肺移植后真菌感染1例并文献复习

Fungal infection after lung transplantation in one case and literature review

回顾分析1例肺移植患者病理过程及诊疗经过,并复习相关文献,总结相关的临床治疗经验。原发性肺动脉高压并三尖瓣关闭不全、充血性心力衰竭女性患者,33岁,2006-04在体外循环下行同种异体原位双肺移植术,术后出现严重的低血容量性休克,伴有严重高钠血症,同时合并严重代谢性碱中毒,pH值最高达7.6,经积极治疗后,血钠水平于术后第14天恢复正常,术后第3天起,从痰培养、气管切开伤口分泌物、血液培养中分离出细菌、真菌共计12种,根据药敏试验给予相应抗生素治疗,真菌培养结果仍持续阳性,于术后第72天死亡。肺移植术后真菌感染是危及生命的严重并发症,对其进行早期诊断、消除各种诱发因素、及时给予足量、联合抗真菌药物治疗是移植后真菌感染防治的关键。

Though retrospective analyzed the pathological development and management of one patient with fungous infection after bilateral lung transplantation, and reviewed the related references, the article summarized clinical treatment experience. The female patient was 33 years old, who suffered with primary pulmonary hypertension accompanied by tricuspid incompetence and congestive heart failure. AIIogenic orthotopic bilateral lung transplantation was performed in April 2006. After operation, the patient had severe hypovolemic shock, hypematremia and metabolic alkalosis. The pH value was 7.6. By comprehensive treatment, the serum sodium levels recovered to normal at 14 days after operation. Since 3 days after operation, 12 kinds of bacteria and fungi were subsequently isolated from sputum samples, blood samples, and effusion surrounding the incision of the tracheal intubation. Antibiotic treatment was performed based on the drug sensitivity tests. Fungi were persistently presented, and the recipient died at 72 days after operation. Fungal infection after lung transplantation was a severe complication of mortality Diagnosis as early as possible, elimination of the inducing factors, and therapy with enough and combined antifungal agents were keys for control of fungal infection after transplantation.