论文部分内容阅读
目的:总结肾移植术后重度肺部感染致急性呼吸窘迫综合征(ARDS)的治疗经验。方法:回顾性分析2000年7月～2009年1月期间24例肾移植术后重症肺部感染致ARDS患者的临床资料:肺部感染致ARDS多在肾移植术后1～12个月发生,尤以术后2～6个月多见,且大剂量激素冲击多为诱因。24例患者均采用综合治疗方案,并按照抗排斥反应药物治疗方案分为三个阶段进行治疗。结果:24例患者中,9例死亡,2例放弃治疗,死亡率为37.5%;其中两个或两个以上器官障碍者死亡8例,最多见于上消化道出血和肾功能衰竭。1例最长呼吸机辅助呼吸达33天,最终痊愈出院。本组患者肺部感染多为混合性感染,多以巨细胞病毒、真菌、耐药菌群和条件致病菌感染为主。结论:移植肾功能的保护或替代是治愈的决定因素;合理、及时调整抗生素是治愈的关键;肠内营养支持是治愈的基础;早期有利的呼吸功能支持是主要手段。
Objective: To summarize the experience of treatment of acute respiratory distress syndrome (ARDS) caused by severe pulmonary infection after renal transplantation. Methods: The clinical data of 24 ARDS patients with severe pulmonary infection after renal transplantation from July 2000 to January 2009 were retrospectively analyzed. ARDS mostly caused by pulmonary infection occurred 1 ~ 12 months after renal transplantation, Especially after 2 to 6 months more common, and large doses of hormones and more for the incentive. Twenty-four patients were treated with a combination therapy and divided into three phases according to anti-rejection drug therapy. Results: Of the 24 patients, 9 died and 2 gave up treatment with a mortality rate of 37.5%. Among them, 8 died of two or more organ disorders, most of them were upper gastrointestinal bleeding and renal failure. One case of the longest ventilator assisted breathing up to 33 days, eventually discharged. The majority of lung infections in patients with mixed infections, mostly cytomegalovirus, fungi, drug-resistant bacteria and opportunistic infections. CONCLUSIONS: The protection or replacement of renal graft function is the determining factor of cure. The rational and timely adjustment of antibiotics is the key to cure. Enteral nutrition support is the basis of cure. Early favorable respiratory function support is the main means.