肾移植后的重症肺炎

背景：肾移植后重症肺炎发生率高,死亡率高,对其进行早期诊断及治疗具有重要意义。 目的：分析呼吸重症监护室收治的肾移植后重症肺炎患者的临床特点、病情及预后,以提高其早期诊断率及治愈率。 方法：对2004年1月至2012年9月郑州人民医院呼吸重症监护室收治的28例肾移植后出现重症肺炎的患者进行回顾性调查分析,总结其临床特点。应用急性生理学与慢性健康状况评分Ⅱ、英国胸科协会改良肺炎评分对患者病情进行评估,并给予适当的治疗。 结果与结论：28例患者重症肺炎感染发生在肾移植后3-8个月,普遍应用免疫抑制剂的剂量较大;主诉有呼吸急促、干咳、胸闷、发热。血浆白蛋白下降明显,动脉血气分析均为低氧血症,低二氧化碳血症,动脉血氧饱和度进行性下降。胸部CT示肺部广泛渗出阴影。停用免疫抑制药物,并给予广谱抗感染药物、甲基泼尼松龙及无创呼吸机治疗后,治愈24例、好转2例、死亡2例。治疗期间患者肝、肾功能无恶化。提示肾移植后免疫抑制过度是并发重症肺炎的高危因素;重视体温监测,活动后气促及不明原因血清白蛋白下降有助于早期诊断。果断停用免疫抑制剂,并进行抗感染、甲基泼尼松龙及恰当无创呼吸机治疗是治疗成功的关键。

Severe pneumonia after renal transplantation

BACKGROUND:The incidence rate and the mortality of severe pneumonia after renal transplantation are high. So it has great significance to early diagnosis and treatment of severe pneumonia. OBJECTIVE:To analyze the clinical characteristics, pathogenetic condition and prognosis of severe pneumonia patients after renal transplantation treated in respiratory intensive care unit, in order to improve the early diagnosis rate and cure rate. METHODS:Twenty-eight severe pneumonia patients after renal transplantation treated in the respiratory intensive care unit of Zhengzhou People’s Hospital from January 2004 to September 2012 were investigated retrospectively, and the characteristics were summarized. The pathogenetic condition of the patients was evaluated with Acute Physiology and Chronic Health Evaluation Ⅱ and British Thoracic Society Modified Pneumonia score CURB-65, and the patients were treated appropriately. RESULTS AND CONCLUSION:The severe pneumonia infection in 28 patients occurred at 3-8 months after renal transplantation and most of the patients received larger immunosuppressant doses. The patients complaint of tachypnea, dry cough, chest tightness and fever. The plasma albumin of the severe pneumonia patients was significantly decreased; the arterial blood gas analysis showed the hypoxemia and low hypercapnia, and the arterial oxygen saturation was gradually decreased. Chest CT showed that there was shadow secretion in the lung. Then the patients disable the immunosuppressive drugs, combined with anti-infection treatment and non-invasive ventilator, finding that 24 patients were cured, two patients were improved and two patients were dead. The liver function and renal function of patients were progression-free during treatment. Excessive immunosuppression after renal transplantation is the risk factor for severe pneumonia; great importance to the monitoring the body temperature after the event, shortness of breath and unexplained serum albumin decreasing are benefit to the early diagnosis. Decisively disable the immunosuppressive drugs combined with the broad-spectrum anti-infective drugs, methyl prednisolone and non-invasive ventilation therapy are the key to the successful treatment.