肾移植受者术后带功状态下肺炎治疗分析

The Experience in Treating Pneumonia after Kidney Transplantation

目的分析肾移植术后感染性肺炎的诊疗,以降低移植术后肺部感染的死亡率。方法回顾性分析2013年1月~2015年10月在我院行肾移植术后感染肺炎41例移植受者的临床资料。结果单纯细菌性肺炎感染者27例,采用五水头孢唑林钠和头孢西丁治疗;病毒合并细菌感染性肺炎(巨细胞病毒)10例,给予更昔洛韦治疗;真菌性肺炎者(烟曲霉感染)4例,给予氟康唑治疗。入院后给予甲泼尼龙冲击治疗,必要时吸氧。36例患者彻底治愈,因呼吸衰竭抢救无效5例,其中病毒合并细菌性肺炎3例,真菌性肺炎2例。结论早期诊断、明确病原体、雾化吸入、甲泼尼龙冲击等相应治疗是提高肾移植术后肺炎生存率的关键措施。

Objective To summarize and analysis the experience in treating the infected pneumonia induced by immunosuppression after kidney transplantation for reduced mortality.Methods Clinical data for 41 recipients with pneumonia infection were analyzed from Jan 2011 to Oct 2015.Results Twenty-seven recipients were simply infected with bacteria,anhydrous sodium cefazolin and cefoxitin were administered to these patients.Ten recipients were found infection mingled with bacteria and virus（cytomegalovirus）,and intravenous ganciclovir were given.Four patients were infected by fungus（aspergillus fumigatus）,were treated by fluconazole.Methyl prednisolone were given after charging in,oxygen inhalation were provided essentially.Immunosuppressant reduction and intravenous immunoglobulin were all applied for 41 recipents.Thirty-six patients were completely cured,5 patients died of lung failure,including 3 patients infected simultaneously by virus and bacteria,the other 2 patients were infected by fungus.Conclusion Early-stage diagnosis,specific the pathogen,aerosol inhalation,methyl prednisolone and so on could be the key measures to enhance the survival rate of infected pneumonia.