摘要
目的 :对肾移植并发严重肺部感染的诊断与治疗方法进行研究。方法 :对住院治疗的 32例肾移植术后严重肺部感染者的临床资料进行回顾性分析。结果 :① 2 6例治愈 ,6例死亡。②支气管肺泡灌洗的病原体检出率为 74 % (2 0 / 2 7) ,血培养结合痰、咽拭子培养病原体检出率为 4 7% (15 / 32 ) ,二者比较差异有统计学意义 (P <0 .0 5 )。③感染发生时间为术后 2周～ 11年。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 35 %(11/ 32 ) ,术后半年内为 72 % (2 3/ 32 ) ,最长者为术后 11年发病。④治疗措施包括早期根据经验应用抗生素 ,根据检查结果及时调整抗生素 ;大胆减用免疫抑制剂 ,必要时停止应用免疫抑制剂 ;病情危重 ,免疫功能极低者可使用免疫增强剂 ;对肺渗出者应用皮质类固醇。结论 :肾移植术后并发严重肺部感染者病情危重 ,死亡率高 ,应早期应用肺泡灌洗检查病原体 ,反复胸片检查 ,应用抗生素并及时调整抗生素 ,早期减用或停用免疫抑制剂 ,并可应用免疫增强药物胸腺肽及干扰素 ,对肺渗出者应用皮质类固醇。
Objective:To introduce our experence in diagnosis and treatment of severe pulmonary infections in kidney transplant recipients. Methods:A retrospective analysis was made on 32 severe pulmonary infections cases in our center between 2000-2002 years . Results:① 26 patients recovered,the mortality rate was 18.8%( 6/32).②Bronco-alveolar-lavage(BAL) alone established a diagnosis in 20 of 27, is remarkable higher than diagnosis by culture of pharynx swab combined sputum (P< 0.05). ③The severe pulmonary infections happened between 2 weeks to 11years after renal transplantation. 11/32 of patients in 3 months and 23/32 in 6 months . ④The treatment protocol consisted of the immediate empirical administration antibiotics and reduction or discontinuance of the immunosuppressive therapy .the drug for immune function enhancement can be used in patients with severely hypo-immune function. The methylprenisolone is administered in patients with infiltration chest X-ray. Conclusions:The pulmonary infections is a severe complication in renal transplantation recipients. A combination of early detection of the responsible pathogen by BAL,aggressive reduction or discontrnuance of the immunosupressive therapy , and the immediate empirical administration of antibiotics is effctive strategies to treat pneumonia in kidney transplantation recipients.
出处
《临床泌尿外科杂志》
2004年第11期670-672,共3页
Journal of Clinical Urology
关键词
肾移植
肺部感染
支气管肺泡灌洗液
Kidney transplantation
Pulmonary infections
Bronchoalveolar lavage fluid
