肾移植术后巨细胞病毒性肺炎合并呼吸窘迫综合征早期诊断和治疗

Early diagnosis and management of acute respiratory distress syndrome caused by cytomegalovirus pneumonia after renal transplantation

目的探讨肾移植术后巨细胞病毒性肺炎合并呼吸窘迫综合征的早期诊断和治疗。方法回顾6例肾移植术后巨细胞病毒性肺炎合并呼吸窘迫综合征患者的临床资料,均给予更昔洛韦静脉滴注,疗程2周。减少他克莫司或环孢素A的用量,停用霉酚酸酯和强的松,使用面罩吸氧、其中4例使用无创呼吸机辅助呼吸,2例气管插管呼吸机辅助呼吸。结果6例患者中4例痊愈,2例死亡。结论持续的低氧血症、胸部X、肺灌洗、CT检查是早期诊断的关键。更昔洛韦抗病毒、调节免疫抑制剂用量、使用无创呼吸机辅助呼吸是治疗肾移植术后巨细胞病毒性肺炎合并呼吸窘迫综合征的有力措施。

[Objective] To study the early diagnosis and management of the patients with acute respiratory distress syndrome （ARDS） caused by cytomegalovirus （CMV） pneumonia after renal transplantation. [Methods] 6 patients with acute respiratory distress syndrome （ARDS） caused by cytomegalovirus （CMV） pneumonia after renal transplantation were treated with inintravenous infusion of gancyclovir, reduced dosage of cyclosporine A or tarolimus and withdrawal of MMF and prednisone. The patients were subjected to breathing machine assist ventilation and nutrition supply. [Results] Four patients recovered and two died. [Conclusions] The key of early diagnosis lives in combining chest X-ray and CT scan and pulmonary pourwash with clinical presentation. Administration with antiviral drugs, adjustment of immunosuppressive agents. Management with breathing machine assist ventilation and effective nutrition supply are important for the treatment of patients with ARDS caused by CMV pneumonia after renal transplantation.