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目的:探讨肝移植术后下呼吸道感染微生物及临床化学实验诊断价值。方法:11例肝移植术后下呼吸道感染者病例,做痰微生物培养及鉴定,测定14项临床化学指标,分析微生物感染状况,找出有特征性临床化学诊断项目。结果:11例肝移植受者为医院感染病例。多种微生物合并感染多(7/11)。细菌分类以非发酵菌、念珠菌和凝固酶阴性葡萄球菌感染较多。1例非发酵菌感染,对多种抗生素耐药。临床化学指标中ALT在新肝期4~6d后始终波动在较高水平(100~200 IU/L),直至感染控制才降至正常。TB、DB在术后逐渐降低时,到新肝期5~6 d又突然升高,呈一回升曲线,感染控制后3~7 d才降至正常。结论:肝移植术后ICU病房患者应注重防治医院感染,及时进行病原微生物调查,合理使用抗生素。ALT、TB、DB 3项临床化学指标的变化特点对判断感染监测疗效具有积极意义。
Objective: To investigate the diagnostic value of microorganism and clinical chemistry experiment of lower respiratory tract infection after liver transplantation. Methods: Eleven patients with lower respiratory tract infection after liver transplantation were enrolled in this study. The sputum was cultured and identified. Fourteen clinical chemistry indexes were determined, the status of microbial infection was analyzed, and the characteristic clinical chemistry diagnosis items were found out. Results: 11 cases of liver transplant recipients were nosocomial infections. Multiple microbial infections and more (7/11). Bacteria classification to non-fermentative bacteria, Candida and coagulase-negative Staphylococcus infection more. One case of non-fermentative bacteria was resistant to multiple antibiotics. ALT in clinical chemistry indicators fluctuated at a relatively high level (100-200 IU / L) after 4 ~ 6 days of neohepatic period until infection control was reduced to normal. When TB and DB decreased gradually after operation, they suddenly increased again from 5 to 6 days after neovascularization, showing a rising curve. Only 3 to 7 days after infection control, they dropped to normal. Conclusion: Patients in ICU ward after liver transplantation should pay attention to the prevention and treatment of nosocomial infections, timely investigation of pathogenic microorganisms and rational use of antibiotics. ALT, TB, DB 3 changes in clinical chemistry indicators to determine the efficacy of infection monitoring has a positive effect.