion requirements during surgery; type of biliary anastomosis; delayed restoration of gastrointestinal function and persistent postoperative hyperglucocemia . Perioperative decontamination of the digestive tract had a protective effect. Conclusions Infections are a major cause of death among liver transplant recipients. Reducing risk factors of infection and perioperative decontamination of the digestive tract may decrease the occurrence of postoperative infection.
出处
《中国普通外科杂志》
CAS
CSCD
2004年第3期216-219,共4页
China Journal of General Surgery
关键词
肝移植
手术后并发症
细菌感染
LIVER TRANSPLANTATION
POSTOPERATIVE COMPLICATOAS
BACTERIAL INFECTIONS