肾移植术后巨细胞病毒性肺炎并发急性呼吸窘迫综合征中治疗方案分析

目的 探讨有创通气治疗、有创-无创通气治疗方案在肾移植术后巨细胞病毒性肺炎并发急性呼吸窘迫综合症（acute respiratory distress syndrome,ARDS）治疗中的应用价值.方法 将50例肾移植术后巨细胞病毒性肺炎并发ARDS患者随机分为两组,以接受常规有创通气治疗者为对照组,以接受有创-无创通气治疗者为观察组,每组25例,对比两组临床治疗效果.结果 两组治疗前动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、动脉血Ph值（Ph）、心率（HR）及收缩压（SBP）比较无统计学意义（P＞0.05）,观察组治疗后死亡率明显低于对照组（P＜0.05）.经治疗7天后,两组以上指标均明显改善（P＜0.05）,两组改善程度比较无统计学意义（P＞0.05）.但观察组的首创通气时间、总通气时间、ICU住院时间及肺炎治疗时间均明显低于对照组（P＜0.05）.结论 有创-无创通气治疗方案可显著降低肾移植术后巨细胞病毒性肺炎并发ARDS患者死亡率,改善患者临床治疗效果,并可降低通气相关并发症.

Analysis of syndrome and treatment of cytomegalovirus pneumonia complicated with acute respiratory distress after renal transplantation

Objective To explore the different therapeutic schemes in kidney transplantation with cytomegalovirus pneumonia and acute respiratory distress syndrome （ARDS）,and to study the application value.Methods 50 cytomegalovirus pneumonia in renal transplant recipients with ARDS were randomly divided into two groups,to accept the conventional invasive mechanical ventilation treatment for the control group,to accept the invasive and non-invasive ventilation in the treatment as the observation group,25 cases in each group.The clinical curative effect were compared between these two groups.Results The mortality rate of the observation group after treatment was significantly lower than the control group （P 〈 0.05）.These two groups before treatment,arterial partial pressure of oxygen （PaO2）,arterial partial pressure of carbon dioxide （PaCO2）,arterial blood Ph （Ph）,heart rate （HR） and systolic blood pressure （SBP） showed statistical significance （P 〈 0.05） 7 days later,after treatment,two groups of above indexes were significantly improved （P 〈0.05）,there was no significant difference between the two groups （P 〈 0.05） in the degree of improvement.But in the observation group,invasive ventilation time,total duration of ventilation,ICU stay and pneumonia treatment time were significantly lower than the control group （P 〈 0.05）.The observation group ventilation associated complication is also significantly lower than the control group （P 〈 0.05）.Conclusions invasive and non-invasive ventilation treatment can significantly reduce the renal transplant recipients with cytomegalovirus pneumonia complicated with mortality in ARDS patients,improve the clinical treatment effect,and reduce the ventilation associated complication.