肾移植术后肺部感染28例诊治分析

Diagnosis and treatment of pulmonary infection in patients after renal transplantation:a repore of 28 cases

目的探讨同种异体肾移植术后肺部感染的诊断和治疗经验。方法回顾性分析28例同种异体肾移植术后肺部感染患者的临床资料。结果 28例患者肺部感染发病时间为术后3个月以内6例,术后4～6个月18例,术后6个月以后4例。患者均以发热起病,早期呼吸道症状轻微,未经治疗者易发展为重症肺炎。肺部体征早期多不明显,X线胸片表现常滞后,胸部CT或磁共振成像有助于早期诊断。肾移植术后肺部感染以细菌、巨细胞病毒、真菌感染为主,混合感染常见。经给予联合使用抗感染药物、减少或者撤除免疫抑制剂、静脉应用肾上腺皮质激素(激素)、营养支持治疗,必要时辅以无创通气或者呼吸机辅助呼吸治疗等综合治疗,治愈22例,死亡6例(均为重症肺炎并发急性呼吸窘迫综合征患者)。结论肾移植术后肺部感染病情进展快,发展为重症肺炎病死率高,应及时予胸部CT或磁共振成像检查,同时加强病原体监测,确诊后及早予使用抗感染药物、调整免疫抑制剂剂量、应用激素、营养支持等治疗,以提高治愈率。

Objective To study the diagnosis and treatment of pulmonary infection in patients after renal transplantation.Methods The clinical data of 28 patients with pulmonary infection after renal transplantation were analyzed retrospectively.Results The onset time of pulmonary infection was within 3 months after transplantation in 6 cases,4-6 months in 18 cases and more than 6 months in another 4 cases respectively.Almost all patients had fever and light respiratory symptoms at the first onset.The patients without treatment ten-ded to develop severe pneumonia.The physical sign of pulmonary was limited in the early stage.The appearances of pulmonary infection were usually lagged in chest roentgenogram,while the computed tomography（CT）or magnetic resonance imaging（MRI）examination of the chest was helpful for early diagnosis.Most of the pulmonary infection in the patients after renal transplantation was bacterial infection,cytomegalovirus infection,mycotic infection and mixed infection.Administration of antibiotics,adjustment of immunosuppression,intravenous administration of glucocorticoid and systemic supportive therapies were given to all patients.Suck of oxygen or mechanical ventilation by respirators were applied when necessary.Twenty-two patients were cured and 6 patients died of severe pneumonia and acute respiratory distress syndrome（ARDS）.Conclusions Pulmonary infection after renal transplantation evolves rapidly.There is a high mortality rate in patients with severe pulmonary infection.CT scanning or MRI examination and pathogen monitoring may be helpful for early diagnosis.Once the diagnosis is confirmed,immediate administration of antibiotics,adjustment of immunosuppressant regimen,glucocorticoid administration as well as nutritional support is helpful to increase the cure rate.