Objective To provide a reference for the clinical diagnosis and treatment of biliary infection resulting from Acinetobacter baumannii after liver transplantation by distinguishing the constituent ratio and resistance phenotype of Acinetobacter baumannii from biliary culture results and drug-resistance test collecting from liver transplant recipients. Methods The results of biliary culture and drug resistance test of 1950 biliary specimens were collected retrospectively from patients who received liver transplantation during January 2009 and September 2013. Constituent ratio and resistance phenotype of Acinetobacter baumannii in pathogen positive specimens were analyzed. Results In 1 950 biliary specimens, 1 348 biliary specimens were turned out to be pathogen positive, a total of 1436 strains of pathogenic microorganism were detected, including 777 strains of Gram—negative bacteria. 82 strains of Acinetobacter baumannii were identified, the constituent ratio was 10.55%(82/777), total ratio was 5.71%(82/1436). There were 12, 21, 19, 22, 8 strains of Acinetobacter baumannii each year respectively, and correspondingly the constituent ratio was 9.38%, 10.50%, 11.24%, 17.32% and 5.34%. Drug resistant test showed that Acinetobacter baumannii in biliary specimens were resistant to most antibiotics frequently used in clinic except for colistin. Conclusion The detection and constituent ratio of Acinetobacter baumannii in biliary specimens of livertransplant recipients is increasing and the majority of them have a high resistance rate to most antibiotics frequendy used in clinic except for colistin.

Otyective To study the clinical characteristics and nursing of long-tenn pulmonary fungal infection after liver transplantation. Methods A retrospective analysis of Transplant Institute of the Armed Police General Hospital from June 2005 to September 2008 long-tenn pulmonary fungal infection after liver transplantation was done. Individual treatment and care was adopted, and nursing characteristics and countermeasures of analysis were summarized. Results In the 608 survived cases of liver transplantation patients of our hospital, long-term postoperative pulmonary fungal infection happened in 12 cases with the incidence of 2.0%. In those 12 cases, 8 cases were cured, 1 improved, 1 died and 2 cases with stable condition did not treated. Conclusions Long-term pulmonary fungal infection after liver transplantation is different from the early pulmonary fungal infection. If it is treated according to its clinical characteristics and with targeted nursing measures, the transplant recipients can get long-term survival.

Objective To evaluate the feasibility, safety of transjugular liver biopsy (TJLB) in patients with liver transplantation (LT) . Methods From December 2013 to January 2014, there were three cases with coagulation impairment or ascites after LT. TJLB was performed in these 3 patients. The results were monitored by clinical follow-up, liver biopsy and complications. Results Technical success was achieved in all TJLB without complications. 1, 2, 3 passages were performed in the procedures, respectively. TJLB were performed within 2 weeks after LT, and 2 cases were diagnosed as acute rejections and 1 as hepatitis recurrence and biliary tract complication. Conclusion Our experience with TJLB, using an automated core needle biopsy, has shown this technique to be a feasible and safe procedure in this small series of patients who underwent LT with severe ascites or coagulation impairment.

Objective To evaluate the diagnosis and treatment of hepatic artery thrombosis（HAT）after pediatric liver transplantation. Methods From January 2012 to August 2013, there were 3 children with HAT. 1 patient experienced interventional therapy with thrombolysis, percutaneous transluminal angioplasty （PTA） and stent. 2 patients underwent emergent hepatic artery revascularization combined with intra-arterial embolectomy. The therapeutic results were monitored by clinical follow—up and imaging examination. Results 3 children developed HAT on 2, 6 and 10 days after operation, respectively. 2 children underwent emergent operation ; 1 child developed hepatic abscess and cured by puncture drainage ; another child didn't experience any complications. 1 patient who performed interventional therapy, appeared ischemic biliary complications in 3 months after operation, and was treated with basket catheter from T-tube approach and drainage tube. All children were with normal liver function, hepatic artery patency on ultrasound. Conclusions It is essential to diagnose HAT by monitoring the artery flow by Doppler ultrasound screening in the early period after operation. Interventional therapy and emergent hepatic artery revascularization are effective rescue treatments.

Objective To retrospectively summerize the anesthetic characteristics in 85 infants and children undergoing living related partial liver transplantation admitted to Tianjin First Center Hospital from January 2010 to October 2013. Methods 85 cases of the American Society of Anesthesiologists (ASA) HI or IV elective pro-donor liver transplantation in children, into the operating room oxygen mask, upper extremity venous channels were open in the ward. Intravenous injection of ketamine 0.15-0.20 mg/kg, midazolam 0.10-0.15 mg/kg, fentany 2-5 pg/kg and vecuronium 0.8-1.0 mg/kg induction of anesthesia. Preoperative intravenous access without children section, intramuscular ketamine 5—10 mg/kg, sevoflurane, open upper extremity venous channels ; intermittent intravenous fentanyl 1-3 pg/kg, vecuronium 0.3-0.5 mg/kg, inhalation of 1.0% to 1.5% sevoflurane anesthesia. Intravenous infusion of dopamine 1-5 pg/ (kg ? min), nitroglycerin 0.2-0.5 (kg ? min) or intravenous epinephrine 5—20 pg or 40-100 jxg of phenylephrine to maintain loop stability. The temperature was maintained with heating devices such as heating bed, heating blanket and fluid warming. Heart rate (HR), electrocaradiogram (ECG), pulse oxygen saturation (SpO₂), mean arterial pressure (MAP), central venous pressure(CVP)were monitored.Blood gas analysis〔 pH value, arterial partial pressure of oxygen (Pa0₂), arterial partial pressure of carbon dioxide (PaC0₂), base excess (BE) J, blood K⁺, Ca" and glucose levels were determined. The prothrombin time, partial prothrombin time, activated partial prothrombin time and fibrinogen levels were also measured. Results Inferior vena cava occlusion time was 40-62 minutes. The durations of portal circulation interruption and surgery were 43-72 minutes, 240-500 minutes. 84 patients were discharged from the hospital. One patient died 6 days after operation because of acute rejection. There were severe pneumonia in 2 patients, and biliary fistula in 4 patients after operation. Conclusion Intraoperative insulation, smooth induction and maintenance of anesthesia, ultrasound guided internal jugular vein catheterization, perioperative hemodynamic stable, effective liver, kidney, heart protective measures to adjust monitor blood gas and electrolytes, coagulation function key management and immunosuppressant and fliers are key issues to ensure the success of pediatric liver transplantation.

