中国感染与化疗杂志
中國感染與化療雜誌
중국감염여화료잡지
CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
2009年
4期
260-263
,共4页
秦燕%张芳%刘永%范昱%包尔敦%邱建新%郭义峰%祝捷%刘志宏%沈兵%龚华%王泳
秦燕%張芳%劉永%範昱%包爾敦%邱建新%郭義峰%祝捷%劉誌宏%瀋兵%龔華%王泳
진연%장방%류영%범욱%포이돈%구건신%곽의봉%축첩%류지굉%침병%공화%왕영
肾移植%肺部感染%巨细胞病毒%真菌
腎移植%肺部感染%巨細胞病毒%真菌
신이식%폐부감염%거세포병독%진균
renal transplantation%pulmonary infection%cytomegalovirus%fungus
目的 探讨肾移植后不同时期肺部感染的临床表现、病原学特点和治疗策略,以提高肾移植后肺部感染患者的存活率.方法 回顾性分析2003年1月-2008年7月于我院因肺部感染住院患者61例.按照肺部感染发病距肾移植手术时间将患者分为两组:近期感染组(术后≤12个月);远期感染组(术后>12个月).分析并比较两组患者在病原学、临床表现、治疗、病程和转归等方面的特点.结果 43例近期感染病例多表现为发热、胸闷气促,影像学表现为两肺弥漫间质性改变,病原体以巨细胞病毒和真菌较多见,常需抗病毒、真菌、细菌综合治疗,并及早使用机械辅助通气.18例远期肺部感染病例有肺部体征和咳嗽、咳痰症状,影像学表现单侧局限改变,但合并心脏、胃肠道并发症较多见,有并发症者病死率较高. 结论 肺部感染是肾移植术后的严重并发症和主要死亡原因之一.肾移植术后远、近期发生的肺部感染在病因、临床特点及转归等方面各有其特点.据此,早期积极取得病原学证据、针对病因施治、预防并发症、积极治疗合并症可能有助于提高肾移植患者的预后.
目的 探討腎移植後不同時期肺部感染的臨床錶現、病原學特點和治療策略,以提高腎移植後肺部感染患者的存活率.方法 迴顧性分析2003年1月-2008年7月于我院因肺部感染住院患者61例.按照肺部感染髮病距腎移植手術時間將患者分為兩組:近期感染組(術後≤12箇月);遠期感染組(術後>12箇月).分析併比較兩組患者在病原學、臨床錶現、治療、病程和轉歸等方麵的特點.結果 43例近期感染病例多錶現為髮熱、胸悶氣促,影像學錶現為兩肺瀰漫間質性改變,病原體以巨細胞病毒和真菌較多見,常需抗病毒、真菌、細菌綜閤治療,併及早使用機械輔助通氣.18例遠期肺部感染病例有肺部體徵和咳嗽、咳痰癥狀,影像學錶現單側跼限改變,但閤併心髒、胃腸道併髮癥較多見,有併髮癥者病死率較高. 結論 肺部感染是腎移植術後的嚴重併髮癥和主要死亡原因之一.腎移植術後遠、近期髮生的肺部感染在病因、臨床特點及轉歸等方麵各有其特點.據此,早期積極取得病原學證據、針對病因施治、預防併髮癥、積極治療閤併癥可能有助于提高腎移植患者的預後.
목적 탐토신이식후불동시기폐부감염적림상표현、병원학특점화치료책략,이제고신이식후폐부감염환자적존활솔.방법 회고성분석2003년1월-2008년7월우아원인폐부감염주원환자61례.안조폐부감염발병거신이식수술시간장환자분위량조:근기감염조(술후≤12개월);원기감염조(술후>12개월).분석병비교량조환자재병원학、림상표현、치료、병정화전귀등방면적특점.결과 43례근기감염병례다표현위발열、흉민기촉,영상학표현위량폐미만간질성개변,병원체이거세포병독화진균교다견,상수항병독、진균、세균종합치료,병급조사용궤계보조통기.18례원기폐부감염병례유폐부체정화해수、해담증상,영상학표현단측국한개변,단합병심장、위장도병발증교다견,유병발증자병사솔교고. 결론 폐부감염시신이식술후적엄중병발증화주요사망원인지일.신이식술후원、근기발생적폐부감염재병인、림상특점급전귀등방면각유기특점.거차,조기적겁취득병원학증거、침대병인시치、예방병발증、적겁치료합병증가능유조우제고신이식환자적예후.
Objective To investigate the clinical features and prognosis of pulmonary infection at different stages after renal transplantation.Methods Medical records of 61 patients with pulmonary infection after renal transplantation from January 2003 to July 2008 in our hospital were reviewed in this retrospective study. According to stages of infection onset, we divided all patients into two groups, early onset group (43/61, 70.5%, ≤12 months after transplantation) and late onset group (18/61, 29.5%, >12 months after transplantation). Clinical manifestations and prognosis were compared between the two groups.Results In the early onset group, the radiographic manifestation suggested diffuse interstitial changes of bilateral lungs. Combination of anti-infective therapy and early mechanical ventilation was preferred. While in the late onset group, unilateral pulmonary lesions were seen in most cases. More patients showed cardiac and gastrointestinal complications in this group, the mortality of which was much higher. Conclusions Pulmonary infection is a major complication of renal transplantation. The etiology, clinical characteristics and prognosis of infection varies with the stage after transplantation. Effective preventive and therapeutic measures should be applied more vigorously in patients with pulmonary infection, especially early onset ones.
