肾移植术后并发巨细胞病毒性肺炎的观察与护理

Observation and nursing of cytomegalovirus pneumonia after renal transplantation

目的探讨肾移植术后并发巨细胞病毒(CMV)性肺炎的临床观察及护理。方法对15例肾移植术后并发CMV性肺炎患者的临床表现、监测内容及护理过程进行回顾性分析。结果15例并发CMV性肺炎患者临床主要表现均以发热、咳嗽起病,胸部X线检查均为间质性肺炎改变。15例中抗CMV-IgM阳性者13例,CMV-DNA阳性9例;9例治疗后外周血CMV抗原检测全部转为阴性,6例死亡,其中2例放弃治疗。结论肾移植术后并发CMV肺炎病情凶险,全面细致地观察与护理有利于CMV肺炎的早期诊断和治疗。

Objective To observe the course cytomegalovirus（＇CMV） pneumonia after renal transplantation and implement it＇s nursing care. Methods The observation and nursing of 15 patients suffering from CMV pneumonia after renal transplantation were retrospectively analyzed. Results The major clinical manifestations were fever, cough and interstitial pneumonia （by X-ray film of the chest）. Blood CMV-IgM tests were positive in 13 patients and CMV-DNA positive in 9 patients. CMV-IgM turned to negative in 9 patients after recovery, 6 patients died （including 2 patients who gave up treatment）. Conclusions CMV pneumonia is a serious complication of renal transplantation. Close observation and nursing care are importion for early diagnosis and treatment. In order to improve cure rate, CMV monitoring by the assay of CMV-DNA. Comprehensive treatment including early use of anti-viral ganciclovir,adjustment of immunosuppressive agent dosage and intensive sup- portive treatment are important measures to be taken. The nursing intervention include mental nursing, oxygen therapy, care of medication and care observation of any clinical changes.