Siniscalchi Antonio, Aurini Lucia, Benini Beatrice, Gamberini Lorenzo, Nava Stefano, Viale Pierluigi, Faenza Stefano
Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
World J Transplant. 2016 Jun 24;6(2):389-95. doi: 10.5500/wjt.v6.i2.389.
To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients undergoing orthotopic liver transplantation (OLT).
This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria.
VAP occurred in 18 (7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation (MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae (79%). Univariate logistic analysis showed that model for end-stage liver disease (MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariate analysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP.
Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.
确定原位肝移植（OLT）患者呼吸机相关性肺炎（VAP）的发病率、病因、危险因素及预后。
这项回顾性研究纳入了242例接受尸体供肝OLT的患者。VAP根据临床和微生物学标准进行诊断。
18例（7.4%）患者发生VAP，机械通气（MV）每1000天的发病率为10例。分离出的细菌病原体主要是肠杆菌科（79%）。单因素逻辑回归分析显示，终末期肝病模型（MELD）评分、术前住院时间、特利加压素治疗、Child-Turcotte-Pugh评分、MV天数和红细胞输注是VAP的危险因素。多因素分析在单因素分析的基础上，考虑显著危险因素，结果显示肺炎与特利加压素使用、术前住院时间、MV天数和红细胞输注密切相关。VAP组的死亡率为22%，无VAP组为4%。
我们的数据表明，VAP是OLT患者术后医院感染的重要原因。MELD评分在单因素分析中是一个显著的危险因素。多次输血、特利加压素治疗、术前住院而非在家中发病时才入院以及MV天数是VAP发生的重要危险因素。
