血行播散性肺结核合并急性呼吸窘迫综合征30例诊治分析

发布时间：2018-05-09 01:42

本文选题：结核病 + 血行播散性肺结核　；参考：《山东医药》2016年28期

【摘要】：目的总结血行播散性肺结核合并急性呼吸窘迫综合征(ARDS)的诊治经验。方法选择血行播散性肺结核合并ARDS患者30例,回顾性分析其临床资料,总结诊断及治疗方法。结果 30例血行播散性肺结核合并ARDS患者中7例既往有结核病史,均未进行正规抗结核治疗;2例曾行肾脏移植手术。患者均出现胸闷、气短及呼吸困难,并呈进行性加重,28例伴发热,25例伴咳嗽、咳痰,23例伴食欲减退、乏力及体质量降低。14例痰结核菌涂片阳性,20例痰或支气管肺泡灌洗液结核菌培养阳性,15例肺活检符合肺结核表现。氧分压(48.5±5.3)mmHg,二氧化碳分压(65.6±5.6)mmHg,氧合指数(210±25)mmHg。28例应用SHRZE(链霉素+异烟肼+利福平+乙胺丁醇+吡嗪酰胺)初治方案治疗,2例肾移植术后根据肾功能情况给予异烟肼、利福喷丁及莫西沙星的个体化方案治疗;均早期应用激素治疗,5例重症患者短期内应用大剂量激素治疗,并行机械通气治疗。5例重症患者中1例死亡,4例预后良好;其余25例中2例因放弃治疗而死亡,23例预后较好。结论血行播散性肺结核合并ARDS的诊断以痰结核菌涂片、胸部CT检查结合血气分析为主,肾上腺皮质激素、机械通气联合个体化抗结核治疗效果较好,重症患者预后较差。
[Abstract]:Objective to summarize the experience of diagnosis and treatment of disseminated pulmonary tuberculosis with acute respiratory distress syndrome (ARDS). Methods 30 patients with disseminated pulmonary tuberculosis complicated with ARDS were retrospectively analyzed and their diagnosis and treatment were summarized. Results among 30 patients with disseminated pulmonary tuberculosis complicated with ARDS, 7 had a history of tuberculosis and 2 had no regular anti-tuberculosis treatment. All the patients had chest tightness, shortness of breath and dyspnea, and 28 cases had progressive exacerbation, 25 cases with fever and cough, 23 cases with expectoration with anorexia. Lassitude and body mass decrease. 14 cases of sputum smear positive and 20 cases of sputum or bronchoalveolar lavage fluid positive culture of tuberculous bacilli 15 cases of lung biopsy accord with the pulmonary tuberculosis manifestation. The partial pressure of oxygen was 48.5 卤5.3 mm Hg, the partial pressure of carbon dioxide was 65.6 卤5.6 卤5.6 mm Hg, the oxygenation index was 210 卤25)mmHg.28, and the initial treatment regimen of streptomycin isoniazid rifambutylamine pyrazinamide was used to treat 2 patients with isoniazid according to the renal function after renal transplantation. The individual regimen of rifapentine and moxifloxacin was used in the early treatment of 5 patients with severe diseases and 5 patients with severe diseases in a short period of time. The prognosis was good in 1 case of death and 4 cases of death in 5 cases of severe patients treated with mechanical ventilation. Among the remaining 25 cases, 2 cases died because of giving up treatment and 23 cases had better prognosis. Conclusion the diagnosis of disseminated pulmonary tuberculosis combined with ARDS is sputum smear, chest CT examination and blood gas analysis. The effect of corticosteroid, mechanical ventilation and individualized antituberculosis therapy is better, and the prognosis of severe patients is poor.
【作者单位】：天津市海河医院;
【分类号】：R521;R563.8

【相似文献】