大叶性干酪性肺炎78例临床分析

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1、大叶性干酪性肺炎78例临床分析【摘要】　　目的探讨大叶性干酪性肺炎的诊断与治疗方法。方法对我院近8年来收治的78例大叶性干酪性肺炎进行回顾分析。结果发病以青少年及50岁以上人群多见，多急性起病，发热症状较突出，血白细胞增多多见，痰菌阳性率较高，但PPD阳性率偏低，发病部位以上叶尖后段多发，多伴有空洞、含气支气管征及卫星播散病灶，病灶内钙化者少见。正规四联（HREZ或HRSZ）抗结核化疗后第1个月痰菌阴转10例（20.4%）；治疗第2个月痰菌阴转者28例（57.1%）；治疗第3个月阴转者7例（14.3%）；3个月以上阴转2例（6.1%）；

2、治疗3个月肺内病灶吸收好转47例（61.4%）；明显吸收好转23例（29.9%）；无变化7例（9.1%）。全疗程结束后空洞闭合25例（65.8%）；空洞未闭合者，综合临床及痰菌认定为净化性空洞者11例（28.9%）。结论干酪性肺炎临床与影像表现易与肺炎等肺部感染性疾病相混淆，综合医院要加强痰抗酸杆菌检查，必要时要行试验性抗结核治疗，正规的抗结核化疗加上适当的免疫支持治疗后效果好，具体疗程要根据空洞闭合、痰菌阴转及合并症的情况而定。【关键词】肺结核；干酪性肺炎；抗结核治疗　　　Abstract：ObjectiveTostudythedia

3、gnosisandthetreatmentofcaseouslobarpneumonia.MethodsAclinicalanalysiswasconductedin78inpatientswithcaseouslobar10pneumoniaintherecenteightyears.ResultsCaseouslobarpneumoniawasmoreprevalentintheteenagersandinthepeopleover50yearsthanintheotherpopulation.Theonsetofthediseas

4、ewasfast.Mostpatientsshowedsystemicsymptoms,predominantlywithfever.Thecountofperipheralwhitebloodcellsusuallyincreased.Thepositiverateofacidfaststainingbysputumsmearwashigh,thoughthepositiverateofpurifiedproteinderivative(PPD)skintestwaslow.Thelesionswereoftenlocatedina

5、picalandposteriorsegmentsofbilateralupperlobes,frequentlycomplicatedwithcavitations,airbronchogramandbronchialdisseminationandrarelywithcalcifiedfoci.Allthepatientsreceivedsystematicantitubercularchemotherapyregiment(HREZorHRSZ).Thesputumnegativeconversionwasshownin10cas

6、es(20.4%)attheendofthefirstmonth,in28cases(57.1%)attheendofthesecondmonth,in7cases(14.3%)attheendofthethirdmonth,in2cases(6.1%)afterthreemonths.Threemonthslater,47cases(61.4%)displayedabsorptionofpulmonarylesions,23cases(29.9%)displayedobviousabsorption,while7cases(9.1%)

7、hadnochange.Attheendoftreatment,cavitiesclosedupin25cases(65.8%),and11caseswereconsideredasopenhealingoftuberculouscavity(diagnosedbyclinicalfeatureandsputum10smeardespitecavitieswerestillthere).ConclusionDependingonclinicalfeatureandimaginganalysis,caseouslobarpneumonia

8、isoftenmisdiagnosedascommonpulmonaryinfectiousdiseases(e.g.pneumonia).Acidfaststainingbysputumsmearmus