论文部分内容阅读
目的探讨肝移植术后早期深部真菌感染的临床特点及危险因素,为临床防治提供参考和依据。方法回顾性分析4年半所施行的118例肝移植患者的临床资料。选取围手术期44个独立变量进行单因素分析及Logistic回归分析,筛选出与肝移植术后早期真菌感染相关的危险因素。结果26例发生深部真菌感染,患病率为22.0%。共分离出49株真菌,以白色念珠菌为主(57.1%)。感染发生的平均时间为术后13.6 d。感染部位主要发生在呼吸道(75.5%)。Logistic回归分析结果显示:术前肝衰竭,有创机械通气时间≥48 h,胸腔积液,ICU留观时间≥5 d,使用抗生素≥3种且时间≥2周等是术后早期真菌感染的危险因素。术后预防性使用抗真菌药的患者其真菌感染率低于未预防用药者(P<0.05)。结论多种因素可以导致肝移植术后早期真菌感染,提示有效控制相关的危险因素是降低术后真菌感染发生率的关键。对高危患者预防性抗真菌治疗有助于降低术后真菌感染率。
Objective To investigate the clinical features and risk factors of early deep fungal infection after liver transplantation and provide references and evidences for clinical prevention and treatment. Methods The clinical data of 118 liver transplant recipients in 4 and a half years were retrospectively analyzed. Forty-four independent variables during perioperative period were selected for univariate analysis and logistic regression analysis to screen out the risk factors associated with early fungal infection after liver transplantation. Results of 26 cases of deep fungal infection, the prevalence was 22.0%. A total of 49 fungi were isolated, mainly Candida albicans (57.1%). The average duration of infection was 13.6 days after surgery. The infection occurred mainly in the respiratory tract (75.5%). Logistic regression analysis showed that: preoperative liver failure, invasive mechanical ventilation ≥ 48 h, pleural effusion, ICU viewing time ≥ 5 d, the use of antibiotics ≥ 3 and time ≥ 2 weeks is the early postoperative fungal infection Risk factors. The fungal infection rate of patients with prophylactic use of antifungal drugs was lower than that of patients without preventive medication (P <0.05). Conclusions Various factors can lead to early fungal infection after liver transplantation, suggesting that effective control of the risk factors is the key to reducing the incidence of postoperative fungal infection. Preventive antifungal therapy in high-risk patients can help reduce postoperative fungal infection.