肾移植术后肺部感染的诊治

Management of pulmonary infection after renal transplantation

目的提高肾移植术后肺部感染的诊疗水平。方法回顾性分析总结36例肾移植术后并发肺部感染患者的临床资料及诊治情况。结果 29例患者找到病原体47例次,7例未找到确切的病原体;并发急性肺损伤/急性呼吸窘迫综合征者共20例,其中12例行机械通气治疗,10例(83.3%)治愈;19例患者行纤维支气管镜(纤支镜)介入诊疗,其中16例(84.2%)明确了病原体,12例患者经纤支镜介入治疗后,临床症状均有不同程度改善;本组36例患者中,32例(88.9%)治愈,2例死亡,2例因经济原因放弃治疗自动出院。结论肾移植术后肺部感染患者应积极进行病原学的检测,重视影像学检查的意义;早期经验性治疗能否覆盖可能感染的病原体是治疗能否成功的关键;纤支镜介入诊疗对于提高肾移植术后肺部感染(尤其是重症肺部感染)的治愈率有重要作用。

Objective To improve the management of pulmonary infection in patients after renal transplantation. Methods A retrospective analysis was made on 36 cases of pulmonary infection post renal transplantation. Results Forty seven pathogens were isolated in 29 patients. The 12 cases with acute lung injury were treated with mechanical ventilation, and 10 （83.3%） were cured. Nineteen cases were treated with bronchofibroscope intervention. And pathogens were identified in 16 cases （84.2%）. After treated with bronchofibroscope, clinical symptoms were improved in the 12 cases to various extents. In all 36 cases, 32 （88.9%） were cured, 2 died, and other 2 were discharged from hospital because of economic reasons. Conclusions Pathogen identification and imaging technique should be highly appreciated in patients with pulmonary infection after renal transplantation. The key point of successful treatment is that the initial treatment should cover all possible pathogens. The ap plication of bronchofibroscope could be especially important in improving the cure of pulmonary infection in renal transplantation recipients, especially in severe cases.