肾移植术后肺部感染的诊治(附25例报告)

目的探讨肾移植术后肺部感染的临床特点及治疗体会。方法对2006年在我院行同种异体肾移植的108例患者进行随访，回顾性分析其中25例发生术后肺部感染而再次入院接受治疗患者的临床资料。结果108例肾移植患者中，发生肺部感染25例，感染发生率为23．15％；感染的中位时间为移植术后83．50d，平均时间为移植术后87．64d；感染时间：〈3个月者16例（64．29％），3～6个月9例（35．71％），其中有4例（3，7（）％）出现急性呼吸窘迫综合征（ARDS），3例医治无效死亡（8．57％）。发生两次肺部感染者3例，其中有2例两次感染均发生于术后3个月内。确诊细菌感染4例、巨细胞病毒感染2例、支原体感染1例、曲霉菌感染1例、未明具体病原体感染17例。结论肾移植术后肺部感染多发生于术后半年尤其是3个月内，感染病原体多样且早期确定困难。早期联合抗细菌、抗病毒、抗真菌及抗支原体治疗，及时调整免疫治疗方案，有低氧血症表现时需无创鼻导管／面罩吸氧，适时予以呼吸机辅助呼吸是救治成功的关键。

Clinical analysis of pulmonary infections in 25 patients after kidney transplantation

Purpose To analyze the clinical features,diagnosis and treatment of pulmonary infections(PI) in kidney transplant patients. Methods One hundred and eight patients underwent the allograft renal transplantation in 2006 at Zhongshan Hospital were follow-up visited,the clinical data of 25 PI patients hospitalized were collected and retrospectively analyzed. Results Of these 108 patients,25(23.15%) patients developed pulmonary infection.The median time and mean time of infection is respectively 83.5 days and 87.64 days after the transplantation.The infection rates within 3 months and 3 to 6 months was respectively 64.29 % and 35.71%.Four(3.70%) patients developed acute respiratory distress syndrome(ARDS) and 3(8.57%) of them died.Among 3 patients who suffered twice pulmonary infections,PI occurred within 3 months in 2 patients.The types of pulmonary infection included bacteria(4 cases),cytomegalovirus(2 cases),aspergillus(1 case),mycoplasma(1 case) and undetermined pathogen infection(17 cases). Conclusions Pulmonary infection mainly occurs within half a year and especially 3 months after transplantation,pathogens are various features and are hard to be diagnosed in the earlier period.The key of successful treatment should involve combination of anti-bacteria,anti-virus,anti-fungi and anti-mycoplasma drugs at the early stage,decrement of the immunodepressant,timely application of non-insulted nasal catheter/ face mask and mechanical ventilation to correct hypoxia.