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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目的研究无创通气(NIPPV)治疗对肾移植术后巨细胞病毒(CMV)肺炎患者的疗效。方法 1998年1月~2005年12月间入住中山大学附属第一医院内科重症监护病房(MICU)的78例肾移植术后CMV肺炎患者，根据是否接受无创通气治疗而分为非NIPPV组和NIPPV组，比较两组患者在接受有创机械通气比例、病死率、住院时间及并发症等方面的差异。对52例NIPPV组患者，比较无创通气治疗前后生命体征及血气分析指标的变化。结果 NIPPV组与非NIPPV组相比，接受有创机械通气比例(30.8％比80.8％)、医院获得性肺炎发生率（32.7％比61.5％)及病死率(30.8％比57.7％)较低，两组比较均有显著性差异(P均 lt;0.05)；而住院时间、气压伤发生率无显著差异。NIPPV组患者无创通气治疗后患者呼吸频率有所减慢，动脉血pH值逐渐降低，PaCO2水平缓慢上升，PaO2、PaO2 ／FiO2及SaO2明显升高，两组比较均有显著差异(P均 lt;0.05)。而无创通气治疗前后心率、血压的变化则无明显规律。结论 NIPPV治疗能够改善肾移植术后CMV肺炎患者的低氧血症，缓解呼吸窘迫症状，降低有创机械通气治疗比例及医院获得性肺炎的发生率，从而降低病死率。用无创通气治疗巨细胞病毒肺炎值得在临床上推广使用。

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，张琼，等．双水平无创正压通气对急性肺损伤的治疗价值．中国呼吸与危重监护杂志，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，薛武军，田普训．肾移植术后巨细胞病毒肺炎的诊治．中华器官移植杂志，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 邝健谊，陈境第，曾勉，等．进展期SARS与巨细胞病毒肺部感染的影像学研究．放射学实践，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.	张鹏宇，周新，金先桥，等．无创机械通气在肾移植术后重症肺部感染合并急性呼吸衰竭中的应用．中国呼吸与危重监护杂志，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，张琼，等．双水平无创正压通气对急性肺损伤的治疗价值．中国呼吸与危重监护杂志，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，薛武军，田普训．肾移植术后巨细胞病毒肺炎的诊治．中华器官移植杂志，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 邝健谊，陈境第，曾勉，等．进展期SARS与巨细胞病毒肺部感染的影像学研究．放射学实践，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. 张鹏宇，周新，金先桥，等．无创机械通气在肾移植术后重症肺部感染合并急性呼吸衰竭中的应用．中国呼吸与危重监护杂志，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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