免疫健全者重症肺炎后巨细胞病毒感染两例并文献复习

发布时间：2018-01-26 05:37

  本文关键词： 免疫健全宿主 重症肺炎 巨细胞病毒感染　出处：《中国呼吸与危重监护杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的总结免疫健全者重症肺炎后活动性巨细胞病毒感染的临床特征和诊治要点。方法报告2例于我院呼吸重症监护病房诊治的基础免疫健全宿主重症肺炎后巨细胞病毒活动性感染病例,并结合文献资料对该病的危险因素、临床特征和诊治要点进行分析。结果 2例患者均为老年患者,因"重症肺炎、Ⅰ型呼吸衰竭"入住我科,经有创机械通气、广谱抗生素抗感染、激素抗炎及支持治疗后体温正常,氧合改善,肺部渗出影吸收好转,成功脱机拔管。之后患者氧合进一步改善不明显,且肺部渗出影进展,外周血巨细胞病毒DNA转阳,加用更昔洛韦抗病毒治疗后氧合改善,肺部渗出影吸收。结合文献资料,在基础免疫健全者,重症肺炎后出现活动性巨细胞病毒感染的危险因素包括有创机械通气、糖皮质激素应用;临床特征为氧合恶化、肺部渗出影增多,而普通细菌、真菌培养无阳性发现;诊断试验包括外周血巨细胞病毒定量核酸扩增试验、巨细胞病毒pp65抗原检测和组织病理学检查;治疗方法推荐缬更昔洛韦片口服或更昔洛韦静脉滴注,疗程至少2周。结论巨细胞病毒活动性感染在基础免疫功能正常的危重症患者中频发,对于原发疾病为重症肺炎、接受有创机械通气及应用糖皮质激素的患者,需警惕巨细胞病毒肺炎的发生,及早诊断并给予相应的治疗,可改善该类患者的预后。
[Abstract]:Objective to summarize the immune sound of severe pneumonia after active cytomegalovirus infection and clinical characteristics of diagnosis and treatment. Methods 2 cases of basic immunization in our hospital respiratory ICU treatment of severe pneumonia after perfect host CMV infection cases, and combined with the literature of the disease risk factors, clinical characteristics and treatment analysis the main points. Results 2 patients were elderly patients, because of severe pneumonia, type I respiratory failure "in our department, the invasive mechanical ventilation, broad-spectrum antibiotics, anti-inflammatory and hormone treatment and support normal body temperature, improve oxygenation, lung exudation absorbed, successful extubation after oxygenation. Further improvement is not obvious, and the progress of pulmonary infiltrates, peripheral blood CMV seroconversion to DNA, improve oxygenation combined with ganciclovir after lung exudation absorbed. Combined with the literature ,鍦ㄥ熀纭，

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