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目的分析肾移植与肝移植术后肺部感染的异同点,探讨有效诊治措施。方法对2004年1月至2008年12月间发生肺部感染的肾移植受者及肝移植受者进行回顾性分析,比较两组受者肺部感染的特点。结果肾移植组肺部感染45例,肝移植组肺部感染23例,其肺部感染发生率分别分7.4%vs56.1%(P<0.001),重症肺炎发生率2.6%vs46.3%(P<0.001),肺炎诊断距移植中位时间(d)230(29-1080)vs4(2-104)(P<0.001),肺炎病死率6.7%vs17.4%(P=NS),肺部感染导致移植受者的死亡率0.5%vs9.8%(P<0.001);两组细菌性感染的病原菌均以G-菌为主,但肝移植组受者多重耐药菌的比例较高(12.9%vs37.0%,P=0.005)。结论了解肾移植及肝移植术后肺部感染的规律,能够为移植术后预防性抗感染治疗以及感染早期的经验性治疗提供依据,减少感染患者的死亡率及提高移植受者的存活率。
Objective To analyze the similarities and differences of lung infection after kidney transplantation and liver transplantation and to explore effective diagnosis and treatment measures. Methods Retrospective analysis was performed on renal transplant recipients with lung infection and liver transplant recipients between January 2004 and December 2008, and the characteristics of pulmonary infection in both groups were compared. Results In the kidney transplantation group, 45 cases were pulmonary infection and 23 cases were pulmonary infection in the liver transplantation group. The incidence of pulmonary infection was 7.4% vs 56.1% (P <0.001), severe pneumonia was 2.6% vs 46.3% Pneumonia was 6.7% vs 17.4% (P = NS) in the median time to diagnosis of pneumonia (d) 230 (29-1080) vs 4 (2-104) (P <0.001) The mortality rate of recipients was 0.5% vs9.8% (P <0.001). The majority of bacterial pathogens in both groups were G-bacteria, but the proportion of multidrug-resistant bacteria in liver transplantation group was higher 12.9% vs 37.0%, P = 0.005). Conclusion Understanding the regularity of lung infection after kidney transplantation and liver transplantation can provide a basis for preventive anti-infection treatment and early empirical treatment of infection after transplantation, reduce the mortality of infected patients and improve the survival rate of transplant recipients.