肾移植术后并发弥漫性肺部出血综合征1例报道并文献复习

Diffuse alveolar hemorrhage syndrome after renal transplantation: one case report and literature review

目的分析并总结肾移植术后并发弥漫性肺部出血综合征(DAHS)的临床特点和治疗经验。方法收集解放军第309医院2012年12月收治的1例肾移植术后并发DAHS患者的临床资料,分析其发病及诊治经过,并结合文献资料总结临床经验。结果该患者以呼吸衰竭、咯血进行性加重、贫血为主要临床表现,影像学显示进行性加重的双肺弥漫性浸润影。确诊DAHS后,及时给予肾上腺皮质激素(激素)冲击治疗及抗感染药物治疗,积极防治并发症,成功获治。随访至投稿日,移植肾功能良好,无肺部并发症。结论 DAHS是肾移植术后罕见而致命的并发症,早期诊断,积极抗感染治疗,并及时应用大剂量激素冲击治疗是治愈该病的关键措施。

Objective To analyze and summarize clinical characteristics and treatment of diffuse alveolar hemorrhage syndrome（ DAHS） complication after renal transplantation. Methods Clinical data of one patient,admitted to the 309 thHospital of People＇s Liberation Army in December 2012, who was complicated with DAHS after renal transplantation,were obtained. The incidence,diagnosis and treatment courses of DAHS were retrospectively analyzed.Literature review was conducted to summarize clinical experience. Results The patient was clinically manifested with respiratory failure,progressive aggravation of hemoptysis and anemia. Imaging examination revealed that diffusive infiltration of bilateral lungs was aggravated. After the diagnosis of DAHS was confirmed,adrenal cortical hormone（ hormone） shock and anti-infectious medication therapies were timely delivered to actively prevent and treat relevant complications. The patient was successfully healed. Until the submission date,the patient presented with normal renal function and no pulmonary complications were noted. Conclusions DAHS is a rare and fatal complication after renal transplantation. Early diagnosis,active anti-infection therapy and timely administration of large-dose hormone shock treatment determine the success of clinical treatment.