摘要
目的 :总结肾移植患者合并严重肺部感染的临床诊断与救治。 方法 :对 35 7例次肾移植术后感染者中的 45例严重肺部感染进行回顾性分析。 结果 :①经积极抢救治疗后 37例治愈 ,8例死亡。②术后 3个月内的严重感染发生例数占所有严重感染病例的 5 7 8% (2 6 / 45 ) ,术后半年内为 95 6 % (43/ 45 ) ,所有因感染死亡者皆为术后 1年内 ,1年后所出现的严重感染经治疗后皆获得治愈。③ 35例可检出病原微生物者中 ,能检出并证实有细菌感染者 30例次 ,真菌感染 14例次 ,巨细胞病毒 (CMV)病 12例次 ,结核病 9例次。 15例为单纯性感染 ,2 0例为混合感染。④病原学诊断手段包括 :血、尿、痰、咽拭子、中段尿的细菌与真菌培养 ;痰、脓液及其它分泌物的涂片检查 ;血CMVIgM、IgG检测 (PCR法 ,ELISA法 )、CMV抗原血症检测 ;血与尿的TB检测 (PCR法 )、血沉、OT与PPD试验。⑤救治中应将此类患者列为急诊与急救范畴 ,可在ICU病房内监护与治疗 ,其措施包括 :根据经验有侧重地选择抗生素、联合选用广谱抗生素 ,根据检查结果及时调整抗生素 ;对免疫抑制剂的剂量与种类作必要的调整 ,必要时停止使用免疫抑制剂 ;全身支持治疗 ,特别是纠正低氧血症、低蛋白血症与粒细胞缺乏症 ,适时使用呼吸机支持与改善通气。 结论 :肾?
Objective:To study the diagnosis and treatment of the severe pulmonary infections after renal transplantation. Methodology:A retrospective analysis was made on 45 severe pulmonary infection cases among 357 patients with other various infectious diseases.The bacteria and fungus were tested by cultures of blood,urine,expectoration,pharynx swab,smear of sputum,purulent and other secretions from body cavity.CMV IgG,IgM antibodies and antigen from blood samples were detected by the methods of PCR and/or ELISA assay.The evaluations of TB antibody in blood and urine were determined by using PCR assay.Erythrocyte sedimentation rate(ESR),OT and PPD tests were also examined by routine methods.The diagnosis of the patients with severe lung infection was based on the clinical informations,laboratory results and chest X ray examinations.The principles of treatment were selecting wide spectrum based on experiences,and to making adequate adjustment on time according to the examination results. Results:①After life supporting managements and anti infection treatment,37 patients recovered,while 8 died.②57 8%(26/45)of patients with severe infections happened in 3 months after renal transplantation and 95 6%(43/45)in 6 months.All patients with severe infection died in the first year after surgery,however,the patients suffering from infection living more than one year after renal transplantation were all cured.③microorganisms coued be detected in 35 cases,42 9%(15/35)of the patients suffered from one organism discovered,and 57 1%(20/35)caused by mixed infection.The infection was caused dominantly by germs in 30 cases;fungus 14 cases;CMV 12cases;and TB in 9 cases.④The adjestment of the dosage and immunoinhibitants or disconfinueing the immunoinhibitants application was necessary.To use the support therapy in accordance with the functional signs of circulation and respiration sys
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2001年第2期106-109,共4页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
肾移植
肺部感染
诊断
治疗
renal transplantation lung infection diagnosis
