甲泼尼龙与醋酸泼尼松治疗肾移植术后肺部感染

发布时间：2018-11-11 12:56

【摘要】：目的:对比甲泼尼龙琥珀酸钠静脉滴注与醋酸泼尼松口服对肾移植后肺部感染的临床疗效。方法:纳入2013年1月至2016年1月接受治疗的肾移植后重症肺部感染患者136例为对象,采用随机数字表法均分为2组。均在常规综合治疗的基础上调整免疫抑制剂应用方案,观察组同时应用甲泼尼龙琥珀酸钠,对照组应用醋酸泼尼松。对比2组临床疗效,存活患者治疗期间体温、动脉血压分压随时间变化情况,存活患者治疗前后尿微量白蛋白/肌酐比值(ACR)、血清肌酐(Scr)、尿β2-微球蛋白变化情况。结果:观察组2例死亡、1例肾移植失功能;对照组2例死亡、3例肾移植失功能,2组临床疗效对比,差异无统计学意义(P0.05)。观察组体温恢复正常时间明显短于对照组,且用药16 h后观察组体温即明显低于对照组,持续至用药4d,差异有统计学意义(P0.05)。观察组动脉血氧分压恢复正常时间明显短于对照组,且用药2d后观察动脉血氧分压即明显高于对照组,持续至统计结束,差异有统计学意义(P0.05)。存活患者中期ACR、Scr、尿β2-微球蛋白均明显上升(P0.05),组间各时点差异无统计学意义(P0.05)。结论:甲泼尼龙能够迅速改善肾移植术后肺部感染患者体温及血气指标,但对降低死亡率及肾移植失功率并无明显作用,对存活患者中期肾功能亦无明显影响。
[Abstract]:Objective: to compare the clinical efficacy of methylprednisone sodium succinate intravenously and prednisone acetate in the treatment of pulmonary infection after renal transplantation. Methods: 136 patients with severe pulmonary infection after renal transplantation received treatment from January 2013 to January 2016 were randomly divided into two groups. The immunosuppressant regimen was adjusted on the basis of routine comprehensive therapy. The observation group was treated with methylprednisolone sodium succinate and the control group with prednisone acetate. The clinical effects of the two groups were compared. The changes of body temperature and arterial blood pressure with time during the treatment and the changes of serum creatinine (Scr), 尾 2-microglobulin in the surviving patients before and after the treatment were compared. Results: in the observation group, 2 cases died, 1 case lost the function of renal transplantation, 2 cases died in the control group and 3 cases lost the function of the kidney transplantation, the difference between the two groups was not statistically significant (P0.05). The body temperature of the observation group was significantly shorter than that of the control group, and the body temperature of the observation group was significantly lower than that of the control group 16 hours after treatment, and the difference was statistically significant until 4 days (P0.05). Observation of arterial partial pressure of oxygen was significantly higher than that of control group 2 days after treatment, and the difference was statistically significant (P0.05). ACR,Scr, urine 尾 _ 2-microglobulin increased significantly in the middle stage of survival patients (P0.05), and there was no significant difference between groups at each time point (P0.05). Conclusion: methylprednisolone can rapidly improve the body temperature and blood gas index of patients with pulmonary infection after renal transplantation, but it has no significant effect on the mortality and power loss of renal transplantation, nor on the renal function in the middle stage of survival patients.
【作者单位】：郑州人民医院器官移植科;
【分类号】：R699.2;R563.1

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