After renal transplantation with acute respiratory

yxfbbiedtj · Wysłany: Pią 18:48, 25 Mar 2011

After renal transplantation with acute respiratory distress syndrome Clinical analysis of 8 cases

; 2.0) d 3 were experts in the diagnosis of high frequency ventilation after 24h of mechanical ventilation or endotracheal intubation, and another 5 patients diagnosed with ARDS 4o ~ 72h after nasotracheal or tracheostomy inserted Camp mechanical ventilation (using Siemens Servo900c ventilator Hamilton Raphael type and Switzerland), ventilation mode A / C mode or SIMV + PEEP, PEEP pressure 7 a l1emil20, tidal volume 6-8 Ⅱ kg, Fi0245% ~ '70% 2 Results In this group of patients within 24h after diagnosis in the implementation of improved mechanical ventilation thereof, and the remaining 5 patients died. Discuss the cause of up to 10o 3 kinds of ARDS, but the infection and shock is the main reason. Long-term use in patients after renal transplantation immunosuppression, immunocompromised (especially T cell immune function), it is easy to Taiwan, and mixed infections with severe and often accompanied by shock; renal transplant patients after 6 months is the most important period, patients often fatal in this time of infection. ARDS caused by pathogens for infection, the bacteria and fungi are the most common pathogens of pulmonary infection was reported 51 cases of autopsy kidney transplant recipients, 23 cases (45%) had systemic fungal infection. Furthermore, it was reported that a group of 51 patients with untreated CMV infection in renal transplant recipients up to 6o%, renal transplantation of Pneumocystis carinii infection rates can be up to 3o%, so that the ARDS after kidney transplantation is due to mixed infection caused severe . Early investigation of such cases should be cultured arterial blood gases and pathogens in order to obtain a basis for early diagnosis, once suspected should also be anti-infective, anti-fungal and anti-viral combination therapy, without having to check the results of other pathogens. Occurred in this group of patients to serious infections stick units, of which 6 patients 3 months after onset, accounting for 75%. Mainly for heating (mostly fever), cough, breathing difficulties, due to early diagnosis of failure to do so, vote in a given triple therapy as soon as possible, unable to control infection caused by removal of the cause of ARDS, leading to higher mortality rate. ARDS occurred in all patients after cyclosporine were not disabled, but by the blood concentration of the lowest maintenance dose, both to prevent rejection and avoid over-immunosuppression reduced resistance to infection, but should be discontinued azathioprine or mycophenolate noted, disable use of prednisone methylprednisolone pulse therapy, per day 2130-400nag. Once after renal transplantation can not correct hypoxemia and pulmonary edema can be ruled out early implementation of mechanical ventilation should be the first method can be used continuous positive airway pressure mask therapy or high-frequency jet ventilation, such as the trachea immediately inserted it does not work control the implementation of mechanical ventilation, according to the disease can be volume or pressure control mode, the condition has become stable to intermittent mandatory ventilation (SIMV) or pressure support ventilation (PSV); positive end expiratory pressure (PEEP) is the treatment of hypoxemia One effective means, so all models need to be coupled with PEEP, PEEP can promote alveolar recruitment and prevent alveolar collapse, so to maintain end-expiratory alveolar reexpansion in the state, on the one hand increase the functional residual capacity, improve ventilation, blood flow ratio, reduced intrapulmonary shunt and improve lung compliance, while preventing the collapse of the alveolar reexpansion during repeated shear force, reducing the likelihood of barotrauma; when PEEP levels exceeding the minimum required for reexpansion pulmonary alveolar pressure, will cause alveolar over-expanded, so that compliance deteriorated; if less difficult to maintain when a large number of collapsed lung re-expansion state, ventilation / perfusion ratio is difficult to improve,[link widoczny dla zalogowanych], it should look for the pressure, PEEP pressure used 5 ~ 15cmH2O In addition, as can be ventilated ARDS patients significantly reduced alveolar volume (alveolar hyperinflation and high pressure, prone to cause deterioration of barotrauma to the lung injury, it should be lower than 9ml/kg tidal volume. The case fatality rate in this group was higher (62.5%), and failed to timely diagnosis, infection control and mechanical ventilation time later on. Hypoxia has been reported in less than 30h are, after active treatment significantly improved survival rate, it is to reduce mortality, need to give attention to all aspects of the above. [
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