肝脏移植术后卡氏肺孢子虫肺炎的诊治.pdfVIP

5·30 · Chin J No socomiol Vol . 15 No . 5 2005 ·论 　著 · 肝脏移植术后卡氏肺孢子虫肺炎的诊治 刘全达 , 周宁新 , 史宪杰 , 段云鹏 , 段伟东 , 王 　刚 (解放军总医院 , 北京 100853) 摘要 : 目的　探讨肝移植术后合并卡氏肺孢子虫肺炎的诊治 。方法 　总结对肝移植术后并发卡氏肺孢子虫肺炎 的成功诊治经验 。结果 　63 例原位肝移植病例中 ,1 例于肝移植术后 94d 发生卡氏肺孢子虫肺炎 ,临床症状为发 热 、呼吸困难 ,影像学显示双肺弥漫性间质浸润改变 ,血气分析提示 Ⅰ型呼吸衰竭 ; 临床诊断“卡氏肺孢子虫肺 炎”,给予激素和超大剂量的复方新诺明后治愈出院。结论 　卡氏肺孢子虫肺炎是肝移植术后少见 、严重的机会 性感染 ,应及时诊治 ;常规小剂量复方新诺明预防性治疗可以有效预防肝移植术后卡氏肺孢子虫肺炎的发生 。 关键词 : 肝移植 ; 并发症 ; 卡氏肺孢子虫肺炎 ; 复方新诺明 中图分类号 : R657 . 3 　　文献标识码 : A 　　文章编号 : (2005) P neumocyst is ca r i nii Pneumonia af ter L iver Transplantation : Its Diagnosis and Treatment L IU Quanda , ZHOU Nin gxin , SH I Xianj ie , DU AN Yunp eng , DU AN Weido ng , WAN G Gan g ( ) I ns t i t ute of H ep atobi l i a ry S u rg ery , Gene ral H osp i t al of PL A , B eij i ng 100853 , Chi n a Abstract : OBJECTIVE To discuss the diagno sis and t reatment of Pneumocy s tis carinii p neumonia after liver transplantation. METHODS The successful experiences of diagno sis and treatment of P. carinii pneumonia after liver transplantation at General Ho spital of PLA were introduced. RESULTS Among the 63 cases underwent liver transplanta tion , one patient complicated with P. carinii p neumonia on the 94th po sttransplant day. Fever and dyspnea were the main manifestations , image scans demonstrated diffuse inter stitial infiltration of both lungs ; blood gas analysis revealed type Ⅰrespiratory failure. P. carinii p neumonia was diagno sed clinically , and the patient recovered uneventfully after using cortico steroids and