肾移植术后合并重症肺炎的临床救治(附9例临床分析)

目的 探讨肾移植术后重症肺炎的临床特点及中西医结合诊治的初步疗效。方法 回顾性总结9例肾移植术后患并发肺炎的发病时间，发热热型、程度及持续的时间，伴随症状，肺部的体征，胸部X线及病原学特点，激素使用的时机、剂量和使用方法及中西医结合综合治疖。结果 全组患以稽留高热为主，持续两周以上长程发热6例，伴进行性呼吸窘迫6例。肺部体征以双肺呼吸音粗为主(7例)，伴肺内少量干、湿罗音(2例)。胸片初期为肺问质病变(7例)，迅速进展为双肺弥漫性中高密度斑片状阴影(9例)，合并气胸1例。全组患均存在低氧血症，7例并发急性呼吸窘迫综合征(ARDS)，1例并发急性肺损伤(ALI)，1例为单纯低氧血症。病原学检查巨细胞病毒(CMV)抗体阳性6例，腺病毒(ADV)抗体阳性5例，EB病毒(EBV)抗体阳性3例，绿脓杆菌6例次，阴沟肠杆菌2例次，洛菲不动杆菌1例次，嗜麦芽窄食单孢菌1例次，白色念珠菌2例次。本组5例患采用经鼻高频喷射给氧，完全纠正低氧血症的时间为3—5d，平均4d。本组9例患，治愈7例，成功率77．8％，死亡2例，死亡率为22．2％。结论 肾移植术后患并发肺炎的临床特点为长期难治性发热，一般超过两周。可迅速发展为ALI／ARDS。病原以CMV病毒及革兰阴性菌为主，治疗宜尽早使用高效、广谱、足量的抗细菌和抗病毒、抗真菌的“三联”治疗。高频通气、适当使用激素和中西医结合综合治疗为治疗本症的有效方法。

The clinical features and the therapeutic efficacy of pneumonia in renal transplant recipients

Objective Pneumonia in renal transplant recipients is associated with very high mortality. The aim of this study was to investigate the clinical features and therapeutic efficacy of the combination of traditional Chinese medicine with western medicine. Methods A retrospective analysis was made in 9 patients with pneumonia after renal transplantation. The clinical data of patients was collected from Jan. 2002 to Dec. 2002. The types and duration of fever, clinical manifestation and chest X- ray, pathogens and principle treatments were analyzed respectively. Results The pneumonia occurred frequently during the second to fifth month (77%) after renal transplantation. The persistant high fever (66%) was common. Seven cases (77.8%) complicated with ARDS. The most common pathogens were gram - negative bacilli (10/12 cases) and CMV (6/9cases) . After treatment with the combination of traditional Chinese medicine with western medicine, 7 cases recovered and 2 cases died with mortality 22.2% . Conclusion Post - renal transplantation pneumonia is severe complication with high mortality. Most patients frequently develop to ARDS. The majority of infections were gram - negative bacilli and CMV. Emergency care and combined therapy should be given as soon as possible. Powerful anti - infection and correcting hypoxia and treatment with traditional Chinese medicine were effective for decreasing mortality.