本文關(guān)鍵詞： 心臟死亡器官捐獻(xiàn) 感染 呼吸機(jī)支持 住院時(shí)間　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：背景與目的： 感染是肝移植術(shù)后的是常見(jiàn)并發(fā)癥,并有可能導(dǎo)致受者死亡。心臟死亡器官捐獻(xiàn)(Donation after Cardiac Death,DCD)被認(rèn)為是擴(kuò)大供器官來(lái)源的一種重要方式。我們的研究評(píng)估了DCD肝移植術(shù)后發(fā)生細(xì)菌和真菌感染的詳細(xì)情況,以期改善DCD肝移植受者的預(yù)后。 方法： 我們回顧性分析了浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院肝移植中心,2010年到2015年之間連續(xù)的231例DCD肝移植受者。其中主要的術(shù)前診斷是肝癌,占112例(48.5%)。 結(jié)果： 經(jīng)統(tǒng)計(jì),共120例(51.9%)受者術(shù)后發(fā)生細(xì)菌或真菌感染。主要感染部位為有呼吸道和血行感染。細(xì)菌感染是最常見(jiàn)的(占86%),真菌感染占14%。大多數(shù)感染發(fā)生在肝移植術(shù)后的第一周內(nèi)(59.2%)。移植后呼吸機(jī)支持時(shí)間大于7天(P=0.041)、住院時(shí)間大于24天(P=0.002)和術(shù)后急性腎損傷(P=0.039)是細(xì)菌和真菌感染的獨(dú)立危險(xiǎn)因子素。移植術(shù)后感染風(fēng)險(xiǎn)評(píng)估模型的ROC曲線下面積為0.788。未感染組的受者1年和3年生存率,顯著優(yōu)于感染組的受者(未感染組為96.1%和89.0%,感染組為81.5%和75.9%,P=0.007)。 結(jié)論： 細(xì)菌和真菌感染在DCD肝移植術(shù)后1周內(nèi)為高發(fā),呼吸機(jī)支持時(shí)間延長(zhǎng)和術(shù)后急性腎損傷的患者為高危。為降低DCD肝移植術(shù)后的死亡率,亟須采取更為嚴(yán)格的感染防控措施。
[Abstract]:Background and purpose: Infection is a common complication after liver transplantation and may lead to death. DCDs are considered to be an important way to expand donor sources. Our study assessed the details of bacterial and fungal infections following DCD liver transplantation. In order to improve the prognosis of DCD liver transplantation recipients. Methods: We retrospectively analyzed 231 consecutive recipients of DCD liver transplantation from 2010 to 2015 in the first affiliated Hospital of Zhejiang University Medical College. The main preoperative diagnosis was liver cancer. There were 112 cases with 48.5%. Results: There were 120 cases of bacterial or fungal infection after operation. The main sites of infection were respiratory tract and blood infection. Bacterial infection was the most common (86%). Most of the infections occurred in the first week after liver transplantation. The time of ventilator support after transplantation was more than 7 days (P < 0.041). Duration of stay longer than 24 days (P0. 002) and postoperative acute renal injury (P0. 039). An independent risk factor for bacterial and fungal infections. The area under the ROC curve of the post-transplant infection risk assessment model was 0.788. The 1-year and 3-year survival rates of the recipients in the uninfected group were 1 and 3 years. It was significantly better than the recipients in the infected group (96.1% and 89.0 in the uninfected group and 81.5% and 75.9 in the infected group). Conclusion: Bacterial and fungal infections were high within 1 week after DCD liver transplantation. Patients with prolonged ventilator support time and postoperative acute renal injury were at high risk to reduce the mortality after DCD liver transplantation. It is urgent to take more strict measures to prevent and control infection.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 潘曉鳴;薛武軍;劉林娟;項(xiàng)和立;丁晨光;何術(shù)琴;任莉;田普訓(xùn);丁小明;;西北地區(qū)開(kāi)展公民心臟死亡后捐獻(xiàn)腎臟移植的報(bào)告[J];南方醫(yī)科大學(xué)學(xué)報(bào);2014年03期

2 Ying Luo;Wen-Bin Ji;Wei-Dong Duan;Sheng Ye;Jia-Hong Dong;;Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies[J];Hepatobiliary & Pancreatic Diseases International;2014年01期

3 Xiao-Bo Chen;Ming-Qing Xu;;Primary graft dysfunction after liver transplantation[J];Hepatobiliary & Pancreatic Diseases International;2014年02期

4 Ming Han;Zhi-Yong Guo;Qiang Zhao;Xiao-Ping Wang;Xiao-Peng Yuan;Xing-Yuan Jiao;Chun-Hua Yang;Dong-Ping Wang;Wei-Qiang Ju;Lin-Wei Wu;An-Bin Hu;Qiang Tai;Yi Ma;Xiao-Feng Zhu;Xiao-Shun He;;Liver transplantation using organs from deceased organ donors: a single organ transplant center experience[J];Hepatobiliary & Pancreatic Diseases International;2014年04期

5 吳曉峰;林棟棟;;肝移植術(shù)后肺部感染的危險(xiǎn)因素[J];北京醫(yī)學(xué);2014年09期

6 Hao Lu;Ling Lu;Zhen-Chao Xu;Yun-Jie Lu;Bo Zhao;Lin Zhuang;Bao-Bing Hao;Feng Zhang;;Tauroursodeoxycholic acid and 4-phenyl butyric acid alleviate endoplasmic reticulum stress and improve prognosis of donation after cardiac death liver transplantation in rats[J];Hepatobiliary & Pancreatic Diseases International;2014年06期

7 萬(wàn)齊全;李靜樂(lè);葉啟發(fā);周建黨;;71例患者腎移植術(shù)后血流感染臨床表現(xiàn)、病原菌組成及耐藥性分析[J];中南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2013年09期

8 孫立章;;食管癌術(shù)后肺部并發(fā)癥原因分析[J];中外醫(yī)療;2014年02期

9 焦健;王江濱;;HCV相關(guān)肝硬化患者肝移植術(shù)后的抗病毒與免疫調(diào)節(jié)治療[J];臨床肝膽病雜志;2014年01期

10 孫洵;宋永琳;趙永恒;王麗軍;鄭昕;;心臟死亡供腎腎移植19例臨床分析[J];昆明醫(yī)科大學(xué)學(xué)報(bào);2014年04期

相關(guān)博士學(xué)位論文 前6條

1 王小軍;去細(xì)胞化的肝臟支架在細(xì)胞移植中的應(yīng)用研究[D];第三軍醫(yī)大學(xué);2013年

2 萬(wàn)齊全;移植后血流感染相關(guān)研究及腎移植感染基因多態(tài)性研究[D];中南大學(xué);2013年

3 吳，

本文編號(hào)：1471085