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目的探讨肾移植术后肺部感染引发急性呼吸窘迫综合征(ARDS)的临床救治。方法对2004年~2005年入住该科RICU的12例肾移植术后并发肺部感染致ARDS患者临床表现,胸部X线,病原体特点及救治经过进行回顾性分析。结果全部患者表现为发热、咳嗽、咳少性黏痰,进行性呼吸窘迫,严重低氧血症。X线以双肺约会温性斑片状,磨玻璃样改变为主,严重者发展为“白肺”。病原体以巨细胞病毒,细菌,真菌为主。经抗病菌,抗真菌三联治疗,呼吸机辅助通气以及CRRT治疗抢救成功4例,死亡4例,由于经济原因放弃治疗4例。结论肺部感染致ARDS是肾移植术后患者的主要死亡原因。尽早使用高效广谱抗生素和抗病毒,抗真菌治疗结合呼气未正压通气,及CRRT治疗是抢救成功的关键。
Objective To investigate the clinical treatment of acute respiratory distress syndrome (ARDS) caused by pulmonary infection after renal transplantation. Methods The clinical manifestations, chest X-ray, pathogen characteristics and treatment of ARDS patients after renal transplantation complicated by pulmonary infection from 2004 to 2005 were reviewed retrospectively. Results All patients showed fever, cough, cough and phlegm, progressive respiratory distress, and severe hypoxemia. X-ray to warm lungs dating patchy, ground-glass-based change, severe development of “white lung.” Pathogen to cytomegalovirus, bacteria, fungi based. In the anti-bacteria, anti-fungal triple therapy, ventilator-assisted ventilation and CRRT treatment of successful rescue in 4 cases, 4 patients died, due to economic reasons to give up treatment in 4 cases. Conclusion ARDS caused by pulmonary infection is the main cause of death in patients after kidney transplantation. Early use of highly effective broad-spectrum antibiotics and antivirals, antifungal therapy combined with expired non-positive airway pressure, and CRRT therapy are key to successful rescue.