妊娠期肺结核23例临床分析

发布时间：2018-01-19 18:25

本文关键词： 妊娠肺结核 IGRA　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：总结妊娠期肺结核的临床特点、诊断及治疗方式，归纳妊娠期肺结核的临床诊断思路，为妊娠期肺结核诊断和治疗提供根据。方法：回顾性分析重庆医科大学附属第一医院呼吸内科2011年01月~2014年02月期间入院并确诊为妊娠期肺结核患者（共23例）的临床资料、实验室检查及治疗方案，并对所有患者电话随访治疗效果，将收集的数据进行相应的统计学分析。结果： 1、本组患者年龄19-34岁（平均26.70±3.87岁），孕周7+4-25+1周，5例为早期妊娠（21.74%），18例为中期妊娠（78.26%）。 2、23例患者中，有5例存在白蛋白轻度缺乏（21.74%），有14例存在白蛋白中度缺乏（60.87%），有3例患者存在白蛋白重度缺乏（12.04%）；有14例患者存在轻度贫血（60.87%），8例患者存在中度贫血（34.78%）。 3、23例患者中，有18例存在反复发热（78.26%），21例存在大于2周的咳嗽、咳痰（91.30%），15例存在胸痛（65.22%），6例存在潮热、盗汗（26.08%），1例存在咯血（4.35%），2例存在体重减轻（8.70%）。 4、23例患者中，有19例存在呼吸衰竭（82.61%），其中3例为急性呼吸窘迫综合征（13.04%）。有18例存在结核性胸膜炎（78.26%），有4例合并肺外结核（17.39%）。 5、23例患者中，有19例患者行胸部CT检查。其中5例为血行播散型肺结核（26.32%），14例为浸润性肺结核（73.68%）。 6、23例患者中，有7例结核抗体阳性（30.44%），有9例痰找抗酸杆菌阳性（39.13%）；有17例患者行PPD皮试，其中6例PPD皮试阳性（34.78%）； 7、23例患者中，有22例接受抗结核化疗（95.65%），在可随访到的19例长期抗结核化疗患者中，有4例患者出现胃肠道反应（21.53%），1例患者出现肝功能损害（5.23%），7例出现高尿酸血症（36.84%）。 8、23例患者中，有2例患者失访（8.70%），1例住院期间因治疗无效死亡（4.35%），1例放弃治疗出院后死亡（4.35%），5例患者正在抗结核化疗，病情好转（21.74%）；13例患者经正规抗结核治疗后痊愈（56.52%）。结论： 1、妊娠期肺结核发病时间以孕中期为主； 2、大部分患者存在程度不等的低蛋白血症及贫血，提示蛋白质能量营养不良； 3、妊娠期肺结核主要表现为发热、迁延不愈的咳嗽、咳痰，，典型结核中毒症状较少见； 4、妊娠期肺结核实验室检查结果PPD皮试、结核抗体、痰找抗酸杆菌阳性率低，其诊断主要依赖于影像学表现； 5、妊娠期肺结核中，重型肺结核较多见，肺外结核发病率高，常合并呼吸衰竭、结核性胸膜炎； 6、妊娠期肺结核正规抗结核化疗后治愈率高。
[Abstract]:Objective: to summarize the clinical characteristics, diagnosis and treatment of pulmonary tuberculosis complicating pregnancy, and summarize the clinical diagnosis and treatment of pulmonary tuberculosis complicating pregnancy, so as to provide basis for diagnosis and treatment of pulmonary tuberculosis complicating pregnancy. Methods: the clinical data of 23 cases of pulmonary tuberculosis complicating pregnancy were analyzed retrospectively from January 2011 to February 2014 in Department of Respiratory, Department of Respiratory, the first affiliated Hospital of Chongqing Medical University. Laboratory examination and treatment regimen, and all patients were followed up by telephone, the collected data were statistically analyzed. Results: 1. The age of the patients was 19-34 years old (mean 26.70 卤3.87 years old, gestational age 7 4-25 1 weeks, 5 cases were early pregnancy and 21.74 years old). 18 cases were second trimester pregnancy. 2Among 23 patients, 5 cases had mild albumin deficiency of 21.74%, and 14 cases had moderate albumin deficiency of 60.87%. There were 3 patients with severe albumin deficiency of 12.04g. There were 14 patients with mild anemia and 8 patients with moderate anemia. Of the 23 patients, 18 had recurrent fever 78.26m, 21 had cough more than 2 weeks, and 15 had chest pain (65.22). 6 cases had hot flashes, 1 case had hemoptysis 4.35% and 2 cases had weight loss 8.70%. Of the 23 patients, 19 had respiratory failure (82.61). Among them, 3 cases were acute respiratory distress syndrome, 18 cases had tuberculous pleurisy and 78.26 cases had tuberculous pleurisy, 4 cases had extrapulmonary tuberculosis and 17.39 cases had tuberculous pleurisy. Of the 23 cases, 19 cases were examined by chest CT, and 5 cases were treated with disseminated pulmonary tuberculosis 26.32% of which 14 cases were invasive pulmonary tuberculosis (73.68%). Of the 23 patients, 7 were positive for tuberculosis antibody and 39.13 for acid-fast bacilli in sputum. PPD skin test was performed in 17 patients, of which 6 were positive for PPD skin test. Of the 23 patients, 22 received antituberculous chemotherapy (95.65%), and 19 cases received long-term antituberculous chemotherapy. There were 4 cases of gastrointestinal reaction and 1 case of liver function damage. 7 cases had hyperuricemia and 36.84%. Of the 823 patients, 2 patients lost their visit and 1 died during hospitalization because of ineffective treatment. One patient died 4.35% after giving up treatment and was discharged from hospital. Five patients were undergoing anti-tuberculosis chemotherapy, and their condition was improved to 21.74%. 13 patients were cured after regular anti-tuberculosis therapy. Conclusion: 1. The onset time of pulmonary tuberculosis in pregnancy was mainly in the second trimester of pregnancy; 2, most patients have hypoproteinemia and anemia in varying degrees, suggesting protein energy malnutrition; 3The main manifestations of pulmonary tuberculosis in pregnancy are fever, persistent cough, expectoration, and typical tuberculosis poisoning symptoms are rare. 4. The positive rate of PPD skin test, tuberculosis antibody and sputum acid-fast bacilli was low, and its diagnosis depended mainly on the imaging findings. 5. In pregnancy, severe pulmonary tuberculosis is more common, the incidence of extrapulmonary tuberculosis is high, often associated with respiratory failure, tuberculous pleurisy; 6. The cure rate of normal anti-tuberculosis chemotherapy in pregnancy was high.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.253

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