摘要
目的:研究肾移植患者术后真菌感染的CT 特征以及经对症治疗后的临床效果,以期为临床治疗提供参考。方法选取2011年1月-2013年1月入院诊治的肾移植术后肺部真菌感染的患者64例,选取资历高的医师组成阅片小组,对患者的C T征象进行分析,并观察对症治疗后患者的预后。结果真菌检出阳性55例,阳性率为85.94%;其中以白色假丝酵母菌居多占32.77%,其次为烟曲霉菌占21.82%,近平滑假丝酵母菌12.73%;肺部真菌感染的CT表现复杂多变,呈多种性质和形态改变,肺部可见单一性质改变,也可见多种病变同时或先后并存,其中以肺门纵隔淋巴结肿大居多占15.65%,其次为结节性病灶占14.06%、肿块占14.06%;64例患者抗真菌治疗5-45 d ,治疗时间(13.8 ± 3.2)d;死亡18例病死率为28.13%,治疗有效44例、有效率为68.75%。结论肾移植术后肺部真菌感染CT征象多样,缺乏典型性,需临床医师仔细鉴别诊断,肾移植术后肺部真菌感染病死率高、预后较差,应根据微生物培养结果选择合适的抗真菌药物。
OBJECTIVE To study the CT characteristics of renal transplantation patients complicated with postoper‐ative fungal infections and observe the clinical effect of symptomatic treatment so as to provide guidance for clinical treatment .METHODS A total of 64 patients who underwent the renal transplantation from Jan 2011 to Jan 2013 and were complicated with postoperative pulmonary fungal infections were enrolled in the study ,the highly quali‐fied doctors were selected to read the pieces and analyze the CT signs ,and the prognosis of the patients was ob‐served after the symptomatic treatment .RESULTS The fungi were tested positive in 55 cases with the positive rate of 85 .94% ,among which the Candida albicans (32 .77% ) was dominant ,followed by the Aspergillus f umigatus (21 .82% ) and the Candida parapsilosis (12 .73% ) .The CT manifestations of the pulmonary fungal infections were complex and diversified ,showing multiple natural and morphological changes ;the single nature change could be seen in the lungs ,and multiple lesions could be seen to coexist simultaneously or successively ;the patients with hilar and mediastinal lymph nodes (15 .65% ) were dominant , followed by the patients with nodular lesions (14 .06% ) and the patients with lumps (14 .06% ) .The anti‐fungal therapy for the 64 patients lasted for 5‐45 days ,with the mean treatment time of (13 .8 ± 3 .2)days ;18 cases died with the mortality rate of 28 .13% ,totally 44 cases were effective ,with the effective rate of 68 .75% .CONCLUSION The CT signs of the renal transplanta‐tion patients complicated with postoperative pulmonary fungal infections are diversified and atypical ,therefore ,the clinicians should pay high attention to the differential diagnosis .The mortality rate of the renal transplantation pa‐tients complicated with postoperative pulmonary fungal infections is high ,and the prognosis is poor ,it is necessa‐ry to choose appropriate anti‐fungal drugs on the basis of the results of microbiological culture .
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2015年第5期1147-1149,共3页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生科技计划A类基金项目(2013KYA036)
关键词
肾移植
肺部真菌感染
CT特征
预后
Renal transplantation
Pulmonary fungal infection
CT characteristic
Prognosis