论文部分内容阅读
２７３例尸体肾移植中有３０例发生肺部弥漫性感染，其中有１８例表现为成人呼吸窘追综合征（ＡＲＤＳ）。经治疗１８例存活（其中ＡＲＤＳ９例），１２例死亡。Ｘ线表现粟粒状病变２例、肉芽肿１例、间质性改变３例、散在斑片状阴影１８例、肺水肿及磨砂玻璃状６例。经尸体解剖、纤支镜、微生物检查证实，肺孢子虫病２例、巨细胞病毒伴曲菌２例，结核病３例，另见血和痰培养有绿脓杆菌及白色念珠菌等。２７例非结核性肺弥漫性病变，其中１５例用四联治疗（同时抗细菌、抗病毒、抗真菌抗、肺孢子虫病），全部治愈；而１２例未用四联治疗的仅１例治愈（Ｐ＜０．０１）。提示肾移植后肺弥漫性病变往往是混合感染，且病因诊断困难，病原体不易检出，宜早期应用联合疗法，以提高救治的成功率。
Thirty cases of diffuse lung infections occurred in 273 cadaveric kidney transplant recipients, of which 18 showed adult respiratory distress syndrome (ARDS). After the treatment of 18 cases of survival (ARDS 9 cases), 12 patients died. The X-ray showed miliary lesions in 2 cases, granuloma in 1 case, interstitial changes in 3 cases, scattered patchy shadows in 18 cases, pulmonary edema and frosted glass in 6 cases. After autopsy, bronchoscopy and microbiological examination confirmed 2 cases of Pneumocystis, 2 cases of cytomegalovirus and Aspergillus, and 3 cases of tuberculosis. In another case, Pseudomonas aeruginosa and Candida albicans were observed in blood and sputum. 27 cases of non-tuberculous pulmonary diffuse lesions, of which 15 cases with quadruple therapy (simultaneously anti-bacterial, anti-virus, anti-fungal anti-Pneumocystis disease), all cured; and 12 cases without quadruple therapy in only 1 case Cured (P <0.01). Prompt renal diffuse lung lesions are often mixed infections, and the etiological diagnosis is difficult, the pathogen is not easy to detect, early combination therapy should be used to improve the success rate of treatment.