肾移植术后巨细胞病毒肺炎合并急性呼吸窘迫综合征患者诊治分析

Analysis on the treatment of patients with acute respiratory distress syndrome caused by cytomegalovirus pneumonia after renal transplantation

目的总结肾移植术后巨细胞病毒(CMV)肺炎并发急性呼吸窘迫综合征(ARDS)患者的临床治疗经验,探讨有效的治疗措施。方法回顾性分析本院4年来肾移植术后发生CMV肺炎并发ARDS的患者21例,对其一般情况、治疗措施以及临床转归进行总结分析,给予患者积极的抗病毒治疗,适当减少免疫抑制剂用量,积极进行全身支持疗法,及时采用呼吸机辅助通气等综合治疗措施。结果 21例患者中16例治疗有效,3例患者出现呼吸衰竭,经积极治疗无效死亡,2例属于自动出院后死亡。有效率为76.19%,治疗后外周血CMV抗原检测全部转为阴性。16例存活的患者中,12例在病程中出现尿量减少,血清肌酐(SCr)升高,随着感染的控制,肺功能恢复,SCr也逐渐恢复正常;另4例肾功能一直保持正常。结论 CMV肺炎合并ARDS应采取抗病毒、重建免疫功能、适时机械通气、支持治疗为主的综合治疗措施,有助于提高患者的救治成功率。

Objective To study the treatment of patients with acute respiratory distress syndrome(ARDS) caused by cytomegalovirus(CMV)pneumonia after renal transplantation. Methods A retrospective analysis of 21 patients with ARDS caused by CMV pneumonia after renal transplantation in 4 years in the hospital was done. The general situation,treatment and clinical outcomes were summarized and analyzed. All the 21 patients were treated with antiviral therapy,decreased the dosage of immunosuppressant,supported with active whole body support therapy,and applied with timely ventilation. Results In the 21 patients,the treatment of 16 cases was effective. Three cases experience respiratory failure and died after active treatment. Two cases died after discharge not suggested by medical staff. The effective rate was 76.19%. All CMV antigen in peripheral blood turned negative after treatment. Of the 16 cases survived,12 cases experienced oliguria,serum creatinine(SCr)increased. Pulmonary function was recovered and SCr was gradually returned to normal along with the control of infection. The renal function of other 4 cases remained normal. Conclusion CMV pneumonia accompanied ARDS should be treated by antiviral therapy,withdrawal of immuno-suppressant drugs,rebuild the body's immunity function,and timely application of ventilation, which are helpful to improve the successful remedy rate.