摘要目的 探讨儿童肝移植术后发生医院感染的危险因素,为采取针对性的预防和控制措施提供理论依据.方法 采用回顾性调查的方法,调查天津市第一中心医院2014年1月至2015年12月223例儿童肝移植患者的临床资料,采用单因素和多因素分析方法,探讨影响患儿移植术后感染的危险因素.结果 223例患者中51例发生术后医院感染,感染率为22.86％;其中在74例次医院感染中,血液系统(含中心静脉导管)感染38例次(51.35％),其次为手术部位感染(21.62％)、呼吸系统感染(18.92％)和其他部位感染(8.11％);共分离出病原菌74株,以革兰阴性菌为主,占48.65％,其次为革兰阳性菌(44.59％)和真菌(6.76％).对术后医院感染危险因素的单因素分析结果显示,患者住院时间、术前住院天数、手术持续时间、是否进行二次手术与患者术后感染相关(P＜0.05),采用多元Logistic回归调整其他因素后,术前住院天数、手术持续时间、进行二次手术和单位体重失血量是患儿肝移植术后发生医院感染的独立危险因素.结论 儿童肝移植术后发生医院感染存在诸多因素,应从手术因素、医护人员以及医院管理等多方面综合考虑,加强管理,以降低医院感染率.

abstractsObjective To analyze the risk factors of nosocomial infection after liver transplantation in children,so as to provide scientific evidence for the prevention and control of nosocomial infection.Method Clinical data of 223 pediatric patients undergoing liver transplantation between January 2014 and December 2015 were analyzed retrospectively.Univariate and multivariate analyses were carried out to investigate the risk factors of infection after transplantation.Result Totally 51 children were infected among the 223 patients,the infection rate was 22.86％ (51/223).Among the 74 cases with infection,38 were infected with the blood (included peripherally inserted central catheters) accounting for 51.35 ％;and surgical site infection accounted for 21.62％,the respiratory tract infections accounted for 18.92％ and the other infections accounted for 8.11％.Totally 74 strains of infectious pathogens were found in 51 cases of infected patients,including Gram-negative bacteria accounting for 48.65％,Gram-positive bacteria accounting for 44.59％ and the fungus accounting for 6.76％.According to a variety of survey factors,univariate analysis showed factors of hospitalization time,hospitalization time before surgery,surgical duration,and reoperation had statistically significant association with nosocomial infection (P ＜ 0.05).Logistic regression analysis showed that hospitalization time before surgery,surgical duration,reoperation and blood loss per unit weight were independent risk factors for nosocomial infection after pediatric liver transplantation.Conclusion There are a variety of risk factors for the postoperative infections after liver transplantation in children.It is necessary to take into account the surgery factor,medical staff factor and hospital management factor.Management strengthening of these factors is necessary to reduce the infection rate.