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论著:肾移植术后不明病原体感染导致急性肺损伤的治疗策略
Therapeutic Strategies of Acute Lung Injury Induced by Unknown Pathogens after Renal Transplantation
屠国伟 罗哲 居旻杰 诸杜明 何义舟 许明 戎瑞明 朱同玉
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作者单位:复旦大学附属中山医院麻醉科外科监护室
中文关键字:肾移植;急性肺损伤;糖皮质激素;无创正压通气
英文关键字:Renal transplantation; Acute lung injury; Corticosteroids; Noninvasive positive pressure ventilation
中文摘要:目的:探讨肾移植术后不明病原体感染导致急性肺损伤的临床特征及初始治疗策略。方法:分析20例肾移植术后不明病原体感染导致急性肺损伤患者的临床资料。予患者免疫抑制剂减量、抗感染联合中等剂量(1.5~2 mg/(kg·d)的糖皮质激素综合治疗。对治疗前后的氧合指数、肺部影像学动态变化、移植肾功能进行比较。结果:20例患者住外科重症监护室的中位天数为7(5.25~8.5)d,总住院天数17.5(10.25~28.25)d。18例(90%)患者治愈出院,2例患者治疗无效病死。20例患者氧合指数的中位数从治疗前的219 mmHg上升至300 mmHg(P<0.05)。患者的维持性免疫抑制剂减量后未见急性排斥反应发生。血肌酐中位数从治疗前的119 μmol/L下降至90 μmol/L(P<0.05)。结论:免疫抑制剂减量、抗感染联合中等剂量的糖皮质激素综合治疗作为不明病原体感染导致急性肺损伤的初始治疗临床疗效良好。
英文摘要:Objective: To investigate the clinical feature and initial strategies for acute lung injury(ALI) induced by unknown pathogens after renal transplantation. Methods: Twenty cases of ALI induced by unknown pathogen were treated with a ‘bundle’ including adjustment of immunosuppressive regimens, anti-infection therapy and moderate-dose corticosteroids (1.5-2 mg/kg/d). Their clinical data were analyzed. We took a close follow up of PaO2/FiO2, chest radiographs and renal graft functions. Results: The median length of stay in ICU was 7(5.25-8.5) days and the median length of stay in hospital was 17.5(10.25-28.25) days. Eighteen (90%) patients survived to hospital discharge and 2(10%) patients passed away. After intensive care unit (ICU) treatment, the median of PaO2/FiO2 increased significantly from 219mmHg to 300mmHg(P<0.05). Although the immunosuppressive therapy was drastically reduced, no acute rejection episodes occurred in 20 patients. After ICU treatment ,the median of serum creatinin level decreased significantly from 119μmol/L to 90μmol/L(P<0.05). Conclusions: We conclude that a combination of early reduction of immunosuppressive therapy, anti-infection therapy and moderate-dose corticosteroids is an effective initial strategy to treat ALI induced by unknown pathogens after renal transplantation.
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