Clinical effects of noninvasive positive pressure ventilation on patients with Cytomegaloviral pneumonia after kidney transplantation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LUO Yifeng ,  XIE Canmao , ZENG Mian , HUANG Jianqiang , TANG Kejing , GUAN Kaiban

Department of Respiratory &;
Critical Care Medicine，The First Affiliated Hospital of Sun Yat-Sen university Guangzhou，Guangdong，510080，China Corresponding author：XIE Can—mao，E—mail：xiecanmao@ 163.com;

Corresponding?author：

XIE Canmao, Email: xiecanmao@163.com

Keywords：

Kidney transplantation; Cytomegaloviral pneumonia; Non-invasive positive pressure ventilation

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目的研究無創通氣(NIPPV)治療對腎移植術后巨細胞病毒(CMV)肺炎患者的療效。方法 1998年1月~2005年12月間入住中山大學附屬第一醫院內科重癥監護病房(MICU)的78例腎移植術后CMV肺炎患者，根據是否接受無創通氣治療而分為非NIPPV組和NIPPV組，比較兩組患者在接受有創機械通氣比例、病死率、住院時間及并發癥等方面的差異。對52例NIPPV組患者，比較無創通氣治療前后生命體征及血氣分析指標的變化。結果 NIPPV組與非NIPPV組相比，接受有創機械通氣比例(30.8％比80.8％)、醫院獲得性肺炎發生率（32.7％比61.5％)及病死率(30.8％比57.7％)較低，兩組比較均有顯著性差異(P均 lt;0.05)；而住院時間、氣壓傷發生率無顯著差異。NIPPV組患者無創通氣治療后患者呼吸頻率有所減慢，動脈血pH值逐漸降低，PaCO2水平緩慢上升，PaO2、PaO2 ／FiO2及SaO2明顯升高，兩組比較均有顯著差異(P均 lt;0.05)。而無創通氣治療前后心率、血壓的變化則無明顯規律。結論 NIPPV治療能夠改善腎移植術后CMV肺炎患者的低氧血癥，緩解呼吸窘迫癥狀，降低有創機械通氣治療比例及醫院獲得性肺炎的發生率，從而降低病死率。用無創通氣治療巨細胞病毒肺炎值得在臨床上推廣使用。

Citation： LUO Yifeng,XIE Canmao,ZENG Mian,HUANG Jianqiang,TANG Kejing,GUAN Kaiban. Clinical effects of noninvasive positive pressure ventilation on patients with Cytomegaloviral pneumonia after kidney transplantation. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(6): 431-434. doi: Copy

1.	Capulong MG，Mendoza M，Chavez J．Cytomegalovirus pneumonia in renal transplant patients．Transplant Proc，1998，30：3151-3153.
2.	曾祥毅，王小平，張瓊，等．雙水平無創正壓通氣對急性肺損傷的治療價值．中國呼吸與危重監護雜志，2006，5：432-434.
3.	Ljungman P,Grifiths P,Paya C.Definitions of cytomegalovirus infection and disease in transplant recipients．Clin Infect Dis，2002，34 ：1094-1097.
4.	Yang CW，Kim YO，Kim YS，et al．Clinical course of cytomegalovirus with and without ganciclovir treatment in CMV sero-positive kidney transplant recipients．Am J Nephrol．1998．18：373-378.
5.	燕航，薛武軍，田普訓．腎移植術后巨細胞病毒肺炎的診治．中華器官移植雜志，2001，22：298-300.
6.	Meduri CU，Cook TR，Turner RE，et al．Noninvasive Positive pressure ventilation in status asthmatics．Chest，1996．110：774 6 7 Hotchkiss JR，Marini JJ．Noninvasive ventilation：an emerging supportive technique for the emergency department．Ann Emerg Med，1998，32：470- 490.
7.	HoreCT．Non-invasive positive pressure ventilation in patients with acute respiratory failure．Emerg Med(Fremantle)，2002，14：281-296. 9 鄺健誼，陳境第，曾勉，等．進展期SARS與巨細胞病毒肺部感染的影像學研究．放射學實踐，2OO4，19：875—878.
8.	An toneLli M，Conti G，Buf M，et al．Noninvasive ventilation for treatment of acute resporstory failure in patients undergoing solid organ transplantation： a randomized tria1．JAMA，2000，283：235 -241.
9.	Hilbert G，Gruson D，Vargans F，et al Noninvasive ventilation in inanuno- suppressed patients with pulmonary infiltrates，fever，and acute respiratory failure．N Engl J Med，2001，344：481-487.
10.	Carlacei A，Richard JC，Wysocki M，et al．NIV versus conventional meehanical ventilatioru Am J Respir Crit Care Med，2001，163：874-880.
11.	Confalonieri M ，Potena A，Carbone G，et al．Acute respiratory failure in patients with severe community-acquired pneumonia A prospective randomized evaluation of noninvasive ventilation．Am J Respir Crit Care Med，1999，160：1585-1591.
12.	Antonelli M，Pennisi MA，Conti G New advances in the use of noninvasive ventilation for acute hypoxemie respiratory failure．Eur Respir J，2003，42：65S-71S.
13.	張鵬宇，周新，金先橋，等．無創機械通氣在腎移植術后重癥肺部感染合并急性呼吸衰竭中的應用．中國呼吸與危重監護雜志，2006，5： 260-263.
14.	KramerN，Meyer TJ，Meharg J．Randomized，Prospective trial of noninvasive positive pressure ventilation in acute respiratory failure．Am J Respir Crit Care Med．1995，151：1799—1806．.

