本文關(guān)鍵詞： 妊娠 肺結(jié)核 IGRA　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：總結(jié)妊娠期肺結(jié)核的臨床特點、診斷及治療方式，歸納妊娠期肺結(jié)核的臨床診斷思路，為妊娠期肺結(jié)核診斷和治療提供根據(jù)。 方法：回顧性分析重慶醫(yī)科大學(xué)附屬第一醫(yī)院呼吸內(nèi)科2011年01月~2014年02月期間入院并確診為妊娠期肺結(jié)核患者（共23例）的臨床資料、實驗室檢查及治療方案，并對所有患者電話隨訪治療效果，將收集的數(shù)據(jù)進行相應(yīng)的統(tǒng)計學(xué)分析。 結(jié)果： 1、本組患者年齡19-34歲（平均26.70±3.87歲），孕周7+4-25+1周，5例為早期妊娠（21.74%），18例為中期妊娠（78.26%）。 2、23例患者中，有5例存在白蛋白輕度缺乏（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例患者存在輕度貧血（60.87%），8例患者存在中度貧血（34.78%）。 3、23例患者中，有18例存在反復(fù)發(fā)熱（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例存在潮熱、盜汗（26.08%），1例存在咯血（4.35%），2例存在體重減輕（8.70%）。 4、23例患者中，有19例存在呼吸衰竭（82.61%），其中3例為急性呼吸窘迫綜合征（13.04%）。有18例存在結(jié)核性胸膜炎（78.26%），有4例合并肺外結(jié)核（17.39%）。 5、23例患者中，有19例患者行胸部CT檢查。其中5例為血行播散型肺結(jié)核（26.32%），14例為浸潤性肺結(jié)核（73.68%）。 6、23例患者中，有7例結(jié)核抗體陽性（30.44%），有9例痰找抗酸桿菌陽性（39.13%）；有17例患者行PPD皮試，其中6例PPD皮試陽性（34.78%）； 7、23例患者中，有22例接受抗結(jié)核化療（95.65%），在可隨訪到的19例長期抗結(jié)核化療患者中，有4例患者出現(xiàn)胃腸道反應(yīng)（21.53%），1例患者出現(xiàn)肝功能損害（5.23%），7例出現(xiàn)高尿酸血癥（36.84%）。 8、23例患者中，有2例患者失訪（8.70%），1例住院期間因治療無效死亡（4.35%），1例放棄治療出院后死亡（4.35%），5例患者正在抗結(jié)核化療，病情好轉(zhuǎn)（21.74%）；13例患者經(jīng)正規(guī)抗結(jié)核治療后痊愈（56.52%）。 結(jié)論： 1、妊娠期肺結(jié)核發(fā)病時間以孕中期為主； 2、大部分患者存在程度不等的低蛋白血癥及貧血，提示蛋白質(zhì)能量營養(yǎng)不良； 3、妊娠期肺結(jié)核主要表現(xiàn)為發(fā)熱、遷延不愈的咳嗽、咳痰，，典型結(jié)核中毒癥狀較少見； 4、妊娠期肺結(jié)核實驗室檢查結(jié)果PPD皮試、結(jié)核抗體、痰找抗酸桿菌陽性率低，其診斷主要依賴于影像學(xué)表現(xiàn)； 5、妊娠期肺結(jié)核中，重型肺結(jié)核較多見，肺外結(jié)核發(fā)病率高，常合并呼吸衰竭、結(jié)核性胸膜炎； 6、妊娠期肺結(jié)核正規(guī)抗結(jié)核化療后治愈率高。
[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 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.253

【參考文獻】

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本文編號：1445008