论文部分内容阅读
目的探讨原位肝移植术后真菌感染的诊断和治疗。方法58例肝移植患者术后怀疑真菌感染时,行体液(痰、血、尿、胆汁、引流液等)或导管真菌培养,结合胸腹部CT影像学检查、活组织检查及诊断性治疗结果综合判断,一旦诊断确定,即给予氟康唑治疗,无效者改用伊曲康唑和两性霉素B,同时调整免疫抑制治疗方案。结果58例患者中,16例术后并发真菌感染21例次(5例患者发生两次以上、不同部位或不同菌株的感染),感染发生率为27.6%(16/58),感染发生在术后4~38d,感染好发部位依次为肺(28.6%)、肠道(19.0%)、泌尿系统(14.3%)、腹腔(14.3%)、切口(9.5%)、血液(4.8%)、胆管(4.8%)及肝脏(4.8%)。在21例次真菌感染中,念珠菌感染占85.7%,曲霉菌感染占14.3%。氟康唑治疗有效者占66.7%,伊曲康唑治疗有效者占14.3%,两性霉素B治疗有效者占14.3%,1例(4.7%)各种抗真菌药物治疗均无效,治疗总有效率为95.2%。结论肝移植术后真菌感染的发生率较高,依据影像学检查、病原学检查及活组织检查综合判断真菌感染,及时选用氟康唑、伊曲康唑及两性霉素B治疗。
Objective To investigate the diagnosis and treatment of fungal infection after orthotopic liver transplantation. Methods 58 cases of liver transplantation patients suspected fungal infection, the body fluid (sputum, blood, urine, bile, drainage, etc.) or duct fungal culture, combined with chest and abdomen CT imaging examination, biopsy and diagnostic treatment results integrated Judgment, once diagnosed, that is given fluconazole treatment, ineffective switch to itraconazole and amphotericin B, while adjusting the immunosuppressive treatment program. Results Among the 58 patients, 16 cases were complicated by fungal infection 21 times (5 cases occurred more than two times, different parts or different strains of infection), the incidence of infection was 27.6% (16/58), the infection occurred in the operation From the 4th to 38th day after infection, the incidence of infection was followed by lung (28.6%), intestine (19.0%), urinary system (14.3%), abdominal cavity (14.3%), incision (9.5%), blood (4.8%) and liver (4.8%). In 21 cases of secondary fungal infections, Candida infections accounted for 85.7%, Aspergillus infection accounted for 14.3%. Fluconazole effective treatment accounted for 66.7%, itraconazole effective treatment accounted for 14.3%, amphotericin B effective treatment accounted for 14.3%, 1 case (4.7%) of various antifungal agents were ineffective, the total treatment Efficiency is 95.2%. Conclusions The incidence of fungal infection after liver transplantation is high. According to the imaging examination, etiological examination and biopsy, the fungal infections are judged synthetically. Fluconazole, itraconazole and amphotericin B are used in time.