上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

肝移植术后多重耐药菌感染危险因素的系统评价

杨富1，陈兰2，方芳2，周炜2，范青2，张瑶2   

  1. 1.上海交通大学 护理学院， 上海 200025； 2.上海交通大学附属第一人民医院护理部， 上海 200080
  • 出版日期:2015-07-28 发布日期:2015-08-27
  • 通讯作者: 方芳, 电子信箱: fang_fang0604@163.com。
  • 作者简介:杨富（1981—）， 女， 护师， 硕士生; 电子信箱: yangfu210@126.com。
  • 基金资助:

    上海市卫生局面上课题资助项目（20134135）

Systematic evaluation of risk factors of multi-drug resistant organisms infection after liver transplantation

YANG Fu1, CHEN Lan2, FANG Fang2, ZHOU Wei2, FAN Qing2, ZHANG Yao2   

  1. 1.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China; 2.Department of Nursing, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
  • Online:2015-07-28 Published:2015-08-27
  • Supported by:

    General Project of Shanghai Municipal Health Bureau, 20134135

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摘要：

目的  系统评价肝移植术后多重耐药菌（MDROs）感染的危险因素，为预防和控制感染提供依据。方法  计算机检索PubMed、OVID、Cochrane Database、Google学术、中国生物医学文献数据库（CBM）、中国知网（CNKI）数据库（检索时间从建库至2013年12月），辅以互联网络检索。收集国内外公开发表的关于肝移植术后多重耐药菌感染危险因素的前瞻性和回顾性研究。由两名研究员按照纳入和排除标准筛选文献并提取资料，参考Newcastle-Ottawa Scale的质量评价标准进行质量评价，使用STATA 12软件进行Meta分析。结果  共纳入5项队列研究，1项病例对照研究。Meta分析结果显示：移植前肝性脑病Ⅱ~Ⅳ、耐药菌定植及广谱抗菌药物的应用及血液透析、移植后并发症（肾功能不全和胆道并发症）、留置ICU时间与气管内导管留置时间的延长（≥72 h）、再次手术是肝移植术后MDROs感染的危险因素。结论  为减少肝移植术后MDROs感染，除了加强手卫生与规范临床抗菌药物的管理与应用，还需进一步加强围手术期间病情的监护，缩短留置ICU时间，尽早拔除气管内导管，减少术后并发症的发生。

关键词: 肝移植, 多重耐药, 感染, 危险因素, Meta分析, 系统评价

Abstract:

Objective  To systematically assess the risk factors of multi-drug resistant organisms (MDROs) infection after liver transplantation and provide evidences for preventing and controlling the infection. Methods We searched the PubMed, OVID, Cochrane Database, Google scholar, CBMdisc, CNKI (literature published before December, 2013 was retrieved), and Internet to collect  prospective and retrospective studies at home and abroad on risk factors of MDROs infection after liver transplantation. Literature was screened and data were extracted by two reviewers according to inclusion and exclusion criteria. The quality of studies was evaluated according to Newcastle-Ottawa Scale evaluation standard and Meta analysis was performed by STATA 12 software. Results  A total of 5 cohort studies and 1 case-control study were included. The results of Meta analysis showed that hepatic encephalopathy Ⅱ-Ⅳ, drug-resistant bacteria colonization and application of antibacterial drugs before transplantation, hematodialysis, complications after transplantation (renal dysfunction and biliary complication), ICU staying time and prolonging endotracheal tube time (72 h), and reoperation were risk factors of MDROs infection after liver transplantation. Conclusion  Besides enhancing hand hygiene and management and application of clinical antibiotics, further improving the monitoring of patients during the perioperative period, shortening ICU stay time, removing the endotracheal tube as early as possible, and reducing the incidence of postoperative complications should be performed in order to reduce MDROs infection after liver transplantation.

Key words: liver transplantation, multi-drug resistant, infection, risk factors, Meta analysis, systematic evaluation