肾移植术后重症肺炎诊治经验.docVIP

肾移植术后重症肺炎诊治经验 　 作者：王栋，谭建明，吴卫真，杨顺良，林文洪，徐廷昭，蔡锦全，陶小琴，杨晓玲 【关键词】 肾移植；肺炎；支气管肺泡灌洗液 　　Experience in diagnosis and treatment of severe pneumonitis following renal transplantation 　　【Abstract】 AIM: To explore the diagnosis and treatment of severe pneumonitis following renal transplantation. METHODS: A retrospective analysis was made on the clinical data of 52 renal transplant recipients with severe pneumonitis, which were diagnosed by the clinical symptoms, chest Xray and CT. The treatments included withdrawal of immunosuppressive agents, administration of empirical antiinfective drugs and methylprednisolone, prevention and treatment of secondary infection, reinforcement of nutritional support and use of respirator if necessary. Simultaneously responsible pathogen was detected by analyses of BAL (bronchoalveolar lavage), sputum and blood specimen, with regard to cell differential count, cytopathologic examination and cultures for bacteria, fungi and viruses. RESULTS: Seventysix cases (8.7%) of pneumonia were found in the 877 renal transplant vecipients, which included 52 (68%) patients with severe pneumonia. Fever and chest distress were the most common initial symptoms of severe pneumonia (100%). However, obvious cough and expectoration were observed only in 10 patients (19%). Positive rate of BAL alone and of blood culture combined with pharynx swab and sputum were 69%(31/45) and 38%(20/52), respectively. The treatments were effective in 39 with 34 being cured and 5 being improved; 13 of 52 finally died. The effective rate was 75%. CONCLUSION: Severe pneumonitis is a most common lifethreatening complication in renal transplant recipient, which mostly occurs during 6 months after renal transplantation. BAL should be performed early for detection of responsible pathogen. The key points of successful treatment involve withdrawal of immunosuppressive agents, administration of empirical antiinfective drugs and methylprednisolone. 　　【Keywords】 kiolney transplantation; pneumonia;