原位肝移植术后早期卡氏肺孢子虫肺炎的临床诊断和治疗  

An initially clinical study of pneumocystis carinii pneumonia during early stage after orthotopic liver transplantation

作　　者：程芮 臧运金 刘懿和 韦中余 王瑜贵 雷联会 吴凤东 沈中阳 

机构地区：[1]武装警察部队总医院肝移植研究所,北京100069

出　　处：《中华器官移植杂志》2006年第12期714-716,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨原位肝移植(OLT)术后早期合并卡氏肺孢子虫肺炎(PCP)的病因、诊断和治疗。方法回顾276例原位肝移植患者的术后资料,并对6例合并PCP患者的临床资料进行分析总结。结果276例肝移植患者术后PCP发病率为2．17％(6例),平均发病时间为(11．17±2．50)d,主要表现为不易纠正的低氧血症。经临床症状、胸部X片、肺部CT、痰卡氏肺孢子虫聚合酶链反应(PCR)检测及镜检卡氏肺孢子虫包囊明确诊断。确诊后给予复方新诺明(SMZco)治疗,同时合理调整免疫抑制方案。经治疗,5例患者治愈出院,1例死于感染性休克。结论原位肝移植术后早期可并发PCP,提高对PCP发病的认识、及时诊断与治疗是影响预后的关键。Objective To investigate the etiology, diagnosis and treatment of pneumocystis earinil pneumonia （PCP） at early stage after orthotopic liver transplantation （OLT）. Method The clini cal data of 276 patients undergoing OLT were retrospectively analyzed and those of 6 cases complicated with PCP were summarized from January 2005 to December 2005. Results The morbidity of PCP in our group was 2.17 % and occurred in early stage after OLT. The average time on set was （11.17±2.50） days and uneasily controlled hypoxemia was the main manifestation. The diagnosis of PCP was established by clinical symptoms, chest X ray, chest CT, pneumocystis earinii PCR detection and vi sualization of PC encysts from sputum samples under a microscope. SMZco was the initial choice of treatment combined with immunosuppressive regimen regulation. Five cases were cured and 1 case died from septic shock. Conclusion PCP can occur among OLT patients in the early stage, and aggressive early diagnosis and treatment were critical to improve the prognosis.

关 键 词：肺炎 肺囊虫性 肝移植 

分 类 号：R657.3[医药卫生—外科学]