Objective To follow for education in transplant recipients, to take active interventions, so as to establish the health belief model to reduce the incidence of adverse health events and improve long-term survival and quality of life of patients. Methods CLTR records and follow-up examination of 374 patients transplanted for HBV-related disease who were admitted to the General Hospital of Chinese People's Armed Police Forces from January 2006 to January 2009 were analysed retrospectively. All participants in this study were given written informed consent and consistently in accord with ethical or legal standards. 374 patients were randomly divided into 190 cases of the health model intervention group and 184 cases the routine follow-up group. The health model intervention group was taken educational intervening during follow up. It was found that many patients often ignore the postoperative follow-up by long-term tracking of liver transplant patients. Results The statistical analysis of investigation results found that elder patients and secondary education need more psychological counseling than others. They were easier to psychological problems and affecting life treatment after improper postoperative follow-up. After the transplant center patients after 6 months of follow—up health model intervention compared with the control group, the major difference in the incidence of postoperative adverse events were statistically significant （all P < 0.05） . Conclusions Liver transplanted patients must attach great importance to the postoperative fbllow-up. The health belief model can reduce the patient's incidence of adverse events and improve their long-term survival rate and quality.

Objective To investigate nursing of small intestine transplantation therapeutic treatment for short bowel syndrome and end-stage bowel diseases. Methods The first small intestine transplantation in Tianjin First Center Hospital was performed on May 23rd 2008. During the small intestine transplantation, the superior mesenteric artery and the superior mesenteric vein of donor small intestine segment were anastomosed to the recipient's abdominal aorta and superior mesenteric vein respectively. A drainage tube was placed insider the donor intestine segment. The upper end of graft was anastomosed to the recipient's duodenum, while the infer end anastomosed to colon. All the anastomoses were performed by the side—side method. And a fistulization was made at the infer end of graft. Results Several strictures were found inside the lumen o￡ graft, 3 weeks after the operation. The patient also suffered from poly infection at the same time. Intravenous nutritional support, anti-rejection, antiinfection treatments were given. The body temperature of patient came down. FK506 solution was #ven by intravenous injection pump as an immune suppression therapy. Conclusions Nurses are facing more complicated daily treatments of intestine transplantation patient. More attentions should be paid to the temperature, stability of nutrient solution and the speed of instillation. The stoma was very important for biopsy. We can also find some information of graft from the stoma. Strict isolation, rigorous procedures and personal hygiene of patient are very important for preventing infections.

Otyective To evaluate the perioperative care of percutaneous transhepatic stent angioplasty for portal vein stenosis following liver transplant. Methods Retrospective analysis of 9 patients who developed portal vein stenosis following liver transplant was done. Percutaneous trans-hepatic angioplasty of the portal vein was performed in all patients. The clinical data, imaging :follow-up data and perioperative care were summarized. Results In all patients, the percutaneous transhepatic angioplasty were successfully. It was placed in self-expanding metallic stents 9 pieces, and 1 piece of membranous stent was placed in because of portal vein tumor thrombus again. Perioperative nursing provide a theoretical basis for clinical care, effectively reduce the incidence of postoperative complications and improve the success rate of surgery. Conclusions Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of portal vein stenosis following liver transplant. Perioperative nursing is an important guarantee for successful operation.

Objective To investigate the prophylaxis, diagnosis and treatment of perforation of intestine post pediatric liver transplantation. Methods Retrospective analysis was done on 33 pediatric liver transplantation in Tianjin First Center Hospital from July 1, 2013 to December 31, 2013 (including 2 gross liver transplantation, 7 split liver transplantation _y and 24 living donor liver transplantation) . Patients were followed up for 3 months. Results One patient suffered from perforation of intestine. The patient was cured by wedge excision and reconstruction of intestine. Conclusions The key points of diagnosis and treatment of intestinal perforation post liver transplantation were early discovery, early diagnosis, and early treatment. The risk factors were the using of glucocorticosteroid, immunosuppressive agents, malnutrition, and infection o￡ abdominal cavity. Manifestation including continuous high fever, abdominal distension, unclear drainage, tenderness of abdominal, and abdominal cavity inflated with air in ultrasound test.