纤维支气管镜联合肺泡灌洗术在肾移植后合并肺部感染患者中的应用  

Early application of fiberoptic bronchoscopy and bronchoalveolar lavage in patients with pulmonary infection after kidney transplantation

作　　者：黄正楷[1] 赵欣 陶俊[1] 费爽[1] 韩志坚[1] 吴边[1] 杨潇[1] 刘绪忠[1] 殷长军[1] 黄茂 谭若芸[1] 顾民[1] 

机构地区：[1]南京医科大学第一附属医院江苏省人民医院泌尿外科,南京210029 [2]南京医科大学第一附属医院江苏省人民医院呼吸科,南京210029

出　　处：《中华器官移植杂志》2015年第3期166-170,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金（81100532,81470981）;江苏省“科教兴卫”工程医学重点人才培养资助项目（RC2011055）;江苏省“333高层次人才培养工程”项目（2011,2013）;江苏省“六大人才高峰”资助项目（2010WSN-56,2011-WS-033）;江苏省卫生厅面上项目（H2009907）

摘　　要：目的探讨纤维支气管镜联合肺泡灌洗术在肾移植后肺部感染患者中早期应用的意义。方法2011年1月至2014年9月期间在南京医科大学第一附属医院收治的同种异体肾移植术后合并肺部感染的患者共43例，根据其是否行纤维支气管镜及肺泡灌洗术分为两组：治疗组22例，对照组21例。两组患者抗生素治疗方案均相同。通过对两组患者的病原学检出率、死亡比例、好转时间，以及住院期间症状、体征、各项感染指标及影像学资料等变化进行统计学分析。结果对照组术后死亡率为14．3％，治疗组22例患者均无死亡。治疗组患者中位好转时间为12d，对照组患者中位好转时间为17d，治疗组好转时间明显缩短，且治疗组的临床表现、影像学好转率高于对照组，移植肾功能更平稳，免疫抑制剂恢复应用时间也较对照组提前。治疗组在行纤维支气管镜及肺泡灌洗术治疗后24h氧合指数为（390．0±127．6）mmHg，较治疗前明显上升，白细胞计数及血清肌酐无明显增加，未发现移植肾急性排斥反应。治疗组病原体诊断阳性率为59．1％，对照组诊断阳性率为38．1％，差异无统计学意义（P=0．169）。结论纤维支气管镜联合肺泡灌洗术在肾移植后合并肺部感染患者中的早期应用安全有效，能明显降低患者死亡率，缩短好转时间，提高治疗效果。但该方法在提高病原体检出率方面的效用尚有待进一步观察。Objective To investigate the early application of fiheroptic hronchoscopy and bronchoalveolar lavage in patients with pulmonary infection after kidney transplantation. Method From January 2011 to September 2014, 43 patients with pulmonary infection after kidney transplantation admitted into our hospital were divided into two groups： case group （n = 22） subject to fiberoptic bronchoscopy and bronchoalveolar lavage, and control group. Two groups of patients were given the same anti-infection therapeutic schedule. The detection rate of pathogens, mortality, improvement time, symptoms and signs, infection indicators, and imaging data during hospitalization were statistically analyzed. Result The mortality in control and case group was 14. 3% and 0 respectively. The median improvement time in case and control groups was 12 days and 17 days respectively （P〈0. 05）. Patients in case group also had obviously higher improvement rate not only in symptoms and signs but also in imaging findings. Meanwhile, patients＂ allograft functions were significantly steadier in case group than in control griyom, and recovery time of immunosuppressants became advanced in case group as compared with control group. Moreover, 24 h after fiberoptic bronchoscopy and bronehoalveolar lavage, the oxygenation index in case group was increased obviouslyto （390. 0 ± 127. 6） mmHg as compared with that before treatment, while leukocyte count and serum creatinine concentration were not affected. No rejection episode occurred. There was no significant difference in the detection rate of pathogens between case group （59. 1%） and control group （38. 1 %） （P = 0. 169）. Conclusion Early application of fiberoptic bronchoscopy and bronchoalveolar lavage in patients with pulmonary infection after kidney transplantation is safe and effective. It can not only obviously reduce mortality and accelerate improvement time, but also improve therapeutic efficacy. But this application has not increased the detection rate of pathogens distin

关 键 词：肾移植 肺部感染 支气管镜 支气管肺泡灌洗 

分 类 号：R587.1[医药卫生—内分泌]