DCD肝移植术后感染的高危因素研究

发布时间：2018-01-28 17:14

本文关键词： 心脏死亡器官捐献感染呼吸机支持住院时间　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：背景与目的：感染是肝移植术后的是常见并发症,并有可能导致受者死亡。心脏死亡器官捐献(Donation after Cardiac Death,DCD)被认为是扩大供器官来源的一种重要方式。我们的研究评估了DCD肝移植术后发生细菌和真菌感染的详细情况,以期改善DCD肝移植受者的预后。方法：我们回顾性分析了浙江大学医学院附属第一医院肝移植中心,2010年到2015年之间连续的231例DCD肝移植受者。其中主要的术前诊断是肝癌,占112例(48.5%)。结果：经统计,共120例(51.9%)受者术后发生细菌或真菌感染。主要感染部位为有呼吸道和血行感染。细菌感染是最常见的(占86%),真菌感染占14%。大多数感染发生在肝移植术后的第一周内(59.2%)。移植后呼吸机支持时间大于7天(P=0.041)、住院时间大于24天(P=0.002)和术后急性肾损伤(P=0.039)是细菌和真菌感染的独立危险因子素。移植术后感染风险评估模型的ROC曲线下面积为0.788。未感染组的受者1年和3年生存率,显著优于感染组的受者(未感染组为96.1%和89.0%,感染组为81.5%和75.9%,P=0.007)。结论：细菌和真菌感染在DCD肝移植术后1周内为高发,呼吸机支持时间延长和术后急性肾损伤的患者为高危。为降低DCD肝移植术后的死亡率,亟须采取更为严格的感染防控措施。
[Abstract]:Background and purpose: Infection is a common complication after liver transplantation and may lead to death. DCDs are considered to be an important way to expand donor sources. Our study assessed the details of bacterial and fungal infections following DCD liver transplantation. In order to improve the prognosis of DCD liver transplantation recipients. Methods: We retrospectively analyzed 231 consecutive recipients of DCD liver transplantation from 2010 to 2015 in the first affiliated Hospital of Zhejiang University Medical College. The main preoperative diagnosis was liver cancer. There were 112 cases with 48.5%. Results: There were 120 cases of bacterial or fungal infection after operation. The main sites of infection were respiratory tract and blood infection. Bacterial infection was the most common (86%). Most of the infections occurred in the first week after liver transplantation. The time of ventilator support after transplantation was more than 7 days (P < 0.041). Duration of stay longer than 24 days (P0. 002) and postoperative acute renal injury (P0. 039). An independent risk factor for bacterial and fungal infections. The area under the ROC curve of the post-transplant infection risk assessment model was 0.788. The 1-year and 3-year survival rates of the recipients in the uninfected group were 1 and 3 years. It was significantly better than the recipients in the infected group (96.1% and 89.0 in the uninfected group and 81.5% and 75.9 in the infected group). Conclusion: Bacterial and fungal infections were high within 1 week after DCD liver transplantation. Patients with prolonged ventilator support time and postoperative acute renal injury were at high risk to reduce the mortality after DCD liver transplantation. It is urgent to take more strict measures to prevent and control infection.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R657.3

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