中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (18): 3398-3400.doi: 10.3969/j.issn.1673-8225.2011.18.041

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

肾移植后败血症7例

陈统清1，林敏娃1，孔耀中1，马均宝2   

  1. 佛山市第一人民医院，1肾内科，2细菌室，广东省佛山市  528000
  • 收稿日期:2010-11-15 修回日期:2010-12-26 出版日期:2011-04-30 发布日期:2011-04-30
  • 作者简介:陈统清，1965年生，广东省高州市人，汉族，1988年上海医科大学医疗系毕业，主任医师，主要从事肾内科及肾脏移植方面的研究。 ctqing@fsyyy. com

Sepsis following renal transplantation in 7 cases

Chen Tong-qing1, Lin Min-wa1, Kong Yao-zhong1, Ma Jun-bao2   

  1. 1Department of Nephrology, 2Bacteria Room, the First People’s Hospital of Foshan, Foshan   528000, Guangdong Province, China
  • Received:2010-11-15 Revised:2010-12-26 Online:2011-04-30 Published:2011-04-30
  • About author:Chen Tong-qing, Chief physician, Department of Nephrology, the First People’s Hospital of Foshan, Foshan 528000, Guangdong Province, China ctqing@fsyyy.com

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摘要：

背景：由于免疫抑制剂及广谱抗生素的使用，使肾移植术后合并败血症的病原菌多样复杂，病情严重，致死率高。因此加强肾移植术后合并败血症临床病原学特点的认识，及早合适的治疗是提高感染治愈率的关键。
目的：分析肾移植后并发败血症的临床病原学特点与治疗情况。
方法：收集佛山市第一人民医院肾内科2007-06/2010-06的376例肾移植患者移植后并发败血症7例的临床资料，分别对其易感因素、病原学特点、临床表现及治疗方案进行回顾性分析。
结果与结论：7例患者均有寒颤、发热(体温38.5~42.0 ℃)，烦燥、气促4例，尿路刺激症4例。血压低于90/60 mm Hg   (1 mm Hg=0.133 kPa)伴血肌酐增高4例。大肠埃希氏菌4例，表皮葡萄球菌1例，白色念珠菌1例，马尔尼菲青霉菌1例。5例细菌感染为院外感染，2例真菌感染者为院内感染。4例感染大肠埃希氏菌者合并尿路感染。4例低血压休克并急性肾功能衰竭。经抗感染治疗、减少免疫抑制药物用量及对症处理。6例痊愈，1例死亡。早期诊断，联合用药，减少免疫抑制剂的用量是提高感染治愈率的关键。

关键词: 败血症, 肾移植, 并发症, 病原学, 免疫抑制剂

Abstract:

BACKGROUND: Due to the use of immunosuppressants and broad-spectrum antibiotic, the pathogenic bacteria of sepsis is diverse and complex, accompanying with severe illness and high death rate. Therefore, to enforce clinical etiology characteristics understanding of sepsis after renal transplantation and to perform appropriate treatment as soon as possibly are the key to improve infection cure rate.
OBJECTIVE: To analyze the clinical etiology characteristics and therapy of sepsis following renal transplantation.
METHODS: The clinical data of 7 cases of sepsis in 376 patients following renal transplantation were collected from the Department of Nephrology, the First people’s Hospital of Foshan from June 2007 to June 2010. Predisposing factor, etiology characteristics, clinical manifestation and treatment of sepsis were retrospectively analyzed, respectively.
RESULTS AND CONCLUSION: There were 7 cases of shivering and fever (T38.5-40.2 ℃), 4 cases of fantod and breathlessness, and 4 cases of urinary irritation symptoms; 4 cases of blood pressure less than 90/60 mm Hg (1 mm Hg=0.133 kPa) with increased serum creatinine, 4 cases of Escherichia, 1 case of Staphylococcus epidermidis, 1 case of Blastomyces albicans, 1 case of Penicillium marneffi; 5 cases of bacterial infection was community infection, 2 cases of fungous infection was hospital oneset of infection; 4 cases suffered from Escherichia combined with urinary tract infection, and 4 cases suffered from hypotension shock and acute renal failure. Six sepsis patients were cured and one died after giving anti-infective therapy, reducing the dosage of immunosuppressant and symptomatic treatment. Early diagnosis, drug combination, and reducing the dosage of immunosuppressant are the key to improving cure rate against infection.

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