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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)患者的临床特点 ,为此类患者的进一步防治提供参考。 方法 :回顾近 3年肾移植术后CMV肺炎并发ARDS的患者共 32例 ,对其一般情况、治疗措施以及临床转归进行总结分析。 结果 :32例术后确诊CMV肺炎患者 ,均符合 1992年美欧ARDS专题会议ARDS诊断标准 ,其中 31例发生在术后 2～ 4个月 ,16例曾发生过急性排斥反应 (AR) ,14例因AR接受过激素冲击治疗 ,冲击治疗后CMV肺炎并发ARDS的发生率显著高于同期未冲击者。入院时外周血CD4 + 、CD8+ 细胞计数及其比值均显著降低。救治措施包括合理应用抗生素抗感染、撤减免疫抑制剂重建免疫功能、适时使用机械通气、支持治疗 ,并辅以连续性高容量血液滤过 (CVVHF)治疗 ,治疗好转出院者 2 0例 ,死亡 12例 ,其中 5例属于自动出院后死亡 ,2例死于肝功能衰竭 ,抢救成功率为 6 2 .5 0 %。 结论 :肾移植术后CMV肺炎并发ARDS集中在术后 2～ 4个月发病 ,因AR接受激素冲击治疗显著增加其发生率 ,此类患者救治困难 ,死亡率高 ,采用包括抗感染、重建免疫功能、适时机械通气、支持治疗以及CVVHF在内的综合治疗措施有助于提高患者的救治成功率
Objective: To summarize the clinical features of patients with cytomegalovirus (CMV) pneumonia complicated with acute respiratory distress syndrome (ARDS) after renal transplantation, and to provide reference for further prevention and treatment of such patients. Methods: A total of 32 patients with CMV pneumonia complicated with ARDS after renal transplantation in recent 3 years were reviewed. The general situation, treatment measures and clinical outcomes were summarized. Results: All the 32 patients with CMV pneumonia were diagnosed according to ARDS diagnostic criteria of ARDS special meeting in 1992, of which 31 cases occurred 2 to 4 months after operation, 16 cases had acute rejection (AR), 14 Cases of AR received hormone shock treatment, the impact of CMV pneumonia after stroke complicated by ARDS was significantly higher than the same period did not impact. Peripheral blood CD4 +, CD8 + cell counts and their ratios were significantly lower at admission. Treatment measures include the rational use of anti-infectives of antibiotics, immunosuppressants to rebuild immunosuppressant withdrawal, timely use of mechanical ventilation, supportive treatment, supplemented with continuous high-volume hemofiltration (CVVHF) treatment, 20 cases of improved discharge, death Of the 12 cases, 5 were automatically discharged from hospital and 2 died of liver failure. The success rate of rescue was 62.5%. CONCLUSION: ARDS complicated with CMV pneumonia after renal transplantation focus on 2 ~ 4 months postoperatively. The incidence of AR shock is significantly increased due to AR treatment. These patients have difficulty in treatment and high mortality rate. They include anti-infection and immune reconstruction The combination of functional, timely mechanical ventilation, supportive care, and CVVHF can help improve patient success rates