无创和有创呼吸机恰当应用抢救肾移植术后巨细胞病毒肺炎合并严重急性呼吸窘迫综合征1例

The rescue of a case of severe acute respiratory distress syndrome post renal transplantation induced by cytomegalovirus pneumonia using proper application of non-invasive and invasive ventilation

目的探讨无创、有创呼吸机在肾移植术后巨细胞病毒(CMV)肺炎并严重急性呼吸窘迫综合征(ARDS)的价值。方法介绍1例肾移植术后出现CMV肺炎并严重ARDS临床资料并文献复习。结果患者肾移植术后3月余,出现发热、憋喘,X线胸片显示双肺间质性改变,常规治疗下,病情逐渐加重,呼吸困难明显,最低氧分压(PaO2)20 mmHg(1 mmHg=0.133 kPa),及时给予无创呼吸机辅助呼吸,根据病情更换有创呼吸机治疗,应用2周后,病情减轻再次更换为无创呼吸机,共治疗1个月,痊愈出院。结论无创、有创呼吸机在肾移植术后CMV肺炎合并严重ARDS及时恰当应用,肺功能得到改善,为患者提供了治疗原发病的时机。

ObjectiveTo explore the role of non-invasive and invasive ventilation in cytomegalovirus (CMV) pneumonia induced severe acute respiratory distress syndrome(ARDS)after renal transplantation.Methods A case of postoperative renal transplant CMV pneumonia and severe ARDS and literature were reviewed.Results More than3 months after renal transplantation,the patient underwent fever and short of breath. The chest radiograph showed bilateral pulmonary interstitial changes. His condition gradually worsened with obviously difficult breathing and the lowest oxygen partial pressure was20 mmHg(1 mmHg=0.133 kPa) despite the conventional treatment. Noninvasive ventilation was given in time,and was changed to invasive ventilation according to the condition. Two weeks after the ventilation treatment,non-invasive ventilator was used again as the disease alleviated. The patient was treated for a total of1 month before discharge.Conclusion With the timely and appropriate application of non-invasive and invasive ventilation in CMV pneumonia induced severe ARDS after renal transplantation,pulmonary function can be improved and the chance for the treatment of primary disease was won.