无创正压机械通气治疗肾移植术后巨细胞病毒肺炎所致急性呼吸窘迫综合征

Noninvasive positive pressure ventilation for patients with acute respiratory distress syndrome as a result of CMV pneumonia after renal transplantation

目的探讨肾移植术后巨细胞病毒（CMV）肺炎合并急性呼吸窘迫综合征（ARDS）无创正压机械通气治疗效果。方法肾移植术后CMV肺炎合并ARDS患者10例。早期应用无创正压机械通气治疗及抗病毒、调整免疫抑制剂、加强营养支持的综合治疗。比较分析患者通气治疗前后动脉血气、生命指标及移植肾功能变化。结果10例患者中治愈7例。1例脱机时发生张力性气胸及广泛皮下气肿死亡；另2例治疗中病情加重改有创机械通气，治疗5、18d无效死亡。7例治愈患者上机前与上机后、脱机前的动脉血气分析血氧分压、血氧饱和度、血二氧化碳分压比较差异有统计学意义（P〈0．05）；治疗前后患者血肌酐（平均156．25对101．85／μmol／L）、血尿素氮（平均11．93对6．55mmol／L）比较差异有统计学意义（P〈0．05）。结论早期应用无创正压机械通气辅以抗病毒为主的综合治疗，是提高重症CMV肺炎治愈率的重要措施。

Objective To discuss the clinical application of noninvasive positive pressure ventilation for patients with acute respiratory distress syndrome （ARDS） as a result of cytomegalovirus （CMV） interstitial pneumonia after renal transplantation. Methods There were 371 renal transplantation from March 2003 to October 2006, 27 patients were diagnosed as CMV pneumonia postoperation. Ten patients were treated with noninvasive positive pressure ventilation within the 11 patients who aggravated to ARDS. The clinical data of before and after mechanical ventilation were reviewed. Results Among patients received noninvasive positive pressure ventilation, 1 died of complication. Seven patients were cured by noninvasive positive pressure ventilation. Significant difference of the physiological index presented between the 7 patients cured with noninvasive positive pressure ventilation before and after the use of ventilation（P〈0.05）, and significant difference of the renal function also existed（P〈0.05）. Conclusion The major value of noninvasive positive pressure ventilation is to correct the hypoxemia.