| 170 | 3 | 82 |
| 下载次数 | 被引频次 | 阅读次数 |
本研究旨在分析并发呼吸衰竭的艾滋病(acquired immune deficiency syndrome,AIDS)合并卡氏肺孢子菌肺炎(Pneumocystis carinii pneumonia,PCP)患者的临床特点、影像学表现以及治疗情况。回顾性分析我院呼吸内科和感染科2016年1月至2016年7月确诊的AIDS合并PCP患者中以呼吸衰竭为首发症状的21例患者的临床资料,包括病史、体征、实验室检查、胸部CT检查、治疗及预后等资料,并进行分析和总结。21例患者中氧合指数(oxygenation index,OI)大于300 mm Hg 3例,201~300 mm Hg 9例,101~200 mm Hg 7例,小于100 mm Hg 2例。主要治疗措施:21例患者均口服复方磺胺甲噁唑(compound sulfamethoxazole,SMZco)(100%),18例给予糖皮质激素(85.7%),16例给予呼吸机辅助呼吸(76.2%),其中无创呼吸机11例,有创呼吸机5例,观察无创通气治疗前及治疗后2 h、24 h、72 h OI的变化情况,治疗24 h、72 h后OI均较治疗前明显改善(p<0.05),而且治疗后72 h OI较治疗后2 h进一步改善(p<0.05)。21例患者中16例病情得到明显缓解,2例病情恶化死亡,3例自动出院,死亡患者OI均在100 mm Hg以下。AIDS合并PCP常有典型的临床特点、实验室指标与胸部影像学表现,血气分析能够帮助判断病情严重程度,尽早明确诊断并给予SMZco治疗,对于吸氧后OI仍然在300 mm Hg以下的患者应给予糖皮质激素及呼吸支持治疗,大部分可临床缓解。
Abstract：In order to study and summarize the clinical feature, chest radiograph feature and treatment of acquired immune deficiency syndrome(AIDS) combined with Pneumocystis carinii pneumonia(PCP) of the respiratory failure. A retrospective analysis of the clinical data of 21 patients with respiratory failure as the first symptom in patients with AIDS complicated with PCP in our hospital from January 2016 to July 2016 were studied prospectively, including history, signs, laboratory tests, chest CT examination, treatment and prognosis, et al. In 21 patients, oxygenation index greater than 300 mm Hg 3 cases, 201~300 mm Hg 9 cases, 101~200 mm Hg 7 cases,below 100 mm Hg in 2 cases. The main treatment measures: compound sulfamethoxazole(SMZco) in 21 cases, glucocorticoid in 18 cases, ventilator assisted breathing in 16 cases, among them, the noninvasive ventilator in 11 cases, 5 cases of invasive ventilator, we observed oxygenation index(OI) changes before and after treatment for 2 h,24 h, 72 h through noninvasive or invasive mechanical ventilation treatment. OI of after treatment for 2 h, 24 h,72 h ameliorated than that of before(p<0.05), and compared with treatment 2 h, OI of 72 h after treatment further improved(p<0.05), 16 cases improved, 2 cases died, 3 cases discharged. The oxygenation index of death patients is below 100 mm Hg. AIDS and PCP often have the clinical manifestations, laboratory indexes and the typical imaging. Blood gas analysis can help to judge the severity of the disease. AIDS combined with PCP should be diagnosed and treated with SMZco as soon as maybe. The patients, whose oxygen index(below 300 mm Hg) was not significantly improved through the oxygen, should be treated with glucocorticoid and ventilator. Most of them could alleviate.
