摘要
目的分析总结供者血培养及供肝灌注液培养的微生物特点,为预防供者来源性感染提供治疗依据。方法回顾性分析2018年8月1日至2020年12月31日郑州大学第一附属医院486例供肝血培养及478例供肝灌注液细菌培养结果及相关临床资料,按照是否通过供肝获取过程中采用不破膈肌及术中切除胆囊并通过胆囊管顺行冲洗胆汁等改进措施,分为供肝处理改进措施前(2018年8月1日至2018年11月26日,59例供者,44瓶血培养标本,118瓶灌注液培养标本)及改进措施后(2018年11月27日至2020年12月31日,427例供者,986瓶血培养标本、838瓶灌注液标本)两个阶段。分别统计分析两个阶段肝移植供者血标本、供肝灌注液标本培养结果,总结并分析供肝维护期间及获取供肝时的感染预防措施。结果分析486例潜在供者血培养及478例供肝灌注液培养结果显示:改进措施前、后血培养感染发生率为4.5%及4.3%(χ^(2)=0.008;P=0.927),而灌注液感染发生率为56.8%及46.2%(χ^(2)=4.569;P=0.031);改进措施前灌注液培养的病原体以肺炎克雷伯杆菌为主,改进措施后灌注液培养的主要病原体以表皮葡萄球菌为主。结论器官捐献前,对潜在供者进行感染筛查、预防以及在供肝获取过程中采取相应的措施能减少供者来源感染,可有效降低受者感染死亡率。
Objective To explore the microbiological characteristics of donor blood culture and donor liver perfusion culture and summarize the clinical experiences to provide basic rationales for preventing donor-derived infections.Methods From August 1,2018 to November 26,2018 and November 27,2018 to December 31,2020 at First Affiliated Hospital,Zhengzhou University,culture results of donor blood and donor liver perfusate were retrospectively reviewed.According to whether or not donor liver was obtained without breaking diaphragm,removing gallbladder intraoperatively and flushing bile through cystic duct,two stages were assigned:before and after improvement measures of liver donor,i.e.August 1,2018 to November 26,2018 and November 27,2018 to December 31,2020.The culture results of donor blood samples and donor liver perfusion fluid samples in two stages of liver transplantation were statistically analyzed and infection preventing measures during donor liver maintenance and obtaining donor liver examined.Results A total of 486 cases of blood culture from potential donors and 478 cases of liver perfusion culture were analyzed.The results showed that the incidence of blood culture infection was 4.5%and 4.3%before and after improvement measures(χ^(2)=0.008;P=0.927)while the incidence of perfusion fluid infection was 56.8%and 46.2%(χ^(2)=4.569;P=0.031);Klebsiella pneumoniae was a major pathogen cultured in perfusion solution before improvement measures and Staphylococcus epidermidis after improvement measures.Conclusions Before organ donation,infection screening and prevention of potential donors and corresponding measures during donor liver acquisition can reduce donor source infection and effectively lower the mortality of recipients.
作者
曹胜利
史晓奕
温培豪
韩建乐
王长安
郭文治
张水军
Cao Shengli;Shi Xiaoyi;Wen Peihao;Han Jianle;Wang Changan;Guo Wenzhi;Zhang Shuijun(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Henan Key Laboratory of Digestive Organ Transplantation,Henan Engineering Technology Research Center of Organ Transplantation,Open and Key Laboratory of Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities,Zhengzhou 450052,China;Kidney Transplant Disease Diagnosis and Treatment Center of Zhengzhou Seventh People's Hospital,Zhengzhou 450016,China)
出处
《中华器官移植杂志》
CAS
2022年第3期135-140,共6页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金项目(U2004122、81701946)
河南省医学科技攻关计划项目(SB201904010)。
关键词
肝移植
供者
感染
Liver transplantation
Donor
Infection
