摘要
目的:探讨肾移植术后近期(术后4个月内)肺部感染并急性呼吸窘迫综合征(ARDS)的临床表现、病原体、综合治疗及转归。方法:回顾性分析21例肾移植术后肺部感染并ARDS患者的临床资料,分析其综合处理手段及救治成功原因。结果:肾移植术后近期肺部感染临床表现无特异性,病原体在病初主要为巨细胞病毒,稍后以阴性杆菌为主,病程后期多为混合感染。主要临床表现为发热、咳嗽、气促或紫绀,早期仅5例可闻及肺部湿啰音,全部病例早期X片或CT示双肺受累,表现为间质性改变,18例最终发展为"白肺",经积极综合处理后所有患者治愈。结论:果断停用免疫抑制剂,营养支持,尽早呼吸机辅助呼吸,合理抗生素及激素使用等综合处理是救治成功的关键,以停用所有免疫抑制剂最为重要。
Objective：To study the clinical manifestation,pathogen,colligated therapy and find result of patients with acute respiratory distress syndrome（ARDS）caused by severe lung infection early after renal transplantation.Methods：To review 21 post-operation recipients who received renal transplantation and got pulmonary infection leading to ARDS,to analysis the methods of treatment and the cause of success.Results：The clinical manifestation of patients with severe pulmonary infection early after renal transplantation was atypical.At the early stage,cytomagalovirus accounted for most of pulmonary infection recently after renal transplantation.However,mixed infection played main role in pulmonary infection at later peroid.All 21 patients had the clinical manifestation of fever,cough,short breath or cyanosis.All of them had the chest-X-ray or CT manifestation of matrix change at early stage,among 18 patients finally developped to ＂white lungs＂.All of them recovered after colligated therapy.Conclusion：Stopping the use of immunosuppressants,nutritional support and taking mechanical ventilation as soon as possible were of the most importance among the colligated therapy.
出处
《中日友好医院学报》
2010年第5期281-285,F0003,共6页
Journal of China-Japan Friendship Hospital
关键词
肾移植
肺部感染
急性呼吸窘迫综合征
病原体
renal transplantation
pulmonary infection
acute respiratory distress syndrome
pathogen
