摘要
背景：由于终末期肝病、肝移植手术本身所带来的复杂病理生理变化以及抗生素滥用导致肝移植后肺部感染新的耐药菌株不断出现。目的：收集6例肝移植患者的临床资料，分析其肝移植后肺部感染的防治措施。设计、时间及地点：回顾性病例分析，于200401／12在广州市第一人民医院肝胆外科完成。对象：选择广州市第一人民医院收治的6例肝移植患者，均行择期同种异体全肝移植，5例行改良背驮式原位肝移植，1例行经典式原位肝移植。方法：回顾性分析6例肝移植患者的临床资料。移植后给予基础消毒隔离、感染防护措施；收集病原学资料；移植后早期每日行胸部X射线片了解肺部情况；吸痰时严格无菌操作，保持胃肠减压引流通畅，防止误吸；移植后即开始针对包括细菌、真菌、病毒在内的预防性抗感染治疗。主要观察指标：观察6例患者肝移植后肺部感染发生情况及治疗转归。结果：6例患者中4例于移植后第4～11天发生肺部感染，1例于移植后第1天即出现肺部感染。其中1例并发呼吸衰竭死亡：其余5例患者经过规范抗感染、呼吸治疗、气道排痰及营养支持，肺部感染治愈。结论：使用有效抗生素、吸痰时无菌操作和通畅呼吸道引流是防治肝移植后肺部感染的重要措施。
BACKGROUND： Subsequent to liver transplantation, pulmonary infection and new drug resistant strain frequently appear due to complex pathophysiological changes and abuse of antibiotics. OBJECTIVE： To collect the clinical data of 6 cases who underwent liver transplantation, and analyze the prevention and treatment measures of pulmonary infection after liver transplantation. DESIGN, TIME AND SETTING： Retrospective case analysis, performed in the Department of Hepatobiliary Surgery, First People＇s Hospital of Guangzhou between January and December 2004. PARTICIPANTS： Six cases that underwent liver transplantation and received treatment in the First People＇s Hospital of Guangzhou were recruited in the present study. All 6 cases underwent selective homologous whole liver transplantation, 5 cases underwent modified orthotopic piggyback liver transplantation, and only 1 underwent classical orthotopic liver transplantation. METHODS： The clinical data of the 6 cases were retrospectively analyzed. After transplantation, basic disinfection, isolation, infection-protection measures should be taken. In addition, etiological information was collected. Chest X-ray was underwent to know the lung at the early stage. Aseptic manipulating was strictly performed during sputum aspiration. Gastrointestinal decompression and non-obstructed drainage were maintained to prevent aspiration. Moreover, preventive anti-infective treatment against the bacteria, fungi, and viruses was performed. MAIN OUTCOME MEASURES： Pulmonary infection and curative effects subsequent to liver transplantation. RESULTS： Of the 6 cases, 5 presented with pulmonary infection, including 1 at 4-11 days after transplantation and 1 at 1 day after transplantation. One case died of respiratory failure. The remaining 5 cases were cured after standardized anti-infection, respiratory therapy, sputum aspiration, and nutritional support. CONCLUSION： Application of effective antibiotics, aseptic operation in sputum aspiration, and unobstructed respiratory tract drainage are important measures for treating pulmonary infection subsequent to liver transplantation.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第40期7951-7954,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
