肝移植后肺部细菌合并真菌感染的诊治

背景：肝移植患者因常规服用免疫抑制剂,免疫力低下,极易发生肺部病原微生物感染。目的：回顾分析1例肝移植后突发肺部细菌联合真菌感染患者诊疗经过,总结相关临床治疗经验。方法：1例乙肝肝硬化失代偿期女性患者行同种异体原位肝移植后8个月余突发畏寒高热入院,经实验室检查结合胸部CT检测考虑为细菌引起的肺部感染,给予头孢哌酮钠舒巴坦钠抗菌治疗。结果与结论：治疗后临床症状缓解。1周后复查胸部CT提示：双肺下叶片状渗出较前有所吸收,但背段出现片状＂毛玻璃样改变＂,考虑合并真菌感染,停用头孢哌酮钠舒巴坦钠,改用氟康唑针,治疗1周后行胸部CT：双肺下叶背段渗出较前吸收,出院继续口服氟康唑10d,复查CT：双肺渗出性改变完全吸收。

Diagnosis and treatment of bacterial and fungal pneumonia following liver transplantation

BACKGROUND： Liver transplant patients prone to lung infections of pathogenic microorganismsdue due to low immunity caused by taking routinei mmunosuppressive drugs. OBJECTIVE： To retrospectively analyze the diagnosis and treatment of one patient with bacterial combined with fungal pulmonary infection after orthotopic liver transplantation, and summarize the clinical treatment experience. METHODS： The female patient with hepatic B cirrhosis decompensation was admitted for fever, chilly, cough and dyspnea at 8 months after allogenic orthotopic liver transplantation. CT showed exudation of lobus inferior pulmonis. Cefoperazone /sulbactam sodium was given to eliminate bacterial infection. RESULTS AND CONCLUSION： After treatment, clinical symptoms were alleviated. One week later, chest CT showed that lobus inferior pulmonis exudation was absorbed compared with pretreatment, but the ＂ground glass＂ change of lungs was observed, which suggested fungous infection. Then fluconazole was used. At the end, the patient was cured and discharged.