本文選題：肝移植 + 危險因素��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:探討肝移植術(shù)后早期(3個月之內(nèi))感染患者的危險因素、病原體分布、耐藥情況及生存現(xiàn)狀等規(guī)律,為臨床醫(yī)師精確診療及感染預防提供參考,以期提高肝移植受者的術(shù)后生存率。方法:收集我院自2014年2月至2016年2月期間,共118例接受肝臟移植手術(shù)患者的臨床資料進行回顧性研究,對相關(guān)的高危因素應用Logistic回歸分析,最終甄選出影響肝臟移植術(shù)后感染的獨立危險因素;同時對各種部位及途徑留取的病原體標本進行培養(yǎng)及藥敏試驗,所有結(jié)果均進行統(tǒng)計學描述;采用Kaplan-Meier法描述生存率。結(jié)果:肝臟移植術(shù)后早期發(fā)生感染的獨立危險因素為手術(shù)時長≥600min[P值=0.002,優(yōu)勢比(OR)=10.339,95%可信區(qū)間(95%CI)=2.289~46.707]、重癥監(jiān)護病房(Intensive Care Unit,ICU)留置時間≥6天(P值=0.008,OR=6.553,95%CI=1.618~26.536)、Child-Pugh分級為C級(P值=0.020,0R=6.600,95%CI=1.354~32.167);在納入研究的118例肝臟移植手術(shù)患者中,其中有61例受者發(fā)生了感染(占51.69%),57例受者未發(fā)生感染(占48.31%),總共分離出病原體株數(shù)為176株。在送檢的病原體標本中,以膽汁、痰液中分離出的病原體菌株為多,其次分別是腹水、引流物及其導管末端、血液、深靜脈導管、中段尿、胸腔積液和經(jīng)外周靜脈穿刺中心靜脈置管(Peripherally Inserted Central Catheter,PICC)等。其中革蘭陽性菌為82株(46.59%)、革蘭陰性菌為52株(29.55%),真菌為32株(18.18%),病毒為10株(5.68%)。肝移植受者感染主要發(fā)生在術(shù)后1個月以內(nèi),約占141株(80.11%),尤以術(shù)后1周最為顯著,約占59株(33.52%),以后隨著時間的推移檢出率逐漸趨于平穩(wěn);革蘭陽性菌對青霉素類、氨基糖苷類、大環(huán)內(nèi)酯類、喹諾酮類、林可酰胺類等藥物均具有較高的耐藥率,其中尤以屎腸球菌的耐藥率最高。革蘭陰性菌的耐藥分布則根據(jù)病原體的不同呈現(xiàn)菌種耐藥的個體化;術(shù)后積極對肝移植患者進行隨訪,其中發(fā)生感染的患者的1月、12月、24月累積生存率分別是96.72%,94.91%,94.91%,而未發(fā)生感染的患者的1月、12月、24月累積生存率則分別為100%,98.25%,96.49%(P值=0.454)。結(jié)論:手術(shù)時長≥600min、ICU留置時間≥6天、Child-Pugh分級為C級是肝移植術(shù)后感染的獨立危險因素。提高肝移植患者術(shù)后病原體標本送檢率及檢出率,及時根據(jù)相應藥敏結(jié)果選擇敏感抗生素。在積極有效抗感染治療的情況下,建立科學、完善、合理的術(shù)后病人隨訪系統(tǒng),及時對術(shù)后病人提供專業(yè)的醫(yī)療指導,力求提高病人的生存質(zhì)量。
[Abstract]:Objective: to investigate the risk factors, pathogen distribution, drug resistance and survival status of patients with early infection after liver transplantation (within 3 months), so as to provide reference for clinicians in accurate diagnosis and treatment and infection prevention. In order to improve the postoperative survival rate of liver transplantation recipients. Methods: the clinical data of 118 patients undergoing liver transplantation from February 2014 to February 2016 in our hospital were retrospectively studied. Logistic regression analysis was used to analyze the risk factors. Finally, the independent risk factors of infection after liver transplantation were selected. At the same time, the culture and drug sensitivity tests of pathogens were carried out. All the results were described statistically. Kaplan-Meier method was used to describe the survival rate. Results: the independent risk factors of early infection after liver transplantation were the length of operation 鈮，

本文編號：1943207