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目的:探讨外科重症监护病房(SICU)肾移植术后严重肺部感染患者的发病特点,总结诊断和治疗方案的有效性。方法:回顾性分析北京大学第一医院2002年～2010年肾移植后因严重肺部感染收入SICU治疗患者的临床资料。结果:8年期间共收治肾移植术后严重肺部感染患者15例,其中肾移植术后6月内12例(80.0%)、3月内9例(60.0%)。15例患者中重症肺炎12例(80.0%),其中急性呼吸窘迫综合症6例(40.0%)。按照发病地点分:院内获得性肺炎8例(53.3%),社区获得性肺炎7例(46.7%);按照致病病原体分:细菌性肺炎12例,真菌性肺炎4例,卡氏肺孢子虫肺炎1例,病原体不明肺炎3例。12例查明病原体的肺炎患者中4例(33.3%)为多重病原体感染。经过综合治疗后13例(86.7%)痊愈,2例(13.3%)死亡。结论:早期行病原学诊断、根据病原体选择有效抗生素、及时调整免疫抑制方案、加强全身支持治疗、适时应用呼吸机支持纠正低氧血症是成功救治肾移植术后肺部严重感染患者的关键。
Objective: To investigate the incidence of severe pulmonary infection in surgical intensive care unit (SICU) after renal transplantation and summarize the effectiveness of diagnosis and treatment. Methods: The clinical data of patients with severe pulmonary infection who received SICU after renal transplantation from 2002 to 2010 in Peking University First Hospital were retrospectively analyzed. Results: A total of 15 patients with severe pulmonary infection after renal transplantation were treated during the 8-year period. Among them, 12 cases (80.0%) were within 6 months after renal transplantation and 9 cases (60.0%) within 3 months. Fifteen patients had severe pneumonia in 12 cases (80.0%), including 6 cases of acute respiratory distress syndrome (40.0%). According to the place of incidence, 8 cases were hospital-acquired pneumonia (53.3%) and 7 cases were community-acquired pneumonia (46.7%). According to the pathogens, 12 were bacterial pneumonia, 4 were fungal pneumonia, 1 case of pneumonia, 3 cases of unknown pathogen pneumonia. Four of the 12 patients (33.3%) with pathogen-identified pneumonia were multiple pathogen infections. After the comprehensive treatment of 13 cases (86.7%) recovered, 2 cases (13.3%) died. Conclusions: Early diagnosis of etiology, effective antibiotics according to the pathogen selection, timely adjustment of immunosuppressive regimen and strengthening of systemic supportive care, timely application of ventilator support to correct hypoxemia is the key to successful treatment of patients with severe pulmonary infection after kidney transplantation.