本文選題：肺毛霉病 + 臨床特點��； 參考：《中國呼吸與危重監(jiān)護雜志》2017年02期

【摘要】：目的探討肺毛霉病(PM)的臨床特點和治療措施,提高醫(yī)務(wù)人員對該病的認識,降低病死率。方法回顧性分析濟寧醫(yī)學(xué)院附屬醫(yī)院呼吸科收治的2例PM患者的病歷資料,同時進行相關(guān)文獻復(fù)習(xí)。以"肺毛霉菌病"為檢索詞檢索中國知網(wǎng)(CNKI)數(shù)據(jù)庫,以"pulmonary mucormycosis"為檢索詞檢索Pubmed數(shù)據(jù)庫,檢索時間為2000年1月到2016年6月。結(jié)果患者1,男性,2014年2月7日以"咳嗽、咳痰伴憋喘5 d"收入院。胸部計算機斷層成像(CT)提示:右肺上葉結(jié)節(jié),鄰近右肺上葉尖段支氣管截斷。2014年2月16日行電子支氣管鏡檢查,活檢病理組織中見毛霉菌,確診后給予兩性霉素B治療好轉(zhuǎn)出院�；颊�2,女性,2015年1月16日以"咳嗽、咳痰伴發(fā)熱10+d"收入院。胸部CT示雙肺紋理增強、紊亂,雙肺內(nèi)見多發(fā)大小不等的圓形結(jié)節(jié)、空洞,邊界清楚,其中最大空洞直徑約1.8 cm,部分空洞內(nèi)見軟組織密度影。行CT引導(dǎo)下肺穿刺,穿刺病理組織回示大部分為壞死性肉芽組織,其中見真菌菌絲,符合毛霉菌感染。確診后給予兩性霉素B、伏立康唑、泊沙康唑治療,效果欠佳,患者自動出院,1周后死亡。文獻檢索經(jīng)過嚴格篩選,最終收集病歷資料完整的6篇文獻進行PM臨床特點及治療措施的歸納總結(jié)。PM患者臨床表現(xiàn)無特異性,多合并基礎(chǔ)疾病,從出現(xiàn)癥狀到確診約需要37.5 d。CT以及組織病理學(xué)檢查有助于早期診斷,及時抗真菌治療有助于改善預(yù)后。結(jié)論 PM是一種罕見的侵襲性真菌病,病死率高,臨床表現(xiàn)無特異性,早期診斷、及時治療是降低病死率的關(guān)鍵。
[Abstract]:Objective to explore the clinical characteristics and treatment of pulmonary trichoderma (PMM), to improve the medical staff understanding of the disease and to reduce the mortality. Methods the medical records of 2 cases of PM in the Department of Respiratory, affiliated Hospital of Jining Medical College were analyzed retrospectively and the related literatures were reviewed. Using "Pulmonary Mucor Disease" as the key word to search the CNKI database of China, and "pulmonary mucormycosis" as the key word to search the Pubmed database, the retrieval time is from January 2000 to June 2016. Results patient 1, male, was admitted to the hospital on February 7, 2014 with "cough, expectoration and asthma for 5 days". Chest computed tomography (CT) showed that the right superior lobe nodule, adjacent to the apical segment of the right lung, was truncated. Electronic bronchoscopy was performed on February 16, 2014. Mucor was found in the pathological tissue of the biopsy. After diagnosis, amphotericin B was given for better discharge. Patient 2, female, admitted to hospital on January 16, 2015 with "cough, expectoration and fever for 10 days". Chest CT showed enhanced and disordered bilateral lungs with multiple round nodules of varying sizes and clear borders. The maximum diameter of the cavity was about 1.8 cm, and soft tissue density was found in some of the cavities. Lung puncture guided by CT showed that most of them were necrotic granulation tissue, mycelium was found, which was consistent with Mucor infection. The patients were treated with amphotericin B, volconazole and posaconazole. Literature Retrieval after strict screening, 6 articles with complete medical records were collected to sum up the clinical characteristics and treatment measures of PM. The clinical manifestations of PM patients were nonspecific and complicated with basic diseases. About 37.5 d.CT and histopathological examination were needed from the onset of symptoms to diagnosis, and timely antifungal treatment was helpful to improve the prognosis. Conclusion PM is a rare invasive fungal disease with high mortality and no specificity in clinical manifestations. Early diagnosis and timely treatment are the key to reduce mortality.
【作者單位】： 濟寧醫(yī)學(xué)院;濟寧醫(yī)學(xué)院附屬醫(yī)院呼吸科;
【分類號】：R519

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本文編號：1909157