肺炎克雷伯菌肝脓肿并脓毒性肺栓塞的临床特点、影像学特征及治疗预后分析

发布时间：2018-08-30 16:35

【摘要】：目的探讨肺炎克雷伯菌肝脓肿并脓毒性肺栓塞的临床特点、影像学特征、治疗及预后。方法回顾性分析2012年1月至2017年1月厦门大学附属东南医院收治的肺炎克雷伯菌肝脓肿并脓毒性肺栓塞患者的临床资料。结果共纳入8例肺炎克雷伯菌肝脓肿并脓毒性肺栓塞患者。所有患者出现发热,呼吸道症状5例,无胸痛、无咯血,腹部压痛2例,眼内炎1例,2型糖尿患者7例。生化检测指标中,降钙素原升高最为明显。8例患者微生物培养均为肺炎克雷伯菌。胸部CT表现为外周结节影(或伴空洞)、外周楔形浸润影、滋养血管征、胸腔积液和片状浸润影。住院期间1例患者最终恶化为急性呼吸衰竭,并死于呼吸窘迫综合征和(或)脓毒性休克;1例自动出院;6例好转治愈。结论肺炎克雷伯菌肝脓肿并脓毒性肺栓塞患者临床表现无特异性,误诊率高;胸部CT影像主要特点为外周结节影(或伴空洞)、外周楔形浸润影及滋养血管征。密切结合临床及原发疾病(肝脓肿)有助于诊断及鉴别诊断。
[Abstract]:Objective to investigate the clinical features, imaging features, treatment and prognosis of Klebsiella pneumoniae liver abscess with septic pulmonary embolism. Methods the clinical data of patients with Klebsiella pneumoniae liver abscess and septic pulmonary embolism treated in Southeast Hospital affiliated to Xiamen University from January 2012 to January 2017 were retrospectively analyzed. Results eight patients with Klebsiella pneumoniae liver abscess and septic pulmonary embolism were included. All patients had fever, respiratory symptoms in 5 cases, no chest pain, no hemoptysis, abdominal tenderness in 2 cases, endophthalmitis in 1 case and type 2 diabetes in 7 cases. Among the biochemical indexes, calcitonin increased significantly in microorganism culture of 8 patients with Klebsiella pneumoniae. Chest CT showed peripheral nodular shadow (or with cavity), peripheral wedge-shaped infiltrating shadow, trophovascular sign, pleural effusion and flaky infiltrating shadow. During hospitalization, one case of acute respiratory failure deteriorated and died of respiratory distress syndrome and / or septic shock. One case was discharged automatically and 6 cases were cured. Conclusion the clinical manifestation of Klebsiella pneumoniae liver abscess with septic pulmonary embolism is nonspecific and the misdiagnosis rate is high. The main features of chest CT imaging are peripheral nodular shadow (or with cavity), peripheral wedge-shaped infiltrating shadow and nourishing vascular sign. Close combination of clinical and primary diseases (liver abscess) is helpful for diagnosis and differential diagnosis.
【作者单位】：厦门大学附属东南医院(解放军一七五医院)呼吸结核科;
【分类号】：R563

【相似文献】