Burack J.H.,Hahn J.A.,Sain-t Maurice D.,and Jacobson M.A.,1994,Microbiology of community-acquired bacterial pneumonia in persons with and at risk for human immunodeficiency virus type 1 infection.Implications for rational empiric antibiotic therapy,Arch.Intern.Med.,154(22):2589-2596
Calderon E.J.,Gutirrez-Rivero S.,Durand-Joly I.,and Dei-Cas E.,2010,Pneumocystis infection in humans:diagnosis and treatment,Expert.Rev.Anti.Infect.Ther.,8(6):683-701
He S.H.,Zhou R.F.,Liu D.F.,Cai L.,Wang Y.,Zhou X.F.,Zhang Y.,Zhang C.L.,Liu X.X.,and Zhang Y.,2014,AIDS patients with opportunistic infections in Sichuan province:clinical analysis of 1 465 cases,Chongqing Yixue(Chongqing Medicine),43(5):592-593(何盛华,周锐锋,刘大凤,蔡林,王印,周晓飞,张毅,张春兰,刘晓霞,张峣,2014,四川地区1465例艾滋病患者机会性感染分析,重庆医学,43(5):592-593)
Huang X.T.,Jiang S.X.,Liu B.,Li Q.,Liang X.M.,and Tan W.,2014,CT imaging diagnosis of Pneumocystis carinii pneumonia in patients with AIDS,Jianyanyixue Yu Linchuang(Laboratory Medicine and Clinic),11(10):1358-1359(黄兴涛,蒋世曦,柳彬,李琦,梁秀梅,谭炜,2014,艾滋病合并卡氏肺孢子菌肺炎的CT影像分析,检验医学与临床,11(10):1358-1359)
Li C.,and Liang X.,2009,The effect of glucocortlcoids on Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome,Zhongguo Shiyong Yiyao(China Practical Medical),4(16):22-24(黎灿,梁欣,2009,糖皮质激素在艾滋病合并卡氏肺孢子菌肺炎中的应用,中国实用医药,4(16):22-24)
Li T.D.,Li W.Q.,and Xiao Y.J.,2013,The efficacy observation of noninvasive positive pressure ventilation in treatment of respiratory failure caused by Pneumocystis pneumonia in AIDS patients,Sichuan Yixue(Sichuan Medical Journal),34(11):1673-1675(李廷东,李文全,肖迎军,2013,艾滋病合并肺孢子菌肺炎所致呼吸衰竭应用无创正压通气疗效观察,四川医学,34(11):1673-1675)
Liu P.Y.,and An C.L.,2014,The pneumocystis antigen and bacterial components for the diagnosis of Pneumocystis pneumonia,Zhongguo Weishengtaixue Zazhi(Chinese Journal of Microecology),26(4):471-474(刘鹏月,安春丽,2014,肺孢子菌肺炎辅助诊断方法研究进展,中国微生态学杂志,26(4):471-474)
Society of Critical Care Medicine,Chinese Medical Association,2007,Guidelines for management of acute lung injury/acute respiratory distress syndrome:an evidence-based update by the Chinese Society of Critical Care Medicine(2006)Chinese,Zhonghua Jizhen Yixue Zazhi(Chinese Journal of Emergency Medicine),16(1):1-6(中华医学会重症医学分会,2007,急性肺损伤/急性呼吸窘迫综合征诊断与治疗指南(2006),中华急诊医学杂志,16(1):1-6)
Xie Z.P.,and Dai F.,2013,MSCT features and differential diagnosis of Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome,Zhonghua Yiyuan Ganranxue Zazhi(Chinese Journal of Nosocomiology),23(23):5674-5676(谢正平,戴峰,2013,艾滋病患者卡氏肺孢子菌肺炎的多排螺旋CT表现及鉴别诊断,中华医院感染学杂志,23(23):5674-5676)
基本信息:
DOI：10.13417/j.gab.036.003302
中图分类号:R512.91;R519.8;R563.8
引用信息:
[1]曾鸣,刘丹,江兵,等.艾滋病合并卡氏肺孢子菌肺炎并发呼吸衰竭21例临床分析[J].基因组学与应用生物学,2016,35(12):3302-3307.DOI:10.13417/j.gab.036.003302.
基金信息:
重庆市卫生计生委医学科研基金项目(20142060)资助
2016-12-25
2016-12-25