【摘要】：背景腎移植已經(jīng)成為治療終末期腎病的一個(gè)最有效和成熟的方法。因?yàn)樾g(shù)后病人長(zhǎng)期處于免疫抑制狀態(tài),免疫功能不健全,因此容易產(chǎn)生多種并發(fā)癥,包括出血、感染、排斥反應(yīng)、高血壓等等。其中感染是常見(jiàn)的并發(fā)癥和死亡原因,據(jù)西方國(guó)家統(tǒng)計(jì),腎移植術(shù)后第一年內(nèi)大約有超過(guò)百分之七十的術(shù)后患者發(fā)生過(guò)感染,并且感染后的病死率較高。尤其是呼吸系統(tǒng)的感染,感染進(jìn)展迅速,預(yù)后較差,死亡率高。腎移植術(shù)后1年內(nèi)患者并發(fā)肺部感的發(fā)病率,國(guó)內(nèi)報(bào)道約8.70%~14.96%,國(guó)外報(bào)道約為5%~10%。在眾多感染中,肺部的感染較為嚴(yán)重,是術(shù)后患者死亡的主要原因之一,對(duì)術(shù)后患者的生存率影響很大。目的回顧性分析我院感染患者的臨床特征,病原體分布,耐藥情況,等資料,為以后臨床上治療腎移植術(shù)后感染提供理論依據(jù)。方法回顧性分析鄭州大學(xué)第一附屬醫(yī)院腎移植科2014年12月至2016年12月診治的119名術(shù)后感染患者的臨床資料。包括:年齡,性別,感染發(fā)生時(shí)間、感染部位、感染癥狀,免疫抑制方案、免疫抑制劑藥物濃度、病原學(xué)檢查資料以及疾病的轉(zhuǎn)歸。重點(diǎn)研究腎移植術(shù)后肺炎及細(xì)菌真菌耐藥性情況。結(jié)果1.119名腎移植術(shù)后感染患者共發(fā)生158次感染,24人至少發(fā)生2次感染(20.1%)。2.79例腎移植術(shù)后肺炎最常發(fā)生于術(shù)后2~6月。38例病原學(xué)診斷明確(48.1%),細(xì)菌感染最為常見(jiàn)(34.2%),其后依次為混合感染(23.6%)、巨細(xì)胞病毒感染(21%)。3細(xì)菌中以大腸埃希菌和鮑曼不動(dòng)桿菌較為常見(jiàn)。4.79例肺炎患者,死亡2例,死亡率2.5%結(jié)論呼吸道及泌尿道為腎移植術(shù)后感染的常見(jiàn)部位,腎移植術(shù)后感染最常發(fā)生于術(shù)后2~6月,不同時(shí)期肺炎具有不同的臨床特點(diǎn),分離病原體以細(xì)菌為主,細(xì)菌對(duì)常用抗生素耐藥情況嚴(yán)重。
[Abstract]:Background Renal transplantation has become one of the most effective and mature methods for the treatment of end-stage kidney disease. Because the patient is in immunosuppressive state for a long time and the immune function is not perfect, it is easy to produce many complications, including bleeding, infection, rejection, hypertension and so on. Infection is one of the most common complications and causes of death. According to the statistics of western countries, more than 70% patients have been infected in the first year after renal transplantation, and the mortality after infection is relatively high. Especially respiratory infection, the progress of infection is rapid, prognosis is poor, mortality is high. Within one year after renal transplantation, the incidence rate of pulmonary sensation was about 8.70% in China and 5% in foreign countries, which was about 8.70% and 14.96% in China and 5% and 10% in foreign countries, respectively. Among many infections, lung infection is one of the main causes of postoperative death, and has a great influence on survival rate of postoperative patients. Aim to analyze retrospectively the clinical characteristics, pathogen distribution, drug resistance and other data of patients with renal transplantation in our hospital, so as to provide a theoretical basis for future clinical treatment of infection after renal transplantation. Methods the clinical data of 119 patients with postoperative infection in the Department of Renal Transplantation, first affiliated Hospital of Zhengzhou University from December 2014 to December 2016 were retrospectively analyzed. Including: age, sex, infection time, infection site, infection symptoms, immunosuppressive regimen, immunosuppressive drug concentration, etiological examination data and prognosis of the disease. The emphasis was placed on the study of pneumonia and bacterial fungal resistance after renal transplantation. Results there were 1.119 cases of infection after renal transplantation, 24 cases had at least two infections (20.1%), 2.79 cases of pneumonia most frequently occurred in 2 ~ 6 months after renal transplantation, 38 cases (48.1%) were diagnosed pathologically. Bacterial infection was the most common (34.2%), followed by mixed infection (23.6%) and cytomegalovirus infection (21%). 3Escherichia coli and Acinetobacter baumannii were the most common bacteria. 4.79 patients with pneumonia were infected by E. coli and Acinetobacter baumannii. The mortality rate was 2.5%. Conclusion Respiratory tract and urinary tract infection are common sites after renal transplantation. Infection after renal transplantation occurs most frequently from 2 to 6 months after renal transplantation. Pneumonia has different clinical characteristics in different periods. The isolated pathogens were mainly bacteria, and the resistance of bacteria to commonly used antibiotics was serious.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R699.2

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