肾移植术后严重肺部感染的综合治疗

Comprehensive Treatment of the Severe Pulmonary Infection after Renal Transplantation

目的:分析讨论肾移植术后严重肺部感染的成因、诊断和治疗。介绍中西医结合治疗方法救治肾移植术后严重肺部感染的经验。方法:肺部感染患者24例,经临床症状、血常规、胸片、血气分析、病原学等确诊后,及时停用细胞毒药物,减少环孢素A用量。治疗采用全身支持疗法;应用大剂量激素;联合使用抗细菌、抗病毒、抗霉菌、抗肺孢子虫、抗支原体等药物;体温持续不退时,配合中药白虎汤加减清热解毒、扶正祛邪;当吸氧状态下血氧饱和度(SaO2)<0.90时,及时使用连续性血液净化(CBP)或呼吸机。结果:本组24例,痊愈20例,死亡4例,其中2例因治疗时机过晚导致多脏器功能衰竭死亡,2例因出现气管插管并发症等原因而死亡。治愈率83%,死亡率17%。结论:临床体会,肾移植术后当出现严重肺部感染时,需中西医结合药物综合治疗,若治疗后,呼吸、体温仍无法改善,出现急性呼吸窘迫综合征(ARDS),吸氧状态下SaO2<0.90,氧分压(PaO2)<60mmHg时,应当及时应用CBP或呼吸机,这是防止病人因呼吸衰竭而死亡的积极有效的手段。综合治疗手段改变了以往单一抗感染治疗的弊端,大大降低了死亡率,提高了肾移植患者的生存质量。

Objetive： To investigate the cause diagnosis and therapy of severe pulmonary infection in renal allograft recipients and to introduce treating experience by combined treatment of traditional Chinese medicine and western medicine.Methods： After 24 cases was diagnosed finally by the clinical symptomes,blood routine examination,chest x-ray, blood gas analysis and etiology, we stopping the use of cytotoxic agents and decreasing dosage of CsA in time.The treatments included. Supporting therapy, using large close glucocorticoids and combing applilation of antibacterials, antiviral drugs, anti- fungal agents, anti-pneumocystis carinii pneumonia drugs and antimycoplasmal drugs etc.Chinese medicinal materials Bai Hu soup should be used if fever continued.Continuous Blood Purification（CBP） or respirator be used when SaO2（arterial,oxygen,saturation） 〈 0.9 under oxygen therapy.Results： Amony the 24 cases, 20 cases was cured and 4 died.2 cases died because of multiple organ failure and the others because of complication of tracheal intubation.Cure rate was 83 %, mortality rate was 17 %. Comelusion： Combined treatment of traditional Chinese medicine and western medicine should be given tO the severe pulmonary infection patients after renal transplantation.But if after treatment respiration and temperature no improving,acute respiratory distress syndrome（ARDS） ocurring and SAO2〈0.90 and PaO2〈 60 mmHg under oxygen therapy ,continuous Blood Purification（CBP） or respirator shoulded be used as early as possible;this is positive and effective means to prevent patients death because of respiratory failure.Comprehensive treatments change the maladies of single anti-infective therapy reduce greatly mortatiy rate and raise living quality of the renal transplantation recipients.