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目的:探讨肾移植术后重症肺部感染的综合治疗,并对影响预后诸因素进行分析。方法:回顾性分析45例肾移植术后发生重症肺部感染患者的临床资料,以死亡是否发生作为因变量,治疗和预后的各项暴露因素作为自变量进行统计学分析。结果:45例患者治愈32例,总治愈率71.1%,死亡13例(其中6例放弃治疗),总死亡率28.9%。合并巨细胞病毒感染、细菌感染、急性呼吸窘迫综合征的死亡率显著升高;感染持续时间和患者死亡率成正比;患者性别、服用免疫抑制剂种类和死亡率之间无显著相关。结论:治疗针对预后风险度高因素采取高效价药物“降阶梯治疗”;免疫抑制过度及时减量或停用免疫抑制剂,加用丙种球蛋白。
Objective: To explore the comprehensive treatment of severe pulmonary infection after renal transplantation, and analyze the factors that affect the prognosis. Methods: The clinical data of 45 patients with severe pulmonary infection after renal transplantation were analyzed retrospectively. All the exposure factors of death as a dependent variable, treatment and prognosis were analyzed as the independent variables. Results: 45 cases were cured in 32 cases, the total cure rate was 71.1%, 13 cases died (6 cases abandoned treatment), the total mortality rate was 28.9%. There was a significant increase in mortality associated with CMV infection, bacterial infection and acute respiratory distress syndrome. The duration of infection was directly proportional to patient mortality. There was no significant correlation between patient gender, type of immunosuppressant and mortality. Conclusion: The treatment of high risk factors for the prognosis of high-titer drugs to “step-down treatment”; excessive immunosuppression in time reduction or discontinuation of immunosuppressive agents, plus gamma globulin.