肺结核合并重症肺炎35例临床分析

目的　探讨肺结核合并重症肺炎的临床特征及病原菌分布和诊疗技术。方法 对1995年1月—2002年12月收治的经纤维支气管镜保护性刷检(PSB)病原学确诊的肺结核合并重症肺炎35例进行回顾性分析。结果 临床特征是高热、咳脓痰、气急、呼吸衰竭、白细胞总数升高。病原菌以嗜麦芽窄食单胞菌、厌氧菌、绿脓杆菌感染为主。治愈31例,病死4例,病死率11.4%。结论 纤支镜PSB检查能及时、准确提供肺结核合并重症肺炎的病原学诊断依据,并指导临床合理使用抗生素。第三代青霉素及头孢菌素与β内酰胺酶抑制剂的复合制剂及甲哨唑疗效显著。合理把握机械通气指征及策略,可提高救治成功率。

Clinical analysis of pulmonary tuberculosis complicating with severe pneumonia

Objective To explore the clinical feature,bacter ia distribution and treatment technology of pulmonary tuberculosis complicating wi th severe pneumonia.Methods The data of thirty five cases of pu lmonary tuberculosis complicating with severe pneumonia diagnosed by bronchoscop e with protected specimens brush (PSB) were analysed retrospectively.Results Clinical feature was high fever,purulent sputum,breathl ess,respiratory failure and high blood cell count.Xanthomonas maltophilia,anaero be and pseudomonas aeruginosa were the main pathogenic bacteria for infection.Th irty one cases were cured,four died,the fatality was 11.4%.Conclusion The clinical manifestation of pulmonary tuberculosis complicating with severe pneumonia was typical,had severely toxic symptoms.Bron choscope with PSB can provide accurate pathogenic diagnosis and guide using anti biotics.The complexing agent of third generation penicillin or cephalosporin and β-lactamase inhibitors and metronidazole were recommended to be used for cont rol of infection.Holding reasonably the indication and tactics of mechanical ve ntilation can increase cure rate.