肝脏移植术后肺部感染的防治.pdfVIP

Chin J Nosocomio1 Vo1．18 No．4 2008 · 论 著 · 肝脏移植术后肺部感染的防治 史宪杰 ，董家鸿 ，宋 青 ，何 蕾 ，纪文斌 ，段伟东 ，苏茂生 ，黄志强 (解放军总医院 1肝胆外科研究所 2外科重症监护室，北京 100853) 摘要：目的 探讨肝脏移植术后肺部感染的防治措施。方法 回顾性分析78例肝移植术后发生肺部感染的临 床资料。结果 肺部感染的发病率为48．8 ；首次发生肺部感染的时间为术后(9．56土5。53)d；78例中右侧肺炎 44例，左侧肺炎 14例，双侧肺炎2O例；手术时间长、术后机械通气时间、腹腔出血、术中输液量、肾功异常等为 肺部感染的高危因素；78例患者中68例(87．2 )好转，1O例(12．8 )死亡。结论 肝移植后肺部感染病死率较 高，细菌、真菌是主要的病原体；缩短手术时间、减少腹腔出血、控制液体入量、术后尽快拔除气管插管、保护肾功、 提高病原检测技术等是防治肝移植术后肺部感染的关键。 关键词：肝移植；肺部感染 中图分类号：181．3 2 文献标识码：A 文章编号：1005-4529(2008)04—0500—02 Prevention and Treatment of Pulmonary Infection after Liver Transplantation SHI Xian—jie，DONG Jia—hong，SONG Qing，HE Lei，JI Wen—bin， DUAN W ei—dong，SU Mao—sheng，HUANG Zhi—qiang (General Hospital of PLA，Beijing 100853，China) Abstract：oBJECTIVE To explore the treatment measure of pulmonary infection after liver transp1antation． METHODS The clinical data of 78 cases of pulmonary infection after liver transp1antation in our hospital were analyzed retrospectively．RESULTS The incidence of pulmonary infection in this group of patients was 48．8 ． The mean onset time of the first pulmonary infection after operation was(9．56±5．53)days after surgery．Forty four patients were diagnosed as right pneumonia，1 4 as left pneumonia，and 20 bilateral pneumonia． Long operation time，mechanical ventilatory time，abdominal bleeding，intraoperative total fluid perfusion and renal dysfunction after liver transplantation were risk factors of pulmonary infection． 87．2 Of these patients improved，and 1 2．8％ died．CONCLUSIONS The mortality of pulmonary infection after liver transplantation is high． Bacteria and fungi are the major pathogens．The key of prevention and cure of pulmonary infection after liver transplantatio