大叶性干酪性肺炎78例临床分析.doc

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1、冬凌草的性状及显微鉴别作者：罗晓铮董诚明苏秀红史应强鲁莉【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。正规四联抗结核化疗后第1个月痰菌阴转10例；治疗第2个月痰菌阴转者28例；治疗第3个月阴转者7例；3个月以上阴转2例；治疗3个月肺内病灶吸收好转47例；明显吸收好转23例；无变化7例。全疗程结束后空洞闭合25例；空洞未闭合者，综合临床及痰菌认定

2、为净化性空洞者11例。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:ObjectiveTostudythediagnosisandthetreatmentofcaseouslobarAclinicalanalysiswascontswithcaseouslobarductedin78inpatienpneumoniaintherecentEightCaseo

3、uslobarpneumoniawasmoreprevalentintheteenagersandinthepeopleover50yearsthanintheotherpopulation.Theonsetofthediseasewasfast.Mostpatientsshowedsystemicsymptoms,predominantlywithfever.Thecountofperipheralshitebloodcellsusuallyincreased.Thepositiverateofacidaststainingbysputumsmearwashigh,thoughth

4、epositiverateofpurifiedprotEInderivative(PPD)skintestwaslow.Thelesionswereoftenlocatedinapicalandposteriorsegmentsofbilateralupperlobes,frequentlycomplicatedwithcavitations,airbronchogramandbronchialdisseminationandrarelywithcalcifiedfoci.Allthepatientsreceivedsystematicantitubercularchemothera

5、pyregiment(HREZorHRSZ).ThesputumnegativeconversionwasshowninlOcases(%)attheendofthefirstmonth,in28cases(%)attheendofthesecondmonth,in7cases(%)attheendofthethirdmonth,in2onpulmonaryinfectiousdiseases(pneumonia).Acidfaststainingbysputumsmearmustbestrengthenedacases(%)afterthreelater,47cases(%)dif

6、pulmonarylesions,dobviousabsorptionnochange.Attheendosclosedupin25casesconsideredasopenhecavity(diagnosedbysputumsmeardespitehere).ConclusionDfeatureandimagingaarpneumoniaisoftentgeneralhospital.Tartreatmentisrecomy.Withregulartheranotherapy,thecuratisfactory,thoughthentvariesaccordinghefocus,t

7、hesputumnndthecomplications.months.Threemonthssplayedabsorptiono23cases(%)displaye,while7cases(%)hadftreatment,cavitie(%),andllcaseswerealingoftuberculousclinicalfeatureandcavitieswerestilltependingonclinicalnalysis,caseouslobmisd