肝移植术后早期感染的危险因素、病原学分布、耐药情况及生存分析

发布时间：2018-05-27 17:45

  本文选题：肝移植 + 危险因素　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨肝移植术后早期(3个月之内)感染患者的危险因素、病原体分布、耐药情况及生存现状等规律,为临床医师精确诊疗及感染预防提供参考,以期提高肝移植受者的术后生存率。方法:收集我院自2014年2月至2016年2月期间,共118例接受肝脏移植手术患者的临床资料进行回顾性研究,对相关的高危因素应用Logistic回归分析,最终甄选出影响肝脏移植术后感染的独立危险因素;同时对各种部位及途径留取的病原体标本进行培养及药敏试验,所有结果均进行统计学描述;采用Kaplan-Meier法描述生存率。结果:肝脏移植术后早期发生感染的独立危险因素为手术时长≥600min[P值=0.002,优势比(OR)=10.339,95%可信区间(95%CI)=2.289~46.707]、重症监护病房(Intensive Care Unit,ICU)留置时间≥6天(P值=0.008,OR=6.553,95%CI=1.618~26.536)、Child-Pugh分级为C级(P值=0.020,0R=6.600,95%CI=1.354~32.167);在纳入研究的118例肝脏移植手术患者中,其中有61例受者发生了感染(占51.69%),57例受者未发生感染(占48.31%),总共分离出病原体株数为176株。在送检的病原体标本中,以胆汁、痰液中分离出的病原体菌株为多,其次分别是腹水、引流物及其导管末端、血液、深静脉导管、中段尿、胸腔积液和经外周静脉穿刺中心静脉置管(Peripherally Inserted Central Catheter,PICC)等。其中革兰阳性菌为82株(46.59%)、革兰阴性菌为52株(29.55%),真菌为32株(18.18%),病毒为10株(5.68%)。肝移植受者感染主要发生在术后1个月以内,约占141株(80.11%),尤以术后1周最为显著,约占59株(33.52%),以后随着时间的推移检出率逐渐趋于平稳;革兰阳性菌对青霉素类、氨基糖苷类、大环内酯类、喹诺酮类、林可酰胺类等药物均具有较高的耐药率,其中尤以屎肠球菌的耐药率最高。革兰阴性菌的耐药分布则根据病原体的不同呈现菌种耐药的个体化;术后积极对肝移植患者进行随访,其中发生感染的患者的1月、12月、24月累积生存率分别是96.72%,94.91%,94.91%,而未发生感染的患者的1月、12月、24月累积生存率则分别为100%,98.25%,96.49%(P值=0.454)。结论:手术时长≥600min、ICU留置时间≥6天、Child-Pugh分级为C级是肝移植术后感染的独立危险因素。提高肝移植患者术后病原体标本送检率及检出率,及时根据相应药敏结果选择敏感抗生素。在积极有效抗感染治疗的情况下,建立科学、完善、合理的术后病人随访系统,及时对术后病人提供专业的医疗指导,力求提高病人的生存质量。
[Abstract]:Objective: to investigate the risk factors, pathogen distribution, drug resistance and survival status of patients with early infection after liver transplantation (within 3 months), so as to provide reference for clinicians in accurate diagnosis and treatment and infection prevention. In order to improve the postoperative survival rate of liver transplantation recipients. Methods: the clinical data of 118 patients undergoing liver transplantation from February 2014 to February 2016 in our hospital were retrospectively studied. Logistic regression analysis was used to analyze the risk factors. Finally, the independent risk factors of infection after liver transplantation were selected. At the same time, the culture and drug sensitivity tests of pathogens were carried out. All the results were described statistically. Kaplan-Meier method was used to describe the survival rate. Results: the independent risk factors of early infection after liver transplantation were the length of operation 鈮，

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