CAJ | 학술논문

目的探讨肾移植术后重症肺部感染的原因、特点及救治措施,以提高人肾存活率.方法分析总结2009年1月至2012年8月收治的24例同种异体尸肾移植术后重症肺部感染患者的临床资料. 结果 24例患者中细菌感染8例,先后以静脉注射头孢哌酮/他唑巴坦和美罗培南治疗；巨细胞病毒感染3例,予静脉注射更昔洛韦治疗；真菌感染2例,静脉应用伊曲康唑或两性霉素B脂质体治疗；结核杆菌感染1例,口服四联抗结核药物治疗；混合感染5例,分别为巨细胞病毒+细菌混合感染(3例),白念珠菌+细菌(1例)、卡氏肺囊虫+细菌(1例),依病原体类型,静脉联合用药；5例未获得病原学依据,根据影像学特点,予经验性联合用药抗感染治疗.24例患者予面罩吸氧或气管插管辅助通气纠正低氧血症、减少免疫抑制剂用量,并静脉应用丙种球蛋白提高免疫力等综合治疗.24例患者中治愈19例,临床治愈并继续抗结核治疗1例；死亡4例,其中移植肾带功死亡2例,移植肾失功死亡2例. 结论肾移植术后重症肺部感染患者病情凶险,进展迅速,易导致患者死亡.尽早明确病原体,果断及时采取抢救措施是救治成功的关键.
목적 탐토신이식술후중증폐부감염적원인、특점급구치조시,이제고인신존활솔.방법 분석총결2009년1월지2012년8월수치적24례동충이체시신이식술후중증폐부감염환자적림상자료. 결과 24례환자중세균감염8례,선후이정맥주사두포고동/타서파탄화미라배남치료；거세포병독감염3례,여정맥주사경석락위치료；진균감염2례,정맥응용이곡강서혹량성매소B지질체치료；결핵간균감염1례,구복사련항결핵약물치료；혼합감염5례,분별위거세포병독+세균혼합감염(3례),백념주균+세균(1례)、잡씨폐낭충+세균(1례),의병원체류형,정맥연합용약；5례미획득병원학의거,근거영상학특점,여경험성연합용약항감염치료.24례환자여면조흡양혹기관삽관보조통기규정저양혈증、감소면역억제제용량,병정맥응용병충구단백제고면역력등종합치료.24례환자중치유19례,림상치유병계속항결핵치료1례；사망4례,기중이식신대공사망2례,이식신실공사망2례. 결론 신이식술후중증폐부감염환자병정흉험,진전신속,역도치환자사망.진조명학병원체,과단급시채취창구조시시구치성공적관건.
Objective To summarize the causes,features and treatments of severe pulmonary infection (PI) in kidney transplant (KT) recipients for improved outcomes.Methods Clinic data for 24 KT recipients with severe PI were analyzed between Jan 2009 and Aug 2012.Results Eight patients were in fected with bacteria,intravenous Cefoperazone/Tazobactam and Meropenem were administered to these patients; 3 were diagnosed with cytomegalovirus (CMV) infection,and intravenous ganciclovir was given therefore.Two were infected by fungus,and was treated with Itraconazole or Amphotericin B.Oen was diagnosed with Mycobacterium tuberculosis,and was treated with oral quadruple anti-tuberculosis drugs; 5 were infected with mixed pathogens:3 CMV and bacterium,1 Candida albicans and bacterium,and 1 Casparian pneumocystis and bacterium.The treatment for these 5 patients were combined regimens.Five cases were diagnosed with severe PI with unknown pathogens.Mask oxygen inhalation/mechanical ventilation for hypoxemia,immunosuppressant reduction and intravenous immunoglobulin were all applied for 24 patients.19 of 24 patients were completely cured,1 obtained clinical remission with continuous oral anti-tuberculosis drugs,2 were dead with functioning grafts and 2 were dead after graft loss.Conclusions Severe PI after KT is an important complication with rapid progression and poor outcomes.The keys to successful rescue for severe PI are identification for the pathogens and prompt treatment after diagnosis.