肾移植术后重症肺部感染的临床诊治

Management of severe pneumonia after renal transplantation

目的 分析肾移植术后重症肺部感染的临床特点和诊治体会。方法 4 7例重症肺部感染患者均系细菌、真菌和(或)病毒的混合性感染。临床上以弛张高热和弥漫性间质浸润为特点。治疗上采用有效的呼吸支持;改善肺毛细血管通透性,消除肺间质水肿,拮抗全身炎症反应;积极进行营养支持;联合抗细菌、真菌和病毒的综合治疗;强有力脏器功能支持。结果 G-菌占85 .4 % ,对G-菌敏感菌株数达5 0 %以上的抗生素依次为美罗培南、亚胺培南、头孢西丁,头孢哌酮/舒巴坦、阿米卡星、头孢他丁、头孢吡肟,在70 %以上仅有美罗培南和亚胺培南;4 7例患者并发多器官功能障碍综合征(MODS) 35例,死亡17例。结论 肾移植后重症肺部感染病情发展迅速,预后差。早期诊治、注重自身抵抗力的提高、强有力的脏器功能支持是救治成功的关键。

Objective To analyze the clinical characteristics and therapeutic results of severe pneumonia after renal transplantation. Results Forty-seven patients, suffered from severe pneumonia, all developed mixed infection in lung including bacteria, virus and fungi, showed poor therapeutic results. Their clinical symptoms mainly showed high fever and a diffuse interstitial abnormality in chest radiograph. Clinical management included oxygen therapy, mechanic ventilation, reducing capillary permeability, improving pulmonary edema, inhibiting systemic inflammatory response and powerful organ support.In addition, the patients were given anti-bacteria, virus and fungi therapy at the same time. Results The pathogen inducing severe pneumonia in 47 patients was mainly gram negative bacteria (85.4%), most common including P.aeruginosa,K.pneumoniae,A.baumannii and E.cloacae. Its susceptibility above 50% to antibiotic was as follows: meropenem, imipenem, cefoxitin, cefoperazone/sulbatam, amikacin, ceftazidime, cefepime. Whereas, meropenem and imipenem was most susceptble to those bacteria. Moreover, in a total of 47 patients, 35 patients complicated with multiple organ dysfunction syndrome,and 30 patients survived after effective clinical management. Conclusions The mortality of severe pneumonia is very high after renal transplantation. It is important for those patients to be given early medical management and potential organ support.