摘要
目的分析肾移植术后肺部感染所致急性呼吸窘迫综合征(ARDS)患者的临床特征,并探讨其预防控制措施,以便为临床提供参考。方法选择本院2016年1月至2019年1月收治的肾移植术后肺部感染所致ARDS患者50例作为研究对象,纳入对象有完整资料进行回顾性分析,总结临床特征与预防控制措施。结果肾移植术后3~6个月是肺部感染所致ARDS高发时期,以发热为主要症状,严重情况下会有气急、胸闷、呼吸困难等;早期胸片检查可见双肺纹理增粗与肺野少许斑块影,CT扫描可见双侧下肺纹理增多,并有毛玻璃状与网格状间质改变;感染病原菌以真菌、病毒为主;经过积极的综合治疗后,存活34例、死亡16例,分析死亡原因发现早期死亡主要是多器官功能不全,晚期死亡则主要是医院获得性耐药菌感染与真菌感染所致呼吸衰竭。结论肾移植术后3~6个月内容易发生肺部感染所致ARDS,死亡率较高,以真菌、病毒感染为主,为此应合理调整免疫抑制剂方案,积极做好抗感染,以及予以肾上腺糖皮质激素处理,有条件下加用无创机械通气处理,能为患者康复争取时间。
Objective To analyze the clinical characteristics of patients with acute respiratory distress syndrome(ARDS)caused by lung infec tion after renal transplantation and to explore the preventive measures for clinical reference.Methods 50 patients with ARDS after renal transplanta tion admitted to our hospital from January 2016 to January 2019 were selected for study.The subjects included in the study had complete data,their data were analyzed retrospectively,and clinical features and preventive measures were summarized.Results 3 to 6 months after kidney transplanta tion is a high incidence of ARDS caused by lung infection.Fever was the main symptom,and in severe cases,they had shortness of breath,chest tightness,and dyspnea.Early chest examination showed that the lung texture was thickened and there were a few patches in the lung field.CT scans showed increased lung texture on both sides,and there were hairy glassy and grid-like interstitial changes.Infected pathogenic bacteria are mainly fungi and viruses;after active comprehensive treatment,34 patients survived and 16 died.Analysis of the causes of death revealed that early death was mainly multi-organ insufficiency,and late death was mainly caused by hospital acquired drug-resistant infections and fungal infections.Conclusion After renal transplantation,ARDS is prone to lung infection within 3 to 6 months.Its mortality rate is high,and caused by fungal and vi ral infections.Therefore,it is necessary to reasonably adjust the immunosuppressant program,actively do anti-infection,and give adrenal glucocorti coids.The use of non-invasive mechanical ventilation treatment can gain time for patients to recover.
作者
于洋
Yu Yang(Internal Medicine,Liaoning Province Occupational Disease Prevention and Control Institute,Fushun,Liaoning,113001,China)
出处
《当代医学》
2020年第7期26-28,共3页
Contemporary Medicine
关键词
肾移植
术后肺部感染
急性呼吸窘迫综合征
临床特征
预防控制
Kidney transplantation
Postoperative lung infection
Acute respiratory distress syndrome
Clinical characteristics
Preventive control