1. Capulong MG，Mendoza M，Chavez J．Cytomegalovirus pneumonia in renal transplant patients．Transplant Proc，1998，30：3151-3153.
2. 曾祥毅，王小平，張瓊，等．雙水平無創正壓通氣對急性肺損傷的治療價值．中國呼吸與危重監護雜志，2006，5：432-434.
3. Ljungman P,Grifiths P,Paya C.Definitions of cytomegalovirus infection and disease in transplant recipients．Clin Infect Dis，2002，34 ：1094-1097.
4. Yang CW，Kim YO，Kim YS，et al．Clinical course of cytomegalovirus with and without ganciclovir treatment in CMV sero-positive kidney transplant recipients．Am J Nephrol．1998．18：373-378.
5. 燕航，薛武軍，田普訓．腎移植術后巨細胞病毒肺炎的診治．中華器官移植雜志，2001，22：298-300.
6. Meduri CU，Cook TR，Turner RE，et al．Noninvasive Positive pressure ventilation in status asthmatics．Chest，1996．110：774 6 7 Hotchkiss JR，Marini JJ．Noninvasive ventilation：an emerging supportive technique for the emergency department．Ann Emerg Med，1998，32：470- 490.
7. HoreCT．Non-invasive positive pressure ventilation in patients with acute respiratory failure．Emerg Med(Fremantle)，2002，14：281-296. 9 鄺健誼，陳境第，曾勉，等．進展期SARS與巨細胞病毒肺部感染的影像學研究．放射學實踐，2OO4，19：875—878.
8. An toneLli M，Conti G，Buf M，et al．Noninvasive ventilation for treatment of acute resporstory failure in patients undergoing solid organ transplantation： a randomized tria1．JAMA，2000，283：235 -241.
9. Hilbert G，Gruson D，Vargans F，et al Noninvasive ventilation in inanuno- suppressed patients with pulmonary infiltrates，fever，and acute respiratory failure．N Engl J Med，2001，344：481-487.
10. Carlacei A，Richard JC，Wysocki M，et al．NIV versus conventional meehanical ventilatioru Am J Respir Crit Care Med，2001，163：874-880.
11. Confalonieri M ，Potena A，Carbone G，et al．Acute respiratory failure in patients with severe community-acquired pneumonia A prospective randomized evaluation of noninvasive ventilation．Am J Respir Crit Care Med，1999，160：1585-1591.
12. Antonelli M，Pennisi MA，Conti G New advances in the use of noninvasive ventilation for acute hypoxemie respiratory failure．Eur Respir J，2003，42：65S-71S.
13. 張鵬宇，周新，金先橋，等．無創機械通氣在腎移植術后重癥肺部感染合并急性呼吸衰竭中的應用．中國呼吸與危重監護雜志，2006，5： 260-263.
14. KramerN，Meyer TJ，Meharg J．Randomized，Prospective trial of noninvasive positive pressure ventilation in acute respiratory failure．Am J Respir Crit Care Med．1995，151：1799—1806．.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical effects of noninvasive positive pressure ventilation on patients with Cytomegaloviral pneumonia after kidney transplantation

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