肾移植术后重症肺部感染危险及预后因素分析

发布时间：2018-03-30 19:40

本文选题：肾移植　切入点：肺部感染　出处：《暨南大学》2013年硕士论文

【摘要】：目的：分析肾移植术后肺部感染的临床特征，探讨肾移植术后重症肺部感染的危险因素及预后因素，为降低重症肺部感染的死亡率，改善预后，提供临床借鉴。方法：收集52例肾移植术后肺部感染患者的基线资料和临床资料，分析肾移植术后肺部感染的好发时段、临床表现、病原学特点、转归等，将52例肺部感染患者分为重症组和非重症，然后运用非条件Logistic回归分析找出肾移植术后重症肺部感染的危险因素，Cox比例风险回归模型寻找与重症肺部感染死亡相关的危险因素。结果：（1）52例肺部感染患者中，非重症组32例，重症组20例。感染发生于术后1年内49例（94.6%），其中术后2~6个月35例（67.3%），术后1年以上仅3例（5.8%）。（2）临床表现不典型，发热常最早出现，中高度发热（67.3%）多见，呼吸系统症状以咳嗽、咳痰多见，，早期肺部听诊多无Up音，病情进展快，症状体征不同步。（3）多数患者存在不同程度的贫血、低蛋白血症、低氧血症和血糖升高，尤以重症肺部感染患者表现明显。感染初期胸部CT多见斑片状高密度影，其诊断准确率比X线胸片高。（4）31例(59.6%)患者病原菌检测阳性，主要为细菌（56.3%），其次为真菌（20.3%）、病毒（18.7%）。（5）经过个体化综合治疗，共14例患者死亡，总病死率26.9%，其中非重症组5例，死亡率为15.63%，重症组9例，死亡率高达45%。（6）急性排斥反应（OR=3.578、P=0.001）和术前透析时间（OR=2.312、P=0.021）重症肺部感染的独立危险因素，预防性应用更昔洛韦（OR=0.546、P=0.032）是保护因素。（7）急性排斥反应（RR=2.763、P=0.023）和血糖（RR=1.612、P=0.045）是与重症肺部感染死亡相关的独立危险因素。结论：（1）肺部感染好发于术后1年内，以术后2~6个月最多见；（2）起病隐匿，发热可作为感染的危险信号，病情进展快，症状和体征不同步；（3）多数患者存在不同程度的贫血、低蛋白血症、低氧血症和血糖升高，尤以重症肺部感染患者表现明显；（4）胸部CT对肺部感染的早期诊断敏感性更高；（5）以混合感染为主，病原菌主要为细菌；（6）重症肺部感染预后差，死亡率高，掌握与重症肺部感染发病和死亡相关的危险因素，对临床上预防重症肺部感染，降低死亡率，意义重大。
[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.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R699.2;R563

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