CAJ | 학술논문

目的探讨纤维支气管镜联合肺泡灌洗术在肾移植后肺部感染患者中早期应用的意义.方法 2011年1月至2014年9月期间在南京医科大学第一附属医院收治的同种异体肾移植术后合并肺部感染的患者共43例,根据其是否行纤维支气管镜及肺泡灌洗术分为两组:治疗组22例,对照组21例.两组患者抗生素治疗方案均相同.通过对两组患者的病原学检出率、死亡比例、好转时间,以及住院期间症状、体征、各项感染指标及影像学资料等变化进行统计学分析.结果对照组术后死亡率为14.3％,治疗组22例患者均无死亡.治疗组患者中位好转时间为12 d,对照组患者中位好转时间为17d,治疗组好转时间明显缩短,且治疗组的临床表现、影像学好转率高于对照组,移植肾功能更平稳,免疫抑制剂恢复应用时间也较对照组提前.治疗组在行纤维支气管镜及肺泡灌洗术治疗后24 h氧合指数为(390.0±127.6)mmHg,较治疗前明显上升,白细胞计数及血清肌酐无明显增加,未发现移植肾急性排斥反应.治疗组病原体诊断阳性率为59.1％,对照组诊断阳性率为38.1％,差异无统计学意义(P=0.169).结论纤维支气管镜联合肺泡灌洗术在肾移植后合并肺部感染患者中的早期应用安全有效,能明显降低患者死亡率,缩短好转时间,提高治疗效果.但该方法在提高病原体检出率方面的效用尚有待进一步观察.
목적 탐토섬유지기관경연합폐포관세술재신이식후폐부감염환자중조기응용적의의.방법 2011년1월지2014년9월기간재남경의과대학제일부속의원수치적동충이체신이식술후합병폐부감염적환자공43례,근거기시부행섬유지기관경급폐포관세술분위량조:치료조22례,대조조21례.량조환자항생소치료방안균상동.통과대량조환자적병원학검출솔、사망비례、호전시간,이급주원기간증상、체정、각항감염지표급영상학자료등변화진행통계학분석.결과 대조조술후사망솔위14.3％,치료조22례환자균무사망.치료조환자중위호전시간위12 d,대조조환자중위호전시간위17d,치료조호전시간명현축단,차치료조적림상표현、영상학호전솔고우대조조,이식신공능경평은,면역억제제회복응용시간야교대조조제전.치료조재행섬유지기관경급폐포관세술치료후24 h양합지수위(390.0±127.6)mmHg,교치료전명현상승,백세포계수급혈청기항무명현증가,미발현이식신급성배척반응.치료조병원체진단양성솔위59.1％,대조조진단양성솔위38.1％,차이무통계학의의(P=0.169).결론 섬유지기관경연합폐포관세술재신이식후합병폐부감염환자중적조기응용안전유효,능명현강저환자사망솔,축단호전시간,제고치료효과.단해방법재제고병원체검출솔방면적효용상유대진일보관찰.
Objective To investigate the early application of fiberoptic bronchoscopy and bronchoalveolar lavage in patients with pulmonary infection after kidney transplantation.Method From January 2011 to September 2014,43 patients with pulmonary infection after kidney transplantation admitted into our hospital were divided into two groups:case group (n =22) subject to fiberoptic bronchoscopy and bronchoalveolar lavage,and control group.Two groups of patients were given the same anti-infection therapeutic schedule.The detection rate of pathogens,mortality,improvement time,symptoms and signs,infection indicators,and imaging data during hospitalization were statistically analyzed.Result The mortality in control and case group was 14.3％ and 0 respectively.The median improvement time in case and control groups was 12 days and 17 days respectively (P＜0.05).Patients in case group also had obviously higher improvement rate not only in symptoms and signs but also in imaging findings.Meanwhile,patients' allograft functions were significantly steadier in case group than in control griyom,and recovery time of immunosuppressants became advanced in case group as compared with control group.Moreover,24 h after fiberoptic bronchoscopy and bronchoalveolar lavage,the oxygenation index in case group was increased obviously to (390.0 ± 127.6) mmHg as compared with that before treatment,while leukocyte count and serum creatinine concentration were not affected.No rejection episode occurred.There was no significant difference in the detection rate of pathogens between case group (59.1％) and control group (38.1％) (P =0.169).Conclusion Early application of fiberoptic bronchoscopy and bronchoalveolar lavage in patients with pulmonary infection after kidney transplantation is safe and effective.It can not only obviously reduce mortality and accelerate improvement time,but also improve therapeutic efficacy.But this application has not increased the detection rate of pathogens distinctly yet.