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目的探讨肾移植后不同时期肺部感染的临床表现、病原学特点和治疗策略,以提高肾移植后肺部感染患者的存活率。方法回顾性分析2003年1月—2008年7月于我院因肺部感染住院患者61例。按照肺部感染发病距肾移植手术时间将患者分为两组:近期感染组(术后≤12个月);远期感染组(术后>12个月)。分析并比较两组患者在病原学、临床表现、治疗、病程和转归等方面的特点。结果43例近期感染病例多表现为发热、胸闷气促,影像学表现为两肺弥漫间质性改变,病原体以巨细胞病毒和真菌较多见,常需抗病毒、真菌、细菌综合治疗,并及早使用机械辅助通气。18例远期肺部感染病例有肺部体征和咳嗽、咳痰症状,影像学表现单侧局限改变,但合并心脏、胃肠道并发症较多见,有并发症者病死率较高。结论肺部感染是肾移植术后的严重并发症和主要死亡原因之一。肾移植术后远、近期发生的肺部感染在病因、临床特点及转归等方面各有其特点。据此,早期积极取得病原学证据、针对病因施治、预防并发症、积极治疗合并症可能有助于提高肾移植患者的预后。
Objective To investigate the clinical manifestations, etiological characteristics and treatment strategies of pulmonary infection at different stages after renal transplantation in order to improve the survival rate of patients with pulmonary infection after renal transplantation. Methods The clinical data of 61 hospitalized patients with pulmonary infection in our hospital from January 2003 to July 2008 were retrospectively analyzed. Patients were divided into two groups according to the time of lung infection and kidney transplantation: the recent infection group (≤12 months after operation); long-term infection group (> 12 months after operation). Analysis and comparison of the two groups of patients in the etiology, clinical manifestations, treatment, duration and prognosis and other characteristics. Results 43 cases of recent infections were fever, chest tightness and shortness of breath. The imaging findings were diffuse interstitial changes in both lungs. The pathogens were more common in cytomegalovirus and fungus, and often needed antiviral, fungal and bacterial combination therapy. Early use of mechanical ventilation. Eighteen patients with distant pulmonary infection had signs of the lungs and symptoms of cough and phlegm and unilateral local changes of imaging manifestations. However, complications of heart and gastrointestinal tract were more common, and complication rates were higher. Conclusions Pulmonary infection is one of the major causes of death and complication after renal transplantation. Far and recent after renal transplantation, pulmonary infection in the etiology, clinical features and prognosis have their own characteristics. Accordingly, early positive etiological evidence, for the treatment of etiology, prevention of complications, aggressive treatment of complications may help to improve the prognosis of renal transplant patients.