肾移植术后重症肺炎的临床特征及救治措施分析

Analysis of clinical features and treatment measures of severe pneumonia after renal transplantation

目的探讨肾移植术后重症肺炎的临床特征及救治措施分析。方法回顾性分析2017年1月~2019年7月武汉大学人民医院31例肾移植术后重症肺炎的临床资料,总结其临床特征,并分析合理应用抗生素,及时调整免疫抑制剂的使用,联合呼吸支持、连续性肾脏替代治疗(CRRT)等综合治疗措施的治疗效果。结果31例肾移植术后重症肺炎患者的平均年龄(43.9±11.7)岁。在肾移植术后6个月内发病的有17例(54.84%),>6个月的有14例(45.16%);主要首发症状包括发热19例(61.29%)、咳嗽15例(48.39%)、咳痰8例(25.80%)、呼吸困难6例(19.35%)、咽痛2例(6.45%)及胸闷1例(3.22%);31例患者中,单一病原菌感染占16例(51.61%),两种及两种以上病原菌感染占8例(25.81%),不明病原体感染7例(22.58%)。入院后积极治疗好转25例,死亡6例。结论肾移植术后重症肺炎多发生在术后6个月内,首发症状以发热多见,病原体感染中以细菌感染及混合感染为主,早期明确病原体,联合使用综合治疗措施是治疗成功的关键。

Objective To investigate the clinical features and treatment measures of severe pneumonia after renal transplantation.Methods The clinical data of 31 cases of severe pneumonia after kidney transplantation in Renmin Hospital of Wuhan University from January 2017 to July 2019 were retrospectively analyzed.The clinical features were summarized,and the effects of rational use of antibiotics,timely adjustment of immunosuppressant use,combined with respiratory support,continuous renal replacement therapy(CRRT)and other comprehensive treatment measures were analyzed.Results The mean age of 31 patients with severe pneumonia after renal transplantation was(43.9±11.7)years old.In 31 cases,17 cases(54.84%)infected within 6 months and 14 cases(45.16%)occurred 6 months after the operation.The main initial symptoms included fever in 19 cases(61.29%),cough in 15 cases(48.39%),sputum in 8 cases(25.80%),dyspnea in 6 cases(19.35%),pharyngeal pain in 2 cases(6.45%)and chest tightness in 1 case(3.22%).Among the 31 patients,single pathogen infection accounted for 16 cases(51.61%),two or more pathogen infections accounted for 8 cases(25.81%),and unknown pathogen infection accounted for 7 cases(22.58%).Among the 31 patients,single pathogen infection accounted for 16 cases(51.61%),two or more pathogen infections accounted for 8(25.81%),and unknown pathogen infection accounted for 7 cases(22.58%).After admission,25 patients improved and 6 patients died.Conclusion Severe pneumonia usually occurs within 6 months after kidney transplantation,and the first symptoms are mostly fever.Bacterial infection and mixed infection are the main pathogens.Early identification of pathogens and combined treatment are the key to successful treatment.