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目的总结肾移植术后肺部感染的临床表现、病原学及救治措施,以提高其治愈率。方法对四川大学华西医院50例次肾移植术后肺部感染住院患者的病历资料进行回顾性分析。结果共收集42例(50例)次肾移植肺部感染患者,痰培养检出病原体38例次(76%),未检出12例次,其中细菌感染17例次(44.7%),真菌感染7例次(18.4%),巨细胞病毒感染19例次(38%),支原体感染6例次(12%),混合感染10例次(20%)。肺部感染发生在肾移植术后1个月以内者3例(7%),1～6个月者16例(38%),6个月以后者23例(55%)。50例次感染患者中48例次经积极治疗抢救后好转出院,有2例患者死亡。结论肾移植术后肺部感染患者的病原体与肾移植术后时间有一定的规律性。对于肾移植术后肺部感染,救治成功的关键是早期病原体及CT检查,及时给予综合治疗措施,包括经验性抗生素治疗措施,及时调整免疫抑制剂方案,加强全身支持。
Objective To summarize the clinical manifestations, etiology and treatment of pulmonary infection after renal transplantation in order to improve its cure rate. Methods A retrospective analysis was performed on the medical records of 50 inpatients with pulmonary infection after renal transplantation in West China Hospital of Sichuan University. Results A total of 42 patients (50 cases) with lung infection were enrolled in this study. Thirty-eight cases (76%) were detected sputum culture and 12 cases were not detected. Among them, 17 cases were bacterial infections (44.7%), fungal infections 7 cases (18.4%), 19 cases of cytomegalovirus infection (38%), 6 cases of mycoplasma infection (12%) and 10 cases of mixed infection (20%). Pulmonary infection occurred in 3 patients (7%) within 1 month after renal transplantation, 16 (1-6%) in 1-6 months, and 23 (55%) after 6 months. Forty-eight cases of 50 cases of infection were discharged after active treatment, and 2 patients died. Conclusions Pathogens in patients with pulmonary infection after kidney transplantation have some regularity with the time after kidney transplantation. For post-transplant lung infection, the key to successful treatment is early pathogens and CT examination, timely and comprehensive treatment measures, including empirical antibiotic treatment measures, timely adjustment of immunosuppressive agents program to strengthen the body support.