肝移植术后受体ICU真菌感染的临床分析_0.docVIP

肝移植术后受体ICU真菌感染的临床分析 作者：季学闻，吕毅，马锋，于良，刘昌，仵正 【关键词】 肝移植；真菌感染；危险因素 【Abstract】 AIM: To study the fungal spectrum and high risk factors associated with fungal infection in the intensive care unit （ICU） after orthotopic liver transplantation (OLTx). METHODS: One hundred and two consecutive OLTx in 100 recipients performed from November 2000 to January 2006 were included in the study. The ir presurgical, surgical and postsurgical variables were retrospectively evaluated using multivariate logistic regression model to identify the significant risk factors. RESULTS: The mean ICU stay was 11.0 d (7-23 d). Out of the 102 OLTx, 16 (16％) developed 29 positive cultures in our ICU and the mean time interval from transplantation to the development of fungal infection was 11.8 d (6-18 d). The most common pathogen was Candida albicans (75％) and the common primary sites were the lungs (73%) and blood (19%). The risk factors for fungal infections included preoperative UNOS status, postoperative detained central venous catheter and other infective complications. CONCLUSION: Fungal infections are a major complication in ICU following OLTx, with Candida albicans bEing the most common pathogen. SurvEIllance for the high risk factors and earlier antifungal prophylactic treatment is the key to decrease the incidence of postoperative fungal infections. 【Keywords】 liver transplantation; fungal infection; risk factors 【摘要】 目的：探讨导致原位肝移植术后重症监护病房（ICU）真菌感染的病原学特征和临床高危因素. 方法 ：回顾我院200011/200601施行的102例次原位肝移植临床资料，对可能导致术后真菌感染的围手术期相关因素进行 分析 ，筛选临床高危因素. 结果：肝移植术后平均ICU留住时间为11.0 d (7～23 d)，其间真菌感染的发病率为16％（16/102），平均发病时间为术后11.8 d（6～18 d）. 主要致病菌为白色念珠菌，约占75％，发生部位以肺部（73％）和血液（19％）多见. 多因素Logistic回归分析显示术前UNOS评分、术后中心静脉导管留置时间以及术后细菌、病毒等其他感染是诱发肝移植术后受体真菌感染的高危因素. 结论：真菌感染是发生于肝移植术后ICU内重要并发症. 白色念珠菌是最常见的致病菌. 针对以上高危因素及早采取合理、有效的防治措施是减少ICU真菌感染的关键. 【关键词】 肝移植；真菌感染；危险因素 0引言 侵袭性真菌感染（invasive fungal infection）是发生于原位肝移植术后早期一种常见的后果严重的并发症. 其起病隐匿，常缺乏临床表现，临床诊断极为困难. 本文通过回顾我院102例次原位肝移植临床资料，初步探讨了发生于术后重症监护室（ICU）真菌感染的病原学特征及相关危险因素. 1对象和方法