發(fā)布時(shí)間：2018-03-30 19:40

  本文選題：腎移植　切入點(diǎn)：肺部感染　出處：《暨南大學(xué)》2013年碩士論文

【摘要】：目的： 分析腎移植術(shù)后肺部感染的臨床特征，探討腎移植術(shù)后重癥肺部感染的危險(xiǎn)因素及預(yù)后因素，為降低重癥肺部感染的死亡率，改善預(yù)后，提供臨床借鑒。 方法： 收集52例腎移植術(shù)后肺部感染患者的基線資料和臨床資料，分析腎移植術(shù)后肺部感染的好發(fā)時(shí)段、臨床表現(xiàn)、病原學(xué)特點(diǎn)、轉(zhuǎn)歸等，將52例肺部感染患者分為重癥組和非重癥，然后運(yùn)用非條件Logistic回歸分析找出腎移植術(shù)后重癥肺部感染的危險(xiǎn)因素，Cox比例風(fēng)險(xiǎn)回歸模型尋找與重癥肺部感染死亡相關(guān)的危險(xiǎn)因素。 結(jié)果： （1）52例肺部感染患者中，非重癥組32例，重癥組20例。感染發(fā)生于術(shù)后1年內(nèi)49例（94.6%），其中術(shù)后2~6個(gè)月35例（67.3%），術(shù)后1年以上僅3例（5.8%）。 （2）臨床表現(xiàn)不典型，發(fā)熱常最早出現(xiàn)，中高度發(fā)熱（67.3%）多見(jiàn)，呼吸系統(tǒng)癥狀以咳嗽、咳痰多見(jiàn)，，早期肺部聽(tīng)診多無(wú)Up音，病情進(jìn)展快，癥狀體征不同步。 （3）多數(shù)患者存在不同程度的貧血、低蛋白血癥、低氧血癥和血糖升高，尤以重癥肺部感染患者表現(xiàn)明顯。感染初期胸部CT多見(jiàn)斑片狀高密度影，其診斷準(zhǔn)確率比X線胸片高。 （4）31例(59.6%)患者病原菌檢測(cè)陽(yáng)性，主要為細(xì)菌（56.3%），其次為真菌（20.3%）、病毒（18.7%）。 （5）經(jīng)過(guò)個(gè)體化綜合治療，共14例患者死亡，總病死率26.9%，其中非重癥組5例，死亡率為15.63%，重癥組9例，死亡率高達(dá)45%。 （6）急性排斥反應(yīng)（OR=3.578、P=0.001）和術(shù)前透析時(shí)間（OR=2.312、P=0.021）重癥肺部感染的獨(dú)立危險(xiǎn)因素，預(yù)防性應(yīng)用更昔洛韋（OR=0.546、P=0.032）是保護(hù)因素。 （7）急性排斥反應(yīng)（RR=2.763、P=0.023）和血糖（RR=1.612、P=0.045）是與重癥肺部感染死亡相關(guān)的獨(dú)立危險(xiǎn)因素。 結(jié)論： （1）肺部感染好發(fā)于術(shù)后1年內(nèi)，以術(shù)后2~6個(gè)月最多見(jiàn)；（2）起病隱匿，發(fā)熱可作為感染的危險(xiǎn)信號(hào)，病情進(jìn)展快，癥狀和體征不同步；（3）多數(shù)患者存在不同程度的貧血、低蛋白血癥、低氧血癥和血糖升高，尤以重癥肺部感染患者表現(xiàn)明顯；（4）胸部CT對(duì)肺部感染的早期診斷敏感性更高；（5）以混合感染為主，病原菌主要為細(xì)菌；（6）重癥肺部感染預(yù)后差，死亡率高，掌握與重癥肺部感染發(fā)病和死亡相關(guān)的危險(xiǎn)因素，對(duì)臨床上預(yù)防重癥肺部感染，降低死亡率，意義重大。
[Abstract]:Objective:. To analyze the clinical features of pulmonary infection after renal transplantation, to explore the risk factors and prognostic factors of severe pulmonary infection after renal transplantation, and to provide clinical reference for reducing mortality and improving prognosis of severe pulmonary infection. Methods:. The baseline data and clinical data of 52 patients with pulmonary infection after renal transplantation were collected, and the time, clinical manifestation, etiological characteristics and prognosis of pulmonary infection after renal transplantation were analyzed. 52 patients with pulmonary infection were divided into severe group and non-severe group. The risk factors of severe pulmonary infection after renal transplantation were found by non-conditional Logistic regression analysis. The Cox proportional regression model was used to find out the risk factors associated with death of severe pulmonary infection. Results:. Among 52 patients with pulmonary infection, 32 cases were in non-severe group and 20 cases in severe group. The infection occurred in 49 cases (94.6%) within one year after operation, of which 35 cases (67.3%) were involved in 2 ~ 6 months after operation, and only 3 cases (5. 8%) in more than one year after operation. The symptoms of respiratory system were cough, expectoration, no up sound in early lung auscultation, rapid progress of the disease, and the syndromes of symptoms and signs were not synchronized. 3) most of the patients had anemia, hypoproteinemia, hypoxemia and increased blood sugar, especially in severe pulmonary infection patients. In the early stage of infection, plaque high density was more common in chest CT, and the diagnostic accuracy was higher than that of X-ray chest radiography. Pathogenic bacteria were detected in 31 cases (59.6%), mainly in bacteria 56.3%, followed by fungi 20.3%, virus 18.7%. The results showed that the pathogenic bacteria were positive in 31 cases (59.6%), mainly in bacteria (56.3%), followed by fungi (20.3%). 5) after individualized comprehensive treatment, 14 patients died with a total mortality rate of 26.9. among them, there were 5 cases in the non-severe group, the mortality rate was 15.63, and 9 cases in the severe group, the mortality rate was as high as 45%. (6) the risk factors of severe pulmonary infection were: acute rejection: 3.578P0. 001) and preoperative dialysis time (OR2. 312). Prophylactic use of ganciclovir was 0. 546% P0. 032) was the protective factor. (7) Acute rejection (RRN 2.763 PU 0.023) and blood glucose rn 1.612 (P0. 045) are independent risk factors associated with death from severe pulmonary infection. Conclusion:. 1) Pulmonary infection occurred within 1 year after operation. The most common symptoms were 2 ~ 6 months after operation. The onset of the disease was concealed. Fever could be used as a dangerous signal of infection. The disease progressed quickly and the symptoms and signs were not synchronized. 3) most of the patients had different degrees of anemia and hypoproteinemia, and most of the patients had different degrees of anemia and hypoproteinemia. Hypoxemia and hyperglycemia, especially in patients with severe pulmonary infection. Chest CT was more sensitive to early diagnosis of pulmonary infection. Mastering the risk factors related to the morbidity and mortality of severe pulmonary infection is of great significance in preventing severe pulmonary infection and reducing mortality.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R699.2;R563

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