实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2014年
3期
150-152
,共3页
肾移植%巨细胞病毒%肺炎%急性呼吸窘迫综合征
腎移植%巨細胞病毒%肺炎%急性呼吸窘迫綜閤徵
신이식%거세포병독%폐염%급성호흡군박종합정
Renal transplantation%Cytomegalovirus%Pneumonia%Acute respiratory distress syndrome
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）患者的临床治疗经验，探讨有效的治疗措施。方法回顾性分析本院4年来肾移植术后发生CMV肺炎并发ARDS的患者21例，对其一般情况、治疗措施以及临床转归进行总结分析，给予患者积极的抗病毒治疗，适当减少免疫抑制剂用量，积极进行全身支持疗法，及时采用呼吸机辅助通气等综合治疗措施。结果21例患者中16例治疗有效，3例患者出现呼吸衰竭，经积极治疗无效死亡，2例属于自动出院后死亡。有效率为76.19%，治疗后外周血CMV抗原检测全部转为阴性。16例存活的患者中，12例在病程中出现尿量减少，血清肌酐（SCr）升高，随着感染的控制，肺功能恢复，SCr也逐渐恢复正常；另4例肾功能一直保持正常。结论 CMV肺炎合并ARDS应采取抗病毒、重建免疫功能、适时机械通气、支持治疗为主的综合治疗措施，有助于提高患者的救治成功率。
目的：總結腎移植術後巨細胞病毒（CMV）肺炎併髮急性呼吸窘迫綜閤徵（ARDS）患者的臨床治療經驗，探討有效的治療措施。方法迴顧性分析本院4年來腎移植術後髮生CMV肺炎併髮ARDS的患者21例，對其一般情況、治療措施以及臨床轉歸進行總結分析，給予患者積極的抗病毒治療，適噹減少免疫抑製劑用量，積極進行全身支持療法，及時採用呼吸機輔助通氣等綜閤治療措施。結果21例患者中16例治療有效，3例患者齣現呼吸衰竭，經積極治療無效死亡，2例屬于自動齣院後死亡。有效率為76.19%，治療後外週血CMV抗原檢測全部轉為陰性。16例存活的患者中，12例在病程中齣現尿量減少，血清肌酐（SCr）升高，隨著感染的控製，肺功能恢複，SCr也逐漸恢複正常；另4例腎功能一直保持正常。結論 CMV肺炎閤併ARDS應採取抗病毒、重建免疫功能、適時機械通氣、支持治療為主的綜閤治療措施，有助于提高患者的救治成功率。
목적：총결신이식술후거세포병독（CMV）폐염병발급성호흡군박종합정（ARDS）환자적림상치료경험，탐토유효적치료조시。방법회고성분석본원4년래신이식술후발생CMV폐염병발ARDS적환자21례，대기일반정황、치료조시이급림상전귀진행총결분석，급여환자적겁적항병독치료，괄당감소면역억제제용량，적겁진행전신지지요법，급시채용호흡궤보조통기등종합치료조시。결과21례환자중16례치료유효，3례환자출현호흡쇠갈，경적겁치료무효사망，2례속우자동출원후사망。유효솔위76.19%，치료후외주혈CMV항원검측전부전위음성。16례존활적환자중，12례재병정중출현뇨량감소，혈청기항（SCr）승고，수착감염적공제，폐공능회복，SCr야축점회복정상；령4례신공능일직보지정상。결론 CMV폐염합병ARDS응채취항병독、중건면역공능、괄시궤계통기、지지치료위주적종합치료조시，유조우제고환자적구치성공솔。
Objective To study the treatment of patients with acute respiratory distress syndrome(ARDS) caused by cytomegalovirus(CMV)pneumonia after renal transplantation. Methods A retrospective analysis of 21 patients with ARDS caused by CMV pneumonia after renal transplantation in 4 years in the hospital was done. The general situation,treatment and clinical outcomes were summarized and analyzed. All the 21 patients were treated with antiviral therapy,decreased the dosage of immunosuppressant,supported with active whole body support therapy,and applied with timely ventilation. Results In the 21 patients,the treatment of 16 cases was effective. Three cases experience respiratory failure and died after active treatment. Two cases died after discharge not suggested by medical staff. The effective rate was 76.19%. All CMV antigen in peripheral blood turned negative after treatment. Of the 16 cases survived,12 cases experienced oliguria,serum creatinine(SCr)increased. Pulmonary function was recovered and SCr was gradually returned to normal along with the control of infection. The renal function of other 4 cases remained normal. Conclusion CMV pneumonia accompanied ARDS should be treated by antiviral therapy,withdrawal of immuno-suppressant drugs,rebuild the body's immunity function,and timely application of ventilation, which are helpful to improve the successful remedy rate.
