中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (5): 742-747.doi: 10.3969/j.issn.2095-4344.2014.05.015

• 肾移植 kidney transplantation • 上一篇    下一篇

甲泼尼龙治疗肾移植后的重症肺部感染

韦  星,蔡  明,李州利,金海龙,洪  欣,陈昌庆,石炳毅   

  1. 解放军第三○九医院全军器官移植研究所泌尿一科,北京市  100091
  • 修回日期:2013-11-13 出版日期:2014-01-29
  • 通讯作者: 蔡明,博士,主任医师,解放军第三○九医院全军器官移植研究所泌尿一科,北京市 100091
  • 作者简介:韦星,男,1980年生,安徽省合肥市人,汉族,2004年解放军第三军医大学毕业,硕士,主治医师,主要从事器官移植免疫基础、临床及泌尿系肿瘤的研究。

Methylprednisolone therapy for severe pulmonary infection after kidney transplantation

Wei Xing, Cai Ming, Li Zhou-li, Jin Hai-long, Hong Xin, Chen Chang-qing, Shi Bing-yi   

  1. Department of Urology, Organ Transplantation Center, the 309th Hospital of PLA, Beijing 100091, China
  • Revised:2013-11-13 Online:2014-01-29
  • Contact: Cai Ming, M.D., Chief physician, Department of Urology, Organ Transplantation Center, the 309th Hospital of PLA, Beijing 100091, China
  • About author:Wei Xing, Master, Attending physician, Department of Urology, Organ Transplantation Center, the 309th Hospital of PLA, Beijing 100091, China

摘要:

背景:肺部感染是肾移植后的主要感染并发症,其发病时间和发病率可能与肾移植后常规口服预防感染药物有关。

目的:分析应用静脉甲泼尼龙替代口服醋酸泼尼松治疗肾移植后重症肺部感染效果。
方法:回顾分析58例肾移植后重症肺部感染患者的临床资料。首先根据患者发病特点及肺部CT表现,应用广谱抗生素及抗真菌治疗,随后在得到病原学及真菌、病毒检测结果后进行针对性治疗,停用或调整免疫抑制剂用量和组合方案。58例患者中30例延续口服醋酸泼尼松,28例应用注射用甲泼尼龙琥珀酸钠替代口服醋酸泼尼松治疗。积极纠正低氧血症,并予支持治疗、免疫替代治疗。

结果与结论:58例患者病原体检测阳性39例(67.2%),其中单纯细菌性肺炎7例,单纯真菌性肺炎4例,单纯巨细胞病毒感染3例,混合感染25例(多重细菌感染5例,真菌和细菌混合感染17例,真菌、细菌和巨细胞病毒混合感染3例)。甲泼尼龙组患者体温恢复正常时间、患者体温恢复正常时间均短于醋酸泼尼松组     (P均< 0.05),肌酐波动范围值小于醋酸泼尼松组(P < 0.05)。结果表明应用静脉甲泼尼龙可加快肺部炎症渗出吸收,缩短治疗时间。



中国组织工程研究
杂志出版内容重点:肾移植肝移植移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植组织工程


全文链接:

关键词: 实验动物, 组织构建, 肾移植, 器官移植, 肺部感染, 甲泼尼龙, 醋酸泼尼松, 重症感染, 血气, 肌酐

Abstract:

BACKGROUND: Pulmonary infection is the main complication after kidney transplantation, and its onset and morbidity may be related to conventional oral drugs after kidney transplantation.

OBJECTIVE: To analyze the effect of methylprednisolone instead of prednisone on severe pulmonary infection after kidney transplantation.
METHODS: Clinical data of 58 patients with severe pulmonary infection after kidney transplantation were retrospectively analyzed. First, according to the characteristics of post-onset patients and lung CT findings, broad-spectrum antibiotics and anti-fungal treatment were adopted, and subsequently targeted therapy, that is, withdrawal or adjustment of dosage and combination regimen of immunosuppressive agents, was employed depending on etiology, fungi and virus detection results. Among the 58 patients, 28 patients were injected methylprednisolone, and 30 patients took oral prednisone. Hyoxemia correction, support therapy and immune replacement therapy were applied.

RESULTS AND CONCLUSION: Thirty-nine of 58 patients (67.2%) were positive for pathogens, including 7 cases of simple bacterial pneumonia, 4 cases of fungal pneumonia, 3 cases of simple cytomegalovirus infection, and 25 cases of mixed infections (5 cases of multiple bacterial infections, 17 cases of fungal and bacterial co-infections, and 3 cases of fungi, bacteria and cytomegalovirus co-infections). Patients subjected to methylprednisolone treatment spent shorter time to recover their temperature than those undergoing oral prednisone (P < 0.05). In addition, creatinine fluctuation range in the methylprednisolone group was less than that in the prednisone group (P < 0.05). The results showed that intravenous injection of methylprednisolone may accelerate absorption of inflammatory exudate in the lung and shorten treatment time.



中国组织工程研究
杂志出版内容重点:肾移植肝移植移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植组织工程


全文链接:

Key words: organ transplantation, kidney transplantation, pneumonia, methylprednisolone, blood gas analysis

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