肝移植术后早期重症肺炎的诊断和治疗

Diagnosis and Management of Severe Pneumonia in Early Stage after L1iver Transplantation

目的 探讨肝移植后早期重症肺炎的诊断和治疗。方法 回顾性分析2005年1月～9月期间9例肝移植后早期重症肺炎患者的临床资料。所有病人表现为咳嗽无力、咯痰困难、继而出现发热；胸部X线表现为肺纹理增粗，病情进展快，可在3d内出现双肺大量炎性渗出；血液常规均有白细胞计数的明显升高。在重症肺炎诊断确立后，即给予抗感染、机械通气和营养支持治疗。结果 重症肺炎感染发生于术后7d内，以细菌和真菌为主。本组9例患者6例痊愈，3例死亡（术后均并发肝功能损害和肾功能衰竭，同时1例合并移植后脑病，1例合并肺部毛细血管渗漏综合征）。结论 肝移植后早期肺部严重感染多为细菌和真菌混合感染，并伴有肝功能损害以及急性肾功能衰竭；在选用适当抗感染治疗药物的同时，维护肝、肾功能并加强支持治疗非常重要。

Objective To study the diagnosis and management of severe pneumonia emerging in the early stage after liver transplantation. Methods From January 2005 to September 2005, the clinical data of 9 patients in our center with severe pneumonia in the early stage after liver transplantation were analyzed retrospectively. All the patients had the symptom of difficulty in cough and expectoration, followed by fever. Great amount of lung inflammatory infiltrations could be observed within 3 days and the white cell count significantly increased in the routine blood tests. As soon as the diagnosis of severe pneunomia was established, antiinfection treatment,mechanical ventilation and nuritional support were provided to the patients. Results The severe pneumonia occurred in 7 days after the operation with the majoy pathogens of bacteria and fungi. Six patients recovered and 3 died. All the 3 patients were complicated with liver dysfunction and renal failure, one experienced cerebropathy and another one capillary leak syndrome. Conclusion The major pathogens of severe pneumonia in the early stage after liver transplantation are bacteria and fungi, most of which are compound infections. Complications such as liver and kidney dysfunction may be frequently found. Proper and enough antiinfection treatment must be accompanied by the protection of liver and kidney functions and powerful supportive therapy.