肾移植术后重症肺炎的诊治经验  

Experience in diagnosis and treatment of severe pneumonitis following renal transplantation

作　　者：王栋[1] 谭建明[1] 吴卫真[1] 杨顺良[1] 林文洪[1] 徐廷昭[1] 蔡锦全[1] 陶小琴[1] 杨晓玲[1] 

机构地区：[1]南京军区福州总医院泌尿外科,福建福州350025

出　　处：《第四军医大学学报》2007年第4期346-349,共4页Journal of the Fourth Military Medical University

摘　　要：目的:探讨肾移植术后重症肺炎的诊断和治疗.方法:对52例肾移植术后并发重症肺炎患者的临床资料进行回顾性分析.结合临床症状、胸片及胸部CT确诊后,给予撤除免疫抑制剂、经验性抗感染药物、甲基强的松龙等治疗,同时防治继发感染,加强营养支持,必要时配合使用呼吸机.并通过支气管肺泡灌洗液(BAL)、痰、咽拭子及血标本的检查进行病原学诊断,包括细胞分类、病理学检查及细菌、真菌和病毒的培养等.结果:877例肾移植患者中有76例患者出现肺炎,发生率为8.7%,其中重症肺炎52例,占68%.发热和胸闷是最常见初发症状(100%),但仅有19%的患者(10/52)具有明显的咳嗽、咳痰症状.BAL的病原体检出率为69%(31/45),血培养结合痰、咽拭子培养病原体检出率为38%(20/52).经过治疗,39例治疗有效,其中治愈34例,好转5例,死亡13例,有效率75%.结论:重症肺炎多发于肾移植术后6月以内,是危及肾移植受者生命的严重并发症,应早期应用BAL检查进行病原学诊断,及时撤除免疫抑制剂、经验性抗感染药物和小剂量甲基强的松龙的应用是救治成功的关键.AIM： To explore the diagnosis and treatment of severe pneumonitis following renal transplantation. METHODS： A retrospective analysis was made on the clinical data of 52 renal transplant recipients with severe pneumonitis, which were diagnosed by the clinical symptoms, chest X-ray and CT. The treatments included withdrawal of i e agents, administration of empirical anti-infective drugs and methylprednisolone, prevention and treatment of secondary infection, reinforcement of nutritional support and use of respirator if necessary. Simultaneously responsible pathogen was detected by analyses of BAL （broncho-alveolar lavage）, sputum and blood specimen, with regard to cell differential count, cytopathologic examination and cultures for bacteria, fungi and viruses. RESULTS： Seventy- six cases （8.7%） of pneumonia were found in the 877 renal transplant recipients, which included 52 （68%） patients with severe pneumonia. Fever and chest distress were the most common initial symptoms of severe pneumonia （ 100% ）. However, obvious cough and expectoration were observed only in 10 patients （19%）. Positive rate of BAL alone and of blood culture combined with pharynx swab and sputum were 69% （31/45） and 38% （20/52）, respectively. The treatments were effective in 39 with 34 being cured and 5 being improved; 13 of 52 finally died. The effective rate was 75%. CONCLUSION： Severe pneumonitis is a most common life-threatening complication in renal transplant recipient, which mostly occurs during 6 months after renal transplantation. BAL should be performed early for detection of responsible pathogen. The key points of successful treatment inolve withdrawal of immunosuppressive agents, administration of empirical anti-infective drugs and methylprednisolone.

关 键 词：肾移植 肺炎 支气管肺泡灌洗液 

分 类 号：R699.2[医药卫生—泌尿科学]