肾移植术后卡氏肺孢子虫肺炎的诊治及预防

目的 探讨肾移植术后发生卡氏肺孢子虫肺炎的诊断、治疗及预防.方法 综合分析我院2002～2004年13例肾移植术后发生卡氏肺孢子虫肺炎患者的临床资料,提出治疗方案以及预防措施.结果 本组患者发病时间在肾移植术后88～142d,平均106d.病程为12～30d,平均22d.本病的临床特点为临床症状重、肺部体征轻,胸片及胸部CT有特异性表现,纤支镜肺泡灌洗可以确诊.经调整免疫抑制药物剂量,给予口服复方新诺明,吸氧、支持治疗,13例患者均康复出院.结论 卡氏肺孢子虫肺炎是一种严重威胁肾移植术后患者生命安全的肺部感染性疾病,常见于过度免疫抑制患者,如不及时治疗可发生急性呼吸窘迫综合征,威胁患者生命.采用复方新诺明治疗本病疗效可靠.

Pneumocystis carinii pneumonia in patients after kidney transplantation

Objective To investigate the diagnosis treatment and prophylaxis of pneumocystis carinii pneumonia in patients after kidney transplantation.Methods To perform aggregate analysis on the clinical data of 13 cases of kidney transplantation recipients from 2002 to 2004 who was infected by Pneumocystis carinii,and to propose the therapeutic regimen and precaution.Results The infection of all the 13 cases occurred from 88d to 142d after kidney transplantation,the average time was 106d.The course of the disease was 12-30d,the average duration was 22d.The clinical manifestation was that the clinical symptom was very serious,but with trifling pulmonary objective sign.X-ray film and CT of chest was sensitive to diagnose the disease.The final diagnosis depended on alveolar wash through bronchofibroscope.Via adjusting the dose of immunodepressive,taking SMZ-TMP,breathing oxygen,and supportive treatment,the 13 patients were all rehabilitation discharge.Conclusion Pneumocystis carinii pneumonia is one serious pulmonary infectious diseases threatening the survival of the patients after kidney transplantation.The infection often occurres during excessive immune suppression,and leads to ARDS without treatment in time,threatens the survival of the patients.SMZ-TMP is efficacious to this disease.