论文部分内容阅读
急性栗粒性肺结核(简称MTB)是成人呼吸窘迫综合征(简称ARDS)的罕见病因,Dyer报道共占收入监护病房的所有ARDS病例的2％。最近我们收治2例,现报道及复习文献如下。 病例1:患者女性,23岁,因顺产一女婴后发热,气促,干咳2天转内科治疗。4年前因发热,关节痛,浮肿,面部蝶形红斑,血中找到狼疮细胞而确诊为系统性红斑狼疮,一直用皮质激素及免疫抑制剂治疗。入院前2个月在外院发现左胸积液,未作规则抗结核治疗,诊断为“狼疮性胸积液”。体检:T37.4℃,BP110/72mmHg、R46次/分。呼吸困难,肢端及口唇轻度发绀。双肺呼吸音粗,散在中、小水泡音。左中、下肺呼吸音明显减弱,心率122次/分,律整,未闻器质性杂音。肝肋下1.5cm,脾未扪及。胸片:左侧中量积液伴胸膜增厚,双肺广泛小片状浸润(图1,见插页)。血气分析(鼻导管吸氧,流量2L/min):pH7.342,PaCO_24.05KPa,PaO_28.32KPa。SR100mm/h,Hb7.9g,RBC266万,WBC8,800,分叶92％,
Acute chestnut tuberculosis (MTB) is a rare cause of adult respiratory distress syndrome (ARDS), accounting for 2% of all ARDS cases admitted to the intensive care unit. Recently, we received 2 cases are reported and review the literature are as follows. Case 1: Female patient, 23 years old, due to a baby after childbirth fever, shortness of breath, dry cough 2 days to medical treatment. 4 years ago due to fever, joint pain, edema, facial butterfly erythema, blood found in lupus cells and diagnosed with systemic lupus erythematosus, has been treated with corticosteroids and immunosuppressive agents. Two months prior to admission, left thoracic fluid was found in the hospital and no anti-TB treatment was given. The diagnosis was “lupus pleural effusion.” Physical examination: T37.4 ℃, BP110 / 72mmHg, R46 times / min. Dyspnea, mild cyanosis of extremities and lips. Breath sounds coarse lungs, scattered, small blisters sound. Left, lower lung breath sounds significantly weakened, heart rate 122 beats / min, law, did not smell organic murmur. Liver ribs 1.5cm, the spleen is not palpable. Chest X-ray: the left middle volume effusion with pleural thickening, lung extensive small piece infiltration (Figure 1, see insert). Blood gas analysis (nasal catheter oxygen, flow 2L / min): pH7.342, PaCO_24.05KPa, PaO_28.32KPa. SR100 mm / h, Hb7.9 g, RBC26.6 million, WBC8,800, leaf 92%