本文選題：結(jié)核病 + 血行播散性肺結(jié)核　； 參考：《山東醫(yī)藥》2016年28期

【摘要】：目的總結(jié)血行播散性肺結(jié)核合并急性呼吸窘迫綜合征(ARDS)的診治經(jīng)驗。方法選擇血行播散性肺結(jié)核合并ARDS患者30例,回顧性分析其臨床資料,總結(jié)診斷及治療方法。結(jié)果 30例血行播散性肺結(jié)核合并ARDS患者中7例既往有結(jié)核病史,均未進(jìn)行正規(guī)抗結(jié)核治療;2例曾行腎臟移植手術(shù)。患者均出現(xiàn)胸悶、氣短及呼吸困難,并呈進(jìn)行性加重,28例伴發(fā)熱,25例伴咳嗽、咳痰,23例伴食欲減退、乏力及體質(zhì)量降低。14例痰結(jié)核菌涂片陽性,20例痰或支氣管肺泡灌洗液結(jié)核菌培養(yǎng)陽性,15例肺活檢符合肺結(jié)核表現(xiàn)。氧分壓(48.5±5.3)mmHg,二氧化碳分壓(65.6±5.6)mmHg,氧合指數(shù)(210±25)mmHg。28例應(yīng)用SHRZE(鏈霉素+異煙肼+利福平+乙胺丁醇+吡嗪酰胺)初治方案治療,2例腎移植術(shù)后根據(jù)腎功能情況給予異煙肼、利福噴丁及莫西沙星的個體化方案治療;均早期應(yīng)用激素治療,5例重癥患者短期內(nèi)應(yīng)用大劑量激素治療,并行機械通氣治療。5例重癥患者中1例死亡,4例預(yù)后良好;其余25例中2例因放棄治療而死亡,23例預(yù)后較好。結(jié)論血行播散性肺結(jié)核合并ARDS的診斷以痰結(jié)核菌涂片、胸部CT檢查結(jié)合血氣分析為主,腎上腺皮質(zhì)激素、機械通氣聯(lián)合個體化抗結(jié)核治療效果較好,重癥患者預(yù)后較差。
[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 鹵5.3 mm Hg, the partial pressure of carbon dioxide was 65.6 鹵5.6 鹵5.6 mm Hg, the oxygenation index was 210 鹵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.
【作者單位】： 天津市海河醫(yī)院;
【分類號】：R521;R563.8

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