肾移植术后肺部感染致ARDS的治疗

目的：总结。肾移植术后重度肺部感染致急性呼吸窘迫综合征（ARDS）的治疗经验。方法：回顾性分析2000年7月-2009年1月期间24例肾移植术后重症肺部感染致ARDS患耆的临床资料：肺部感染致ARDS多在肾移植术后1～12个月发生。尤以术后2～6个月多见．且大剂量激素冲击多为诱因。24例患者均采用综合治疗方案，并按照抗排斥反应药物治疗方案分为三个阶段进行治疗。结果：24例患者中。9例死亡，2例放弃治疗．死亡率为37．5％；其中两个或两个以上器官障碍者死亡8例，最多见于上消化道出血和肾功能衰竭。1例最长呼吸机辅助呼吸达33灭．最终痊愈出院。本组患者肺部感染多为混合性感染，多以巨细胞病毒、真菌、耐药菌群和条件致病菌感染为主。结论：移植肾功能的保护或替代是治愈的决定因素；合理、及时调整抗生素是治愈的关键；肠内营养支持是治愈的基础；早期有利的呼吸功能支持是主要手段。

Treatment of the ARDS Caused by Severe Pulmonary Infection after Kidney Transplantation

Objective： To summarize the treatment of the acute respiratory distress syndrome（ARDS） caused by severe pulmonary infection after kidney transplantation. Methods：The clinical data of 24 cases with ARDS caused by severe pulmona ry infection after kidney transplantation from September 2000 to January 2009 were analyzed retrospectively. The ARDS caused by severe pulmonary infection always occurred during 1-12 months after the kidney transplantation, especially in 2 6 months. Furthermore, application of large dose steroid pulse was the major inducement. Clinical observation on all 24 cases treated with comprehensive antbrejection therapeutic plan which was divided into three effective stages. Results：There were 7 death cases, 2 cases abandon treatment, and the death rate was 37.5% of the 24 patients. There were 8 deaths with two or more organs dysfunction, which were mostly upper gastrointestinal bleeding and renal failure. The longest time of assisted respiration with breathing machine was 33 days for only one patient who eventually recovered and discharged. Therefore, pulmonary infections were mixed infections, and the pathogens mainly included cytomegalovirus, eumyeetes, drug-resistance bacteria and conditional pathogenic bacteria. Conclusions： As curing for the ARDS caused by severe pulmonary infection after kidney transplantation, to replace or protect the transplated kidney function is the determinant; to adjust the usage of antibi otic reasonable and timely is the key; and to give the enteral nutrition is the foundation; and to use positive end-expiratory pressure early is the important method.