移植肾功能延迟恢复期间并发重症肺部感染的治疗经验

陈卫国; 周婷婷; 李晓伟; 周鹏; 王庆堂; 李沙丹

doi:10.3969/j.issn.1674-7445.2015.04.007

移植肾功能延迟恢复期间并发重症肺部感染的治疗经验

doi: 10.3969/j.issn.1674-7445.2015.04.007

610083 成都军区总医院泌尿外科

详细信息

通讯作者:
周婷婷, Email:10391904@qq.com

中图分类号: R617
计量
- 文章访问数: 198
- HTML全文浏览量: 113
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2015-05-04
- 网络出版日期: 2021-01-19
- 刊出日期: 2015-07-15

Experience of treatment on delayed graft function complicated with severe pulmonary infection

Department of Urology, Chengdu Military General Hospital, Chengdu 610083, China

More Information

Corresponding author: Zhou Tingting, Email:10391904@qq.com

摘要

摘要: 目的总结移植物(肾)功能延迟恢复(DGF)期间并发重症肺部感染的治疗经验。方法回顾性分析2008年1月至2014年11月在成都军区总医院行肾移植术, 术后出现DGF期间并发重症肺部感染的15例患者的临床资料, 了解其治疗经过及预后。结果采用连续性肾脏替代疗法及根据连续性静脉-静脉血液滤过药物调整剂量表来调整给药方案, 采用降阶梯抗生素治疗策略, 调整免疫抑制剂并使用小剂量肾上腺皮质激素, 辅以其它综合治疗措施。15例患者中, 8例行气管插管、2例行气管切开后给予呼吸机机械通气治疗, 5例行无创呼吸机辅助呼吸治疗。经积极抢救治愈11例, 治愈率为73%;死亡4例, 病死率为27%, 均为并发急性呼吸窘迫综合征的患者。结论移植肾DGF并发重症肺部感染具有病情严重、发展快的特点。一旦确诊, 应"尽早"和"充分"地应用连续性肾脏替代疗法, 根据连续性静脉-静脉血液滤过药物调整剂量表来调整给药方案, 结合其他综合治疗, 以提高治愈率。
- 肾移植 /
- 移植物功能延迟恢复 /
- 重症肺部感染 /
- 连续性肾脏替代疗法
Abstract: Objective To sum up the experience in the treatment on delayed graft function (DGF) complicated with severe pulmonary infection. Methods Clinical data of 15 patients undergoing renal transplantation and suffering delayed graft function(DGF) complicated with severe pulmonary infection in Chengdu Military General Hospital from January 2008 to November 2014 were retrospectively studied. The treatment course and prognosis were studied. Results Continuous renal replacement therapy was adopted and dosage regimen was adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration. Antibiotic de-escalation therapy was adopted. Immunosuppressive agents were adjusted and low-dose adrenocortical hormone and other comprehensive treatment were applied. Of the 15 patients, 8 cases underwent tracheal intubation, 2 cases underwent mechanical ventilation after tracheotomy and 5 cases underwent noninvasive ventilator-assisted breathing. Through positive rescue treatment, 11 patients were cured and 4 patients died. The cure rate was 73% and the fatality rate was 27%. All died patients were complicated with acute respiratory distress syndrome. Conclusions DGF complicated with severe pulmonary infection after renal transplantation is characterized by severe condition and fast progression. Once cases confirmed, continuous renal replacement therapy shall be‘fully’applied ‘as early as possible’, and dosage regimen shall be adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration. And other comprehensive treatments shall be combined in order to improve the cure rate.
- Renal transplantation /
- Delayed graft function /
- Severe pulmonary infection /
- Continuous renal replacement therapy

HTML全文

参考文献(18)

[1]	Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J]. Clin Infect Dis, 2007, 44(Suppl 2):S27-S72. http://www.medscape.com/medline/abstract/17278083
[2]	曾力, 刘鹏, 张雷, 等.肾移植患者术后重症肺部感染的诊治经验(附46例报告)[J].器官移植, 2011, 2(3):152-156. http://www.organtranspl.com/browse/detail/cat/32/id/493 Zeng L, Liu P, Zhang L, et al. Diagnosis and treatment of severe pulmonary infection after renal transplantation:a report of 46 cases[J]. Organ Transplant, 2011, 2(3):152-156. http://www.organtranspl.com/browse/detail/cat/32/id/493
[3]	肖漓, 何秀云, 周文强, 等.外周血中性粒细胞CD64检测在肾移植受者肺部感染诊断中的应用价值[J].中华器官移植杂志, 2013, 34(8):469-472. http://d.wanfangdata.com.cn/Periodical/zhqgyz98201308007 Xiao L, He XY, Zhou WQ, et al. Applied value of peripheral neutrophile granulocyte CD64 test in the diagnosis of pulmonary infection in patients after renal transplantation[J]. Chin J Organ Transplant, 2013, 34(8):469-472. http://d.wanfangdata.com.cn/Periodical/zhqgyz98201308007
[4]	查艳, 杨霞, 袁静, 等.连续性肾脏替代治疗对长期使用免疫抑制剂合并重症肺炎患者的疗效[J].中华结核和呼吸杂志, 2013, 36(3):169-172. http://d.wanfangdata.com.cn/Periodical/zhjhhhx201303003 Zha Y, Yang X, Yuan J, et al. The effect of continuous renal replacement therapy on the outcome of severe pneumonia in patients receiving long-term immunosuppressants[J]. Chin J Tuberc Respir Dis, 2013, 36(3):169-172. http://d.wanfangdata.com.cn/Periodical/zhjhhhx201303003
[5]	杨琦, 王养民, 梁晓燕, 等.肾移植术后重症肺部感染的临床研究[J].现代中西医结合杂志, 2012, 21(1):16-17, 20. http://www.cnki.com.cn/Article/CJFDTOTAL-XDJH201201010.htm Yang Q, Wang YM, Liang XY, et al. Clinical research of the treatment for severe pulmonary infection after renal transplantation[J]. Mod J Integr Tradit Chin West Med, 2012, 21(1):16-17, 20. http://www.cnki.com.cn/Article/CJFDTOTAL-XDJH201201010.htm
[6]	Cui HX, Xu JY, Li MQ. Efficacy of continuous renal replacement therapy in the treatment of severe acute pancreatitis associated acute respiratory distress syndrome[J].Eur Rev Med Pharmacol Sci, 2014, 18(17):2523-2526. http://www.medscape.com/medline/abstract/25268099
[7]	Mu TS, Palmer EG, Batts SG, et al. Continuous renal replacement therapy to reduce inflammation in a piglet hemorrhage-reperfusion extracorporeal membrane oxygenation model[J]. Pediatr Res, 2012, 72(3):249-255. doi: 10.1038/pr.2012.69
[8]	Seczyńska B, Królikowski W, Nowak I, et al. Continuous renal replacement therapy during extracorporeal membrane oxygenation in patients treated in medical intensive care unit:technical considerations[J]. Ther Apher Dial, 2014, 18(6):523-534. doi: 10.1111/tap.2014.18.issue-6
[9]	Silva S, de Cal M, Cruz D, et al. Oxidative stress and 'monocyte reprogramming' in septic patients with acute kidney injury requiring CRRT[J]. Blood Purif, 2008, 26(2):188-192. doi: 10.1159/000117308
[10]	潘晓鸣, 薛武军, 田普训, 等.连续性肾脏替代治疗肾移植术后重症肺部感染的疗效评估[J].西安交通大学学报:医学版, 2008, 29(2):239-封3. http://www.cnki.com.cn/Article/CJFDTOTAL-XAYX200802033.htm Pan XM, Xue WJ, Tian PX, et al. Efficacy evaluation on continuous renal replacement therapy of severe pulmonary infection after renal transplantation[J]. J Xi'an Jiaotong Univ:Med Sci, 2008, 29(2):239-cover3. http://www.cnki.com.cn/Article/CJFDTOTAL-XAYX200802033.htm
[11]	Jamal JA, Mueller BA, Choi GY, et al. How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy?[J]. Diagn Microbiol Infect Dis, 2015, 82(1):92-103. doi: 10.1016/j.diagmicrobio.2015.01.013
[12]	Lewis SJ, Mueller BA. Antibiotic dosing in critically ill patients receiving CRRT:underdosing is overprevalent[J]. Semin Dial, 2014, 27(5):441-445. doi: 10.1111/sdi.2014.27.issue-5
[13]	Morabito S, Pistolesi V, Maggiore U, et al. Pharmacokinetics of antibiotics in continuous renal replacement therapies (CRRT)[J]. G Ital Nefrol(意大利文), 2012, 29(4):425-444. https://www.ncbi.nlm.nih.gov/pubmed/22843155
[14]	Ranco C, Bellomo R, Kellum J. Critical care nephrology[M]. 2nd ed. Canada:Elsevier Inc, 2009:1190-1201.
[15]	Trotman RL, Williamson JC, Shoemaker DM, et al. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy[J]. Clin Infect Dis, 2005, 41(8):1159-1166. doi: 10.1086/444500
[16]	Bourquin V, Ponte B, Saudan P, et al. Drugs dosing in intensive care unit during continuous renal replacement therapy[J]. Nephrol Ther(法文), 2009, 5(6):533-541. doi: 10.1016/j.nephro.2009.02.010
[17]	Jamal JA, Economou CJ, Lipman J, et al. Improving antibiotic dosing in special situations in the ICU:burns, renal replacement therapy and extracorporeal membrane oxygenation[J]. Curr Opin Crit Care, 2012, 18(5):460-471. doi: 10.1097/MCC.0b013e32835685ad
[18]	Covajes C, Scolletta S, Penaccini L, et al. Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy[J]. Int J Antimicrob Agents, 2013, 41(3):261-266. doi: 10.1016/j.ijantimicag.2012.10.018