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目的 :对肾移植并发严重肺部感染的诊断与治疗方法进行研究。方法 :对住院治疗的 32例肾移植术后严重肺部感染者的临床资料进行回顾性分析。结果 :① 2 6例治愈 ,6例死亡。②支气管肺泡灌洗的病原体检出率为 74 % (2 0 / 2 7) ,血培养结合痰、咽拭子培养病原体检出率为 4 7% (15 / 32 ) ,二者比较差异有统计学意义 (P <0 .0 5 )。③感染发生时间为术后 2周～ 11年。术后 3个月内的严重感染发生例数占所有严重感染病例的 35 %(11/ 32 ) ,术后半年内为 72 % (2 3/ 32 ) ,最长者为术后 11年发病。④治疗措施包括早期根据经验应用抗生素 ,根据检查结果及时调整抗生素 ;大胆减用免疫抑制剂 ,必要时停止应用免疫抑制剂 ;病情危重 ,免疫功能极低者可使用免疫增强剂 ;对肺渗出者应用皮质类固醇。结论 :肾移植术后并发严重肺部感染者病情危重 ,死亡率高 ,应早期应用肺泡灌洗检查病原体 ,反复胸片检查 ,应用抗生素并及时调整抗生素 ,早期减用或停用免疫抑制剂 ,并可应用免疫增强药物胸腺肽及干扰素 ,对肺渗出者应用皮质类固醇。
Objective: To study the diagnosis and treatment of severe pulmonary infection after kidney transplantation. Methods: The clinical data of 32 hospitalized patients with severe pulmonary infection after kidney transplantation were analyzed retrospectively. Results: ① 26 cases were cured, 6 died. ② The detection rate of bronchoalveolar lavage pathogens was 74% (20/27). The detection rate of blood culture combined with sputum and throat swab pathogens was 47% (15/32), the difference was statistically significant Significance (P <0. 05). ③ infection occurred after 2 weeks to 11 years. The incidence of serious infection within 3 months after operation accounted for 35% (11/32) of all serious infections, 72% (2/32) within half a year after surgery, and the longest incidence after 11 years. ④ treatment measures include the early use of antibiotics based on experience, according to the results of timely adjustment of antibiotics; bold use of immunosuppressive agents, if necessary, stop the application of immunosuppressive agents; critically ill, immunocompromised immune enhancer can be used; Apply corticosteroids. CONCLUSIONS: Patients with severe pulmonary infection after kidney transplantation are critically ill and have a high mortality rate. Early detection of pathogens by alveolar lavage, repeated chest radiography, antibiotics and timely adjustment of antibiotics, early use or discontinuation of immunosuppressive agents, And immunostimulants can be applied thymosin and interferon, the application of corticosteroids in lung exudate.