静脉应用毒品致脓毒性肺栓塞的临床特点与治疗

目的探讨静脉应用毒品致脓毒性肺栓塞（SPE）的临床特点和诊治经过，提高对该病的诊断和治疗水平。方法回顾性分析1994年1月至2006年12月收治的22例静脉应用毒品致脓毒性肺栓塞患者的临床表现、胸部影像学特点、血培养结果、超声心动图结果和诊治经过。结果临床表现为发热（22／22）、呼吸困难（20／22）、咳嗽（18／22）、胸痛（10／22）和咯血（8／22）。X线胸片和CT表现为结节（15／22）、局灶浸润影（12／22）、楔型阴影（5／22）、气囊（18／22）、空洞（11／22）及胸膜病变（11／22）。病灶分布在外周或胸膜下（20／22），CT较X线胸片可更清晰地显示病灶。血标本可培养出金黄色葡萄球菌（22／22）。超声心动图可见三尖瓣赘生物（22／22）。所有患者静脉使用2—4周耐酶青霉素、丁胺卡那霉素、万古霉素或左氧氟沙星，同时分别给予呼吸、循环支持和胸腔闭式引流。14例患者痊愈出院，8例好转出院。结论病情隐匿，缺乏特异性。高危人群如静脉吸毒者出现发热、影像学表现为多发和散在的胸膜下或周边气囊、结节影伴或不伴有空洞形成提示本病。早期诊断、及时给予抗生素治疗、控制肺外感染灶、给予呼吸支持，多数患者预后良好。

Septic pulmonary embolism in intravenous drug users

OBJECTIVE: To analyze the characteristics of septic pulmonary embolism (SPE) in intravenous drug users. METHODS: The clinical manifestations, radiographic findings, bacteriology, echocardiography and outcome of intravenous drug users were analyzed retrospectively. RESULTS: Twenty-two patients were identified with SPE between January of 1994 and December of 2006. Presenting symptoms included fever (22/22), dyspnea (20/22), pleuritic chest pain (10/22), cough (18/22), and hemoptysis (8/22). Chest radiographic features included nodular (15/22) and focal (12/22) infiltrates, wedge-shaped lesions (5/22), cysts (18/22), cavities (11/22), and pleural lesions (11/22). Peripheral or subpleural zones were most commonly affected (20/22). CT was more helpful and revealed multiple air cysts or nodules peripherally, often with cavitation. Staphylococcus aureus was the aetiological pathogen in all patients. Tricuspid valve vegetations were detected in all patients. Aside from antimicrobial therapy, the management included mechanical ventilation, control of shock and tube thoracostomy. Most patients recovered from their illness. CONCLUSIONS: SPE manifests with variable and often nonspecific clinical and radiographic features. The diagnosis is usually suggested by the presence of a predisposing factor, fever, and radiographic findings of multiple, peripheral or subpleural air cysts, or nodules with or without caritation. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients.