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目的：研究肾移植后不明原因呼吸系统感染患者的微生物特点及并发急性呼吸窘迫综合征（ＡＲＤＳ）的氧缺陷机制。方法：对并发ＡＲＤＳ的患者除了痰的病原学检查外，进行了氧代动力学、肿瘤坏死因子（ＴＮＦ）及血小板计数（ＢＰＣ）的监测。结果：发现结核杆菌和真菌感染例次较多（５／７）。在ＡＲＤＳ患者中，当氧消耗增加（１３２±５２ｍｌ·ｍｉｎ－１／ｍ２比１９１±５５ｍｌ·ｍｉｎ－１／ｍ２，Ｐ＜０．０５），而氧输送维持正常时，氧摄取率没有相应增加；ＴＮＦ水平显著高于正常（１３０．９±５５．９ｍｇ／Ｌ比＜５．０ｍｇ／Ｌ，Ｐ＜０．００１）。入院第３天的死腔通气率（ＶＤ／ＶＴ）高于第１天（０．３２８±０．１０３比０．１７９±０．０３６，Ｐ＜０．０５），ＢＰＣ正相反〔（７４．０±３２．１）×１０９／Ｌ比（１２９．４±５２．５）×１０９／Ｌ，Ｐ＜０．０５〕。表明肾移植后不明原因呼吸系统感染中，结核杆菌和真菌感染率较高。并发ＡＲＤＳ患者的氧缺陷表现为高氧耗型，并可能与ＴＮＦ介导的系统性炎症反应有关。结论：肺的微循环梗塞导致ＶＤ／ＶＴ增加是肺氧合难以改善的主要原因；对于高氧耗型氧缺陷患者维持正常水平氧供可能是不够的，需达到超正常水平氧输送。
OBJECTIVE: To investigate the microbiological characteristics of patients with unexplained respiratory infections after kidney transplantation and the mechanism of oxygen deficiency associated with acute respiratory distress syndrome (ARDS). METHODS: In addition to sputum etiology, patients with concurrent ARDS were monitored for oximetry, tumor necrosis factor (TNF), and platelet count (BPC). Results: Mycobacterium tuberculosis and fungal infection were found more frequently (5/7). In ARDS patients, there was no corresponding increase in oxygen uptake when oxygen consumption increased (132 ± 52 ml · min-1 / m2 vs 191 ± 55 ml · min-1 / m2, P <0.05) while oxygen delivery remained normal ; TNF levels were significantly higher than normal (130.9 ± 55.9 mg / L vs <5.0 mg / L, P <0.001). The dead space ventilation rate (VD / VT) on the third day after admission was higher than that on the first day (0.328 ± 0.103 vs 0.179 ± 0.036, P <0.05), and the BPC was opposite [(74). 0 ± 32.1) × 109 / L (129.4 ± 52.5) × 109 / L, P <0.05〕. That unexplained respiratory infections after kidney transplantation, tuberculosis and fungal infection rates. Oxygen defects in patients with ARDS manifest as hyperpyrexia, and may be related to TNF-mediated systemic inflammatory response. CONCLUSIONS: Pulmonary microcirculation infarction leading to increased VD / VT is the main reason for pulmonary oxygenation is difficult to improve; for patients with oxygen deficient oxygen deficiency to maintain normal levels of oxygen may not be enough, to achieve the level of oxygen delivery beyond normal.