本文關鍵詞： 免疫健全宿主 重癥肺炎 巨細胞病毒感染　出處：《中國呼吸與危重監(jiān)護雜志》2015年05期 　論文類型：期刊論文

【摘要】：目的總結免疫健全者重癥肺炎后活動性巨細胞病毒感染的臨床特征和診治要點。方法報告2例于我院呼吸重癥監(jiān)護病房診治的基礎免疫健全宿主重癥肺炎后巨細胞病毒活動性感染病例,并結合文獻資料對該病的危險因素、臨床特征和診治要點進行分析。結果 2例患者均為老年患者,因"重癥肺炎、Ⅰ型呼吸衰竭"入住我科,經(jīng)有創(chuàng)機械通氣、廣譜抗生素抗感染、激素抗炎及支持治療后體溫正常,氧合改善,肺部滲出影吸收好轉(zhuǎn),成功脫機拔管。之后患者氧合進一步改善不明顯,且肺部滲出影進展,外周血巨細胞病毒DNA轉(zhuǎn)陽,加用更昔洛韋抗病毒治療后氧合改善,肺部滲出影吸收。結合文獻資料,在基礎免疫健全者,重癥肺炎后出現(xiàn)活動性巨細胞病毒感染的危險因素包括有創(chuàng)機械通氣、糖皮質(zhì)激素應用;臨床特征為氧合惡化、肺部滲出影增多,而普通細菌、真菌培養(yǎng)無陽性發(fā)現(xiàn);診斷試驗包括外周血巨細胞病毒定量核酸擴增試驗、巨細胞病毒pp65抗原檢測和組織病理學檢查;治療方法推薦纈更昔洛韋片口服或更昔洛韋靜脈滴注,療程至少2周。結論巨細胞病毒活動性感染在基礎免疫功能正常的危重癥患者中頻發(fā),對于原發(fā)疾病為重癥肺炎、接受有創(chuàng)機械通氣及應用糖皮質(zhì)激素的患者,需警惕巨細胞病毒肺炎的發(fā)生,及早診斷并給予相應的治療,可改善該類患者的預后。
[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熀紜，

本文編號：1464826