肝移植术后重症间质性肺炎的诊治

目的总结肝移植术后重症间质性肺炎的治疗经验。方法回顾性分析2008年5月至2013年10月福州总医院肝胆病中心收治的8例肝移植术后出现重症间质性肺炎患者的临床资料,分析其治疗经过及治疗成功的原因。结果 8例患者出现间质性肺炎的时间为术后1~3个月,均以发热为首发症状,进而表现为进行性低氧血症,胸片提示有明显间质性肺炎表现。经停用免疫抑制剂、使用免疫增强剂、加强抗感染、呼吸支持治疗、控制液体入量和营养支持等治疗后,8例患者临床症状好转,胸片恢复正常,均痊愈出院。结论肝移植术后并发重症间质性肺炎,病情重、发展快,若抢救不及时,病死率高。早期诊断、早期停用免疫抑制剂、使用免疫增强剂、控制液体出入量及营养支持等是提高治愈率的重要因素。

Diagnosis and treatment of severe interstitial pneumonia after liver transplantation

Objective To summarize the experience in the treatment of severe interstitial pneumonia after liver transplantation.Methods A retrospective analysis was made on the clinical data of 8 cases of severe interstitial pneumonia after liver transplantation who were diagnosed and treated from May 2008 to October 2013.Their processes of treatment and reasons for treatment success were analyzed.Results Eight patients appeared with interstitial pneumonia within 1 -3 months after liver transplantation;their first symptoms were fever,followed by pro-gressive hypoxemia;chest X-ray showed significant interstitial pneumonia.After stopping immunosuppressants,using immunostimulants, strengthening anti-infective therapy,respiratory support,controlling fluid intake,and nutritional support,the clinical symptoms of 8 pa-tients were relieved,the chest radiograph returned to normal,and all patients were cured and discharged.Conclusion Severe interstitial pneumonia is a complication of liver transplantation,with severe illness status and rapid progression.If rescue is not timely,it has high mor-tality.Early diagnosis and stopping immunosuppressants,using immunostimulants,controlling liquid intake,and nutritional support are im-portant factors to increase the cure rate.