肾移植术后重症肺炎的临床特征及救治措施分析

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Abstract Objective To investigate the clinical features and treatment measures of severe pneumonia after renal transplantation. Methods The clinical data of 31 cases of severe pneumonia after kidney transplantation in Renmin Hospital of Wuhan University from January 2017 to July 2019 were retrospectively analyzed. The clinical features were summarized, and the effects of rational use of antibiotics, timely adjustment of immunosuppressant use, combined with respiratory support, continuous renal replacement therapy (CRRT) and other comprehensive treatment measures were analyzed. Results The mean age of 31 patients with severe pneumonia after renal transplantation was (43.9±11.7) years old. In 31 cases, 17 cases (54.84% ) infected within 6 months and 14 cases（45.16%） occurred 6 months after the operation. The main initial symptoms included fever in 19 cases (61.29%), cough in 15 cases (48.39%), sputum in 8 cases (25.80%), dyspnea in 6 cases (19.35%), pharyngeal pain in 2 cases (6.45%) and chest tightness in 1 case (3.22%). Among the 31 patients, single pathogen infection accounted for 16 cases(51.61%), two or more pathogen infections accounted for 8 cases (25.81%), and unknown pathogen infection accounted for 7 cases (22.58%). Among the 31 patients, single pathogen infection accounted for 16 cases (51.61%), two or more pathogen infections accounted for 8 (25.81%), and unknown pathogen infection accounted for 7 cases (22.58%). After admission, 25 patients improved and 6 patients died. Conclusion Severe pneumonia usually occurs within 6 months after kidney transplantation, and the first symptoms are mostly fever. Bacterial infection and mixed infection are the main pathogens. Early identification of pathogens and combined treatment are the key to successful treatment.

Key words： Kidney transplantation Severe pneumonia Retrospective study Clinical characteristics

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	PAN Zhou XIA Wenfang DENG Zhimin LI Bingyu ZHANG Yonggang ZHOU Qingshan▲

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PAN Zhou XIA Wenfang DENG Zhimin LI Bingyu ZHANG Yonggang ZHOU Qingshan▲. Analysis of clinical features and treatment measures of severe pneumonia after renal transplantation[J]. 中国医药导报, 2019, 16(36): 77-80.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I36/77

[1] Iliyasu G，Abdu A，Dayyab FM，et al. Post-renal transplant infections：single-center experience from Nigeria [J]. Transpl Infect Dis，2016，18（4）：566-574.
[2] Kinnunen S，Karhapaa P，Juutilainen A，et al. Secular Trends in Infection-Related Mortality after Kidney Transplantation [J]. Clin J Am Soc Nephrol，2018，13（5）：755-762.
[3] 杨晓闪.肾移植术后重症肺炎的临床特征及死亡危险因素分析[D].郑州：郑州大学，2018.
[4] 梁守敬.大型多功能呼吸机无创通气治疗急性肺水肿转换为有创通气的时机观察及影响因素[J].中国医药科学，2018，8（23）：254-256.
[5] Mandell LA，Wunderink RG，Anzueto A，et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults [J]. Clin Infect Dis，2007， 44 Suppl 2：S27-S72.
[6] Yeo WS，Zhang YC. Bioengineering in renal transplantation：technological advances and novel options [J]. Pediatr Nephrol，2018，33（7）：1105-1111.
[7] Canet E，Zafrani L，Azoulay E. The Critically Ill Kidney Transplant Recipient：A Narrative Review [J]. Chest，2016， 149（6）：1546-1555.
[8] Tu G，Ju M，Zheng Y，et al. Early- and late-onset severe pneumonia after renal transplantation [J]. Int J Clin Exp Med，2015，8（1）：1324-1332.
[9] Hoyo I，Linares L，Cervera C，et al. Epidemiology of pneumonia in kidney transplantation [J]. Transplant Proc，2010， 42（8）：2938-2940.
[10] Dizdar OS，Ersoy A，Akalin H. Pneumonia after kidney transplant：incidence，risk factors，and mortality [J]. Exp Clin Transplant，2014，12（3）：205-211.
[11] Cervera C，Agusti C，Angeles M，et al. Microbiologic features and outcome of pneumonia in transplanted patients [J]. Diagn Microbiol Infect Dis，2006，55（1）：47-54.
[12] Kara S，Sen N，Kursun E，et al. Pneumonia in Renal Transplant Recipients：A Single-Center Study [J]. Exp Clin Transplant，2018，16 Suppl 1（Suppl 1）：122-125.
[13] Wilmes D，Coche E，Rodriguez-Villalobos H，et al. Bacterial pneumonia in kidney transplant recipients [J]. Respir Med，2018，137：89-94.
[14] 陆菲婕，任义峰.肾移植术后重症肺炎21例临床分析[J].现代实用医学，2016，28（12）：1590-1592.
[15] 韩文龙，彭川.急性重症左心衰抢救中应用有创机械通气及无创机械通气的临床价值[J].中国医学创新，2019， 16（16）：61-64.
[16] 田悦明，邹敏，张琪琪.ICU机械通气患者成功脱机拔管的影响因素分析[J].中国医药导报，2018，15（1）：60-63.
[17] Pham T，Brochard LJ，Slutsky AS. Mechanical Ventilation：State of the Art [J]. Mayo Clin Proc，2017，92（9）：1382-1400.
[18] Jubran A，Tobin MJ. Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation [J]. Am J Respir Crit Care Med，1997，155（3）：906-915.
[19] Serpa Neto A，Cardoso SO，Manetta JA，et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome：a meta-analysis [J]. JAMA，2012，308（16）：1651-1659.
[20] 贺蛟龙.连续性血液浄化用于重症肺炎合并心力衰竭患者的临床效果观察[J].临床合理用药杂志，2018，11（29）：118-119.
[21] Xu J，Zhao J，Jia X，et al. Application of early continuous renal replacement therapy in the bundle treatment of severe pneumonia [J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue，2018，30（3）：246-250.
[22] Sun Q，Liu ZH，Chen J，et al. An aggressive systematic strategy for acute respiratory distress syndrome caused by severe pneumonia after renal transplantation [J]. Transpl Int，2006，19（2）：110-116.