摘要
目的收集并分析本院ICU收治的32例肾移植术后并发重症耶氏肺孢子菌肺炎(PJP)患者的临床资料,探讨其危险因素及临床特征,以寻找更有效的临床治疗策略。方法回顾性分析2022年1月至2025年2月期间本院ICU收治的32例肾移植术后并发重症PJP的患者,所有患者均接受有创机械通气治疗。对其危险因素、治疗方案及预后进行统计学分析。结果单因素分析,在肾移植术后发生重症PJP的患者中,高龄(t=-2.595,P=0.021)和低淋巴细胞计数(t=12.500,P=0.037)的患者死亡率更高。多因素Logistic回归分析显示,气管切开(OR=0.240,95%CI:0.012~0.895,P=0.048)和液体负平衡管理(OR=0.052,95%CI:0.023~0.842,P=0.040)为肾移植术后重症PJP患者死亡的保护因素。高龄(OR=11.589,95%CI:1.196~9.120,P=0.035)和低淋巴细胞计数(OR=17.286,95%CI:2.092~38.156,P=0.043)是患者死亡的独立危险因素。结论对于肾移植术后并发重症PJP需要有创通气的患者,实现液体负平衡管理和早期行气管切开有助于提高救治成功率。
Objective The clinical data of 32 patients with severe Pneumocystis jirovecii pneumonia(PJP)after kidney transplantation who were admitted to the intensive care unit(ICU)of our hospital were collected and analyzed to explore the risk factors and clinical characteristics,in order to find more effective clinical treatment strategies.Methods A retrospective analysis was performed on 32 kidney transplant recipients with severe PJP who were admitted to the ICU of our hospital between January 2022 and February 2025.All patients required invasive mechanical ventilation.Statistical analysis was performed on their risk factors,treatment modalities,and outcomes.Results Univariate analysis showed that in patients with severe PJP after kidney transplantation,those with advanced age(t=-2.595,P=0.021)and low lymphocyte count(t=12.500,P=0.037)had a higher mortality rate.Multivariate Logistic regression analysis revealed that tracheotomy(OR=0.240,95%CI:0.012-0.895,P=0.048)and fluid negative balance management(OR=0.052,95%CI:0.023-0.842,P=0.040)were protective factors for the death of patients with severe PJP after kidney transplantation.Advanced age(OR=11.589,95%CI:1.196-9.120,P=0.035)and low lymphocyte count(OR=17.286,95%CI:2.092-38.156,P=0.043)were independent risk factors for patient death.Conclusion For patients with severe PJP after kidney transplantation who require invasive ventilation,achieving negative fluid balance management and early tracheotomy can help improve the success rate of treatment.
作者
李冲
张富祥
吕振平
赵倩楠
张玉可
张建宁
LI Chong;ZHANG Fuxiang;LU Zhenping;ZHAO Qiannan;ZHANG Yuke;ZHANG Jianning(Department of RICU,the First Affiliated Hospital of Shandong First Medical University,Jinan,Shandong 250014,China)
出处
《临床肺科杂志》
2026年第1期25-29,共5页
Journal of Clinical Pulmonary Medicine
基金
山东省医药卫生科技发展计划(202003021296)。
关键词
肾移植术
重症耶氏肺孢子菌肺炎
有创机械通气
Renal transplantation
Severe pneumocystis jirovecii pneumonia
Invasive mechanical ventilation
