早期强化治疗对肾移植后并发肺炎预后的影响

目的 探讨不同的初始治疗方案对肾移植受者并发肺炎预后的影响.方法 将67例肾移植后并发肺炎的患者按照入院日分为病例组(34例)和对照组(33例),病例组初始治疗方案为亚胺培南/西司他丁+复方磺胺甲噁唑(SMZ/TMP)+更昔洛韦,对照组给予常规治疗.分析各组病死率和住院时间.结果 病例组的病死率为5.9%(2/34),明显低于对照组的18.2%(6/33),住院时间为15 d,也明显少于对照组的23 d,差异均有统计学意义(P＜0.05).非重症肺炎病例中,病例组的病死率(3.4%,1/29)低于对照组(17.2%,5/29,P＜0.05),而住院时间≥21 d的病例(3.4%,1/29)明显少于对照组(37.9%,11/29,P＜0.05).无论患者入院早晚,病例组住院时间≥21 d者均少于相应对照组(P＜0.05).无论病原学诊断明确与否,病例组住院时间≥21 d的病例均少于对照组相应病例(P＜0.05).合并心肺疾病的患者中,病例组住院时间≥21 d的病例少于对照组(P＜0.05).结论 早期强化治疗能改善肾移植后并发肺炎患者的预后.

Effect of initial treatment protocol on prognosis of pneumonia in the kidney transplant recipients

Objective To explore the effects of different initial treatment protocols on the prognosis of pneumonia in the kidney transplant recipients. Methods Sixty-seven cases of pneumonia following kidney transplantation were divided into case group (34 cases) and control group (33 cases).The patients in case group were treated with Imipenem and Cilastatin, SMX/TMP and ganciclovir,and those in control group received routine treatments. Mortality and length of stay in hospital (LOS)were analyzed. Results Mortality (5.9 % ) and LOS (15 days) in case group were reduced as compared with those in control group ( 18. 2 %, 23 days, respectively) (P＜ 0. 05). Among the patients without severe pneumonia, the mortality and incidence of LOS beyond 21 days in case group (3. 4 %, 1/29; 3. 4 %, 1/29) were lower than those in control group (17. 2 %, 5/29; 37. 9 %, 11/29, respectively) (P＜0. 05). Whether the patients were admitted to hospital sooner or later, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05).Whether the etiologies were determined or undetermined, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05). The incidence of LOS beyond 21 days in case group was lower than that in control group among the patients with cardiopulmonary disease (P＜0. 05). Conclusion The initial appropriate treatment would improve the prognosis of pneumonia in the kidney transplant recipients.