中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (5): 895-898.doi: 10.3969/j.issn.1673-8225.2010.05.032

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

肾移植术后重症肺部感染14例：诊治及病原分布

王养民，赵志强，王  楠，董永超，杨  琦，赵玉海，鲁守琳   

  1. 解放军兰州军区兰州总医院全军泌尿外科中心，甘肃省兰州市 730050
  • 出版日期:2010-01-29 发布日期:2010-01-29
  • 作者简介:王养民★，男，1958年生，陕西省临潼市人，汉族， 1992年解放军第四军医大学毕业，硕士，教授，主任医师，硕士生导师，主要从事泌尿系肿瘤的基础与临床研究。 wangymmr@yahoo.com.cn

Diagnosis and pathogens distribution in 14 cases with severe pulmonary infection following kidney transplantation

Wang Yang-min, Zhao Zhi-qiang, Wang Nan, Dong Yong-chao, Yang Qi, Zhao Yu-hai, Lu Shou-lin   

  1. Department of Urology, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA, Lanzhou  730050, Gansu Province, China
  • Online:2010-01-29 Published:2010-01-29
  • About author:Wang Yang-min★, Master, Professor, Chief physician, Master’s supervisor, Department of Urology, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA, Lanzhou 730050, Gansu Province, China

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摘要：

目的：加强对肾移植后肺部感染的认识及随访，是预防重症肺部感染发生的关键所在。探讨肾移植后重症肺部感染的诊治及病原体分布。
方法：选择2004-05/2008-09解放军兰州军区兰州总医院全军泌尿外科中心收治的肾移植后重症肺部感染患者14例，男10例，女4例，年龄20~65(44.8±11.0)岁。感染时间：肾移植后3个月6例，3~6个月7例，6个月以上1例，移植后6个月内感染率最高达93%。肺部感染的诊断主要根据呼吸系统的临床表现，并结合各病原菌相对较为特异的X射线胸片、CT表现及病原体检测。14例患者入院后均给予面罩持续吸氧，无明显缓解者即给予持续无创机械通气，每天检测电解质、酸碱平衡情况，定期复查肝肾功能。采用降阶梯综合抗感染治疗，采用注射用亚胺培南西司他丁钠、更昔洛韦、伏立康唑三联疗法12例，加阿奇霉素行四联疗法2例。同时根据病原菌培养及药敏检测结果调整治疗药物。免疫抑制剂根据环孢素浓度、CD4+/CD8+及C-反应蛋白的变化调整剂量。
结果：细菌感染5例，真菌感染4例，多重细菌感染1例，细菌加真菌2例，2例未检出病原菌；4例最终发生急性呼吸窘迫综合征救治无效死亡，1例自动放弃治疗死亡，治愈9例，死亡5例，死亡率36%，治愈率64%。
结论：肾移植后合并重症肺部感染者早期联合抗感染治疗、免疫抑制剂的适当调整、早期的病原学诊断、呼吸支持治疗、免疫调节剂应用和营养补充等综合治疗能提高其治愈率。

关键词: 肺部感染, 病原体, 诊治, 肾移植

Abstract:

OBJECTIVE: Strengthen realization of pulmonary infection and perform follow-up plays a key role in preventing severe pulmonary infection following kidney transplantation. The aim of this study is to analyze the diagnosis and pathogens distribution in patients with pulmonary infection following kidney transplantation.
METHODS: Totally 14 patients with severe pulmonary infection following kidney transplantation, who received treatment at The Department of Urology Center, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA, from May 2004 to September 2008, were analyzed．Including 10 males and 4 females, aged from 20 to 65 (37.3±11.4) years. Six patients suffered pulmonary infection within 3 months, 7 patients occurred pulmonary infection occurred during 3-6 months, and pulmonary infection occurred in 1 patient at 6 months after kidney transplantation. The infection rate was 93% during 6 months after kidney transplantation. The diagnosis of pulmonary infection was according to the clinical manifestation of respiratory system, and combined with specificity display of sternum, CT or detection of pathogen. Oxygen inhale and mechanical ventilation were employed for admitted patients. And electrolytes, acid-base equilibrium was daily detected. Twelve patients accepted “three-medicine” treatment and 2 cases accepted “four-medicine” treatment. The therapeutic drugs could be regulated individually. The dose of immunosuppressive agent was adjusted due to ciclosporin, CD4+/CD8+, and C-reactive protein levels. 
RESULTS: The pathogens of pulmonary infection were bacteria (5 patients), fungi (4 patients), and mixed infection (3 patients). No pathogen was found in 2 patients. Four patients died of acute respiratory distress syndrome, 1 patient died for quitting treatment. The remained 9 patients were cured. The mortality was 36%, and the recovery rate was 64%.
CONCLUSION: The cure rate of patients with severe pulmonary infection following kidney transplantation can be increased by early combining antibiotics treatment, regulating immunosuppressive agents, early identifying pathogens, taking respiratory support therapy, as well as adding nutritional supplement.

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