摘要
目的总结肝移植术后肺部细菌性感染的诊治经验。方法对33例同种异体原位肝移植后发生肺部细菌感染者的临床资料进行分析。结果33例术后住院期间发生肺部细菌感染53例次,所有患者的痰或胸水培养均有阳性发现;较常见的病原菌为铜绿色假单胞菌、肺炎克雷伯氏菌、鲍曼/溶血不动杆菌、金黄色葡萄球菌等;对革兰氏阴性杆菌敏感的抗生素有阿米卡星、亚胺培南、环丙沙星,对革兰氏阳性球菌敏感的抗生素有万古霉素;16例在感染治疗过程中发生急性排斥反应,死亡5例;治疗时根据药物敏感试验选用抗生素,必要时调整免疫抑制方案;33例中,治愈20例,死亡13例。结论肺部细菌感染是肝移植术后常见并发症,其诊断有赖于对临床资料综合分析,治疗上除应遵循一般肺部感染的处理原则外,应注意合理选择抗生素及对受者免疫功能的调控。
Objective To improve the diagnosis and treatment of bacterial pneumonia in the recipients of liver transplantation. Methods The data of the allogenic liver transplantations performed in our center were analyzed retrospectively. Results One hundred and three cases of allogenic liver transplantations were performed in our center from Feb. 1999 to Jan. 2003. Thirty three recipients had 53 episodes of bacterial pneumonia during their staying in the hospital after transplantation. Seven clinical manifestations and laboratory results were reviewed in these cases including expectoration, panting, fever, rates, white blood cell count, result of chest X ray and culture of tracheal secretions and pleural fluid. Only 42.4 % of the recipients with bacterial pneumonia were found to have more than 3 abnormal items in those 7 variables. The etiologies of bacterial pneumonia were pseudomonas aeruginosa ( 17.48 % ), Klebsiella pneumoniae ( 15.53 % ), Acinetobacter baumannii ( 10.68 % ), staphylococcus aureus ( 7.77 % ) and so on. The sensitive antibiotics included amilkacin, tienam, ciprofloxacin, vancomycin etc. Acute rejections occurred during the treatment of bacterial pneumonia in 16 cases, and 5 of those recipients died. Conclusion Bacterial pneumonia is a common complication after liver transplantation, and its diagnosis relies on overall analysis of the clinical information of the recipient. Attentions should be paid to reasonable use of antibiotics and mediation of immunity besides other routine therapies during the treatment of this complication.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2004年第5期288-290,共3页
Chinese Journal of Organ Transplantation
