18例肾移植术后肺部混合性感染临床分析

目的 探讨肾移植术后肺部混合感染（MPI）的临床特征与诊治。方法 回顾性分析18例肾移植术后MPI的临床资料。结果二、三、四重感染分别为44．4％、38．9％、16．7％；细菌感染率100％、真菌感染77，8％，MCV感染61％，卡氏肺囊虫病22．2％，结核菌感染11．1％，细菌以革兰性阴性菌为主，真菌以念珠菌为主，14例（77．8％）出现ARDS，院内死亡5例（27．8％），放弃治疗3例（16．7％），院后追踪均死亡；痊愈10例（55．6％）。结论肾移植术后肺部混合感染符合免疫缺陷宿主肺部感染特点，高死亡率可能与早期痛原体检测困难、病原体耐药、患者经济状况有关，早期进行侵袭性肺部检查可能对提高早期病原菌的检出率、降低死亡率有重大意义。

Clinical analysis of mixed pulmonary infections in 18 patients after kidney tranplantation

Objective To analysis the clinical features,diagnosis and treatment of the mixed pulmonary infections(MPI) in kidney transplant recipients. Methods The clinical data of 18 MPI patients post-operation were collected and retrospectively analysed. Results The mixed infection rates of two,three and four pathogens were 44.4%,38.9%,16.7%;the infection rates of bacterium,fungus,cytomegalovirus(MCV),Pneumocystis carinii and tuberculosis were 100%,77.8%,61%,22.2%and 11.1%.Gram-negative bacterium was the main bacteria and cndida was the main fungus.14 cases(77.8%) developed into adult respiratory distress syndrome(ARDS),5 cases(27.8%)died in hospital,3 cases(16.7%) died at home because of economical reason,10 cases(55.6%) were recovered. Conclusion The features of the mixed pulmonary infections in kidney transplant recipients coincide with that of the pulmonary infections in immunocompromised host.The causes of high mortality may be relating to the difficult diagnosis of pathogens early,drug resistance and economic reason.The early invasive procedures may be improve the diagnosis rate of the pulmonary pathogens and decline mortality.