摘要
目的 :总结肾移植术后巨细胞病毒 (CMV)肺炎并发急性呼吸窘迫综合征 (ARDS)患者的临床特点 ,为此类患者的进一步防治提供参考。 方法 :回顾近 3年肾移植术后CMV肺炎并发ARDS的患者共 32例 ,对其一般情况、治疗措施以及临床转归进行总结分析。 结果 :32例术后确诊CMV肺炎患者 ,均符合 1992年美欧ARDS专题会议ARDS诊断标准 ,其中 31例发生在术后 2～ 4个月 ,16例曾发生过急性排斥反应 (AR) ,14例因AR接受过激素冲击治疗 ,冲击治疗后CMV肺炎并发ARDS的发生率显著高于同期未冲击者。入院时外周血CD4 + 、CD8+ 细胞计数及其比值均显著降低。救治措施包括合理应用抗生素抗感染、撤减免疫抑制剂重建免疫功能、适时使用机械通气、支持治疗 ,并辅以连续性高容量血液滤过 (CVVHF)治疗 ,治疗好转出院者 2 0例 ,死亡 12例 ,其中 5例属于自动出院后死亡 ,2例死于肝功能衰竭 ,抢救成功率为 6 2 .5 0 %。 结论 :肾移植术后CMV肺炎并发ARDS集中在术后 2～ 4个月发病 ,因AR接受激素冲击治疗显著增加其发生率 ,此类患者救治困难 ,死亡率高 ,采用包括抗感染、重建免疫功能、适时机械通气。
Objective:Cytomegalovirus (CMV) pneumonia accompanied by acute respiratory distress syndrome (ARDS) is a life-threatening complication in transplantation, and also an important factor affecting the near term prognosis of renal allograft recipients. No satisfactory strategy has ever come to a consensus in clinical setting of renal transplantation. In this study, we reported an aggressive systematic strategy that we are practicing in our clinic for the treatment of renal allograft recipients who developed cytomegalovirus (CMV) pneumonia and ARDS. Methodology:Thirty-two patients out of the 341 cadaveric renal transplant recipients were diagnosed as CMV pneumonia and ARDS, during a period of (84.61±21.25) days after renal transplantation. All the 32 patients were treated with an aggressive systematic strategy, include reasonable use of antibiotics, withdrawal immunosuppressant drugs and rebuilt the body's immunity function, timely application of mechanic ventilator, and continuous high volume hemofiltration (CVVHF). The clinical responses of the 32 patients were reviewed retrospectively. Results:Fourteen of 32 patients received additive methylprednisolone pulse therapy for developed acute rejection episodes after transplantation. This percentage is significantly higher than those patients without CMV infection (p<0.05). Of the 32 patients, 20 patients survived with a survival rate of 62.50%, the highest ever reported in this area( in China). In the 12 deceased patients, 5 died of ARDS, 2 of liver failure, and the other 5 died after uncompleted salvage therapy for social or financial reasons. Conclusion:CMV infection accompanied by ARDS usually developed during the 2 nd to 4 th month after transplantation. Acute rejection and followed methylprednisolone pulse therapy significantly increase the incidence of CMV infection accompanied by ARDS. Our aggressive systematic strategy include reasonable use of antibiotics, withdrawal of immunosuppressant and rebuilding of immunity, early application of mechanic ventilat, and CVVHF. Our experience of the strategy improved the outcome of 32 patients with CMV infection accompanied with ARDS.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2004年第2期141-145,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
