肾病综合征肺孢子菌肺炎并发气胸3例报告并文献复习.docVIP

肾病综合征肺孢子菌肺炎并发气胸3例报告并文献复习 赵伟业 魏风芹 刘学东 青岛市市立医院呼吸内科 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的 分析肾病综合征肺孢子菌肺炎并发气胸的临床和影像学表现, 总结其影像学特点及诊治经验。方法 对3例肾病综合征肺孢子菌肺炎并发气胸患者的临床资料进行回顾性分析, 并进行相关文献复习。结果 3例患者肾病综合征诊断明确, 皆以发热、咳嗽、进行性呼吸困难为首发症状, 影像学表现为双肺弥漫性磨玻璃影、网织结节影、铺路石征、肺气囊, 合并气胸征象;2例合并呼吸衰竭, 进行胸腔闭式引流、气管插管、机械通气;3例支气管肺泡灌洗液中均找到肺孢子菌包囊;治疗药物包括复方磺胺甲唑, 克林霉素、伯氨喹、卡泊芬净及激素;1例好转, 2例死亡。结论 肾病综合征肺孢子菌肺炎并发气胸时, 有典型的影像学表现, 病情更重, 预后极差, 需早期诊断及治疗。 关键词： 肾病综合征; 肺孢子菌肺炎; 气胸; 诊断; 治疗; 收稿日期：2017-07-10 Reports and documents review of nephrotic syndrome complicating pneumocystis carinii pneumonia with pneumothorax 3