移植肾功能延迟恢复期间并发重症肺部感染的治疗经验

Experience of treatment on delayed graft function complicated with severe pulmonary infection

目的总结移植物(肾)功能延迟恢复(DGF)期间并发重症肺部感染的治疗经验。方法回顾性分析2008年1月至2014年11月在成都军区总医院行肾移植术,术后出现DGF期间并发重症肺部感染的15例患者的临床资料,了解其治疗经过及预后。结果采用连续性肾脏替代疗法及根据连续性静脉-静脉血液滤过药物调整剂量表来调整给药方案,采用降阶梯抗生素治疗策略,调整免疫抑制剂并使用小剂量肾上腺皮质激素,辅以其它综合治疗措施。15例患者中,8例行气管插管、2例行气管切开后给予呼吸机机械通气治疗,5例行无创呼吸机辅助呼吸治疗。经积极抢救治愈11例,治愈率为73%;死亡4例,病死率为27%,均为并发急性呼吸窘迫综合征的患者。结论移植肾DGF并发重症肺部感染具有病情严重、发展快的特点。一旦确诊,应"尽早"和"充分"地应用连续性肾脏替代疗法,根据连续性静脉-静脉血液滤过药物调整剂量表来调整给药方案,结合其他综合治疗,以提高治愈率。

Objective To sum up the experience in the treatment on delayed graft function（ DGF）complicated with severe pulmonary infection. Methods Clinical data of 15 patients undergoing renal transplantation and suffering delayed graft function（ DGF） complicated with severe pulmonary infection in Chengdu Military General Hospital from January 2008 to November 2014 were retrospectively studied. The treatment course and prognosis were studied. Results Continuous renal replacement therapy was adopted and dosage regimen was adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration. Antibiotic de-escalation therapy was adopted. Immunosuppressive agents were adjusted and lowdose adrenocortical hormone and other comprehensive treatment were applied. Of the 15 patients,8 cases underwent tracheal intubation, 2 cases underwent mechanical ventilation after tracheotomy and 5 cases underwent noninvasive ventilator-assisted breathing. Through positive rescue treatment,11 patients were cured and 4 patients died. The cure rate was 73% and the fatality rate was 27%. All died patients were complicated with acute respiratory distress syndrome. Conclusions DGF complicated with severe pulmonary infection after renal transplantation is characterized by severe condition and fast progression. Once cases confirmed,continuous renal replacement therapy shall be‘fully＇applied‘as early as possible＇,and dosage regimen shall be adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration. And other comprehensive treatments shall be combined in order to improve the cure rate.