中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
14期
980-981
,共2页
杨春华%何晓顺%陈娟%欧阳彬%朱晓峰%陈敏英%谢文峰%陈丽%郑东华%钟韵%陈雪霞%管向东
楊春華%何曉順%陳娟%歐暘彬%硃曉峰%陳敏英%謝文峰%陳麗%鄭東華%鐘韻%陳雪霞%管嚮東
양춘화%하효순%진연%구양빈%주효봉%진민영%사문봉%진려%정동화%종운%진설하%관향동
肝移植%真菌病%危险因素
肝移植%真菌病%危險因素
간이식%진균병%위험인소
Liver transplantation%Mycoses%Risk factors
目的 探讨肝移植术后真菌感染的危险因素,为肝移植术后真菌感染的防治提供依据.方法 回顾性分析2003年1月至2010年11月94例肝移植术后真菌感染患者的临床资料,取同期的未发生真菌感染的肝移植患者603例作对照,采用x2检验和t检验对可能存在的真菌感染危险因素进行分析.结果 肝移植术后真菌感染率为13.5％(94/697),真菌感染病死率为86.2％(81/94),感染菌种以白念珠菌居多,感染部位以肺部为主.感染组术后24 h急性生理学和慢性健康状况评分高于对照组(26.0±5.4比21.5±4.7,P＜0.01).感染组中原发性肝癌患者比例低于对照组(26.6％比45.8％),乙肝肝硬化、合并糖尿病患者比例高于对照组(23.4％比11.6％、9.6％比2.8％),器官功能不全、持续肠外营养时间较长、血糖控制不佳、机械通气及抗生素应用时间较长的患者比例均高于对照组(均P＜0.01).结论 术前原发病与术后病情危重程度、长期高血糖、长期抗生素应用和机械通气等可能是肝移植后真菌感染的重要危险因素.
目的 探討肝移植術後真菌感染的危險因素,為肝移植術後真菌感染的防治提供依據.方法 迴顧性分析2003年1月至2010年11月94例肝移植術後真菌感染患者的臨床資料,取同期的未髮生真菌感染的肝移植患者603例作對照,採用x2檢驗和t檢驗對可能存在的真菌感染危險因素進行分析.結果 肝移植術後真菌感染率為13.5％(94/697),真菌感染病死率為86.2％(81/94),感染菌種以白唸珠菌居多,感染部位以肺部為主.感染組術後24 h急性生理學和慢性健康狀況評分高于對照組(26.0±5.4比21.5±4.7,P＜0.01).感染組中原髮性肝癌患者比例低于對照組(26.6％比45.8％),乙肝肝硬化、閤併糖尿病患者比例高于對照組(23.4％比11.6％、9.6％比2.8％),器官功能不全、持續腸外營養時間較長、血糖控製不佳、機械通氣及抗生素應用時間較長的患者比例均高于對照組(均P＜0.01).結論 術前原髮病與術後病情危重程度、長期高血糖、長期抗生素應用和機械通氣等可能是肝移植後真菌感染的重要危險因素.
목적 탐토간이식술후진균감염적위험인소,위간이식술후진균감염적방치제공의거.방법 회고성분석2003년1월지2010년11월94례간이식술후진균감염환자적림상자료,취동기적미발생진균감염적간이식환자603례작대조,채용x2검험화t검험대가능존재적진균감염위험인소진행분석.결과 간이식술후진균감염솔위13.5％(94/697),진균감염병사솔위86.2％(81/94),감염균충이백념주균거다,감염부위이폐부위주.감염조술후24 h급성생이학화만성건강상황평분고우대조조(26.0±5.4비21.5±4.7,P＜0.01).감염조중원발성간암환자비례저우대조조(26.6％비45.8％),을간간경화、합병당뇨병환자비례고우대조조(23.4％비11.6％、9.6％비2.8％),기관공능불전、지속장외영양시간교장、혈당공제불가、궤계통기급항생소응용시간교장적환자비례균고우대조조(균P＜0.01).결론 술전원발병여술후병정위중정도、장기고혈당、장기항생소응용화궤계통기등가능시간이식후진균감염적중요위험인소.
Objective To explore the risk factors of fungal infection so as to provide rationales for the prevention of fungal infection after liver transplantation.Methods The clinical data of 94 cases of fungal infections after liver transplantation from January 1,2003 to November 30,2010 at our hospital were collected as the infective group.A total of 603 liver transplant patients without fungal infections during the same period were selected as the control group.x2 test and t test were utilized for the analysis of possible risk factors for fungal infection.Results Fungal infection rate was 13.5％(94/697) after liver transplantation and mortality rate of fungal infection 86.2％(81/94).Candida albicans was the majority infective fungi.And the main site of infection was the lungs. The postoperative acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ) score of the infective group was significantly higher than that of the control group (26.0±5.4 vs 21.5±4.7,P＜0.01).The number of patients with primary liver cancer was lower than that of the control group(26.6％ vs 45.8％,P＜0.01).The number of decompensated HBV cirrhosis and diabetics in the infective group was higher than that of the control group at pre-operation (23.4％ vs 11.6％,9.6％ vs 2.8％,both P＜0.01).The number of patients with postoperative mechanical ventilation over 10 days,postoperative antibiotics over 14 days,postoperative cardiopulmonary dysfunction and liver function recovery time over 7 days,parenteral nutrition over 12 days and hyperglycemia over 7 days in the infective group were significantly higher than that in the control group (all P＜0.01). Conclusion Preoperative primary disease,postoperative disease severity,postoperative organ dysfunction,long-term mechanical ventilation,antibiotics and hyperglycemia,etc. may be the important risk factors of fungal infection after liver transplantation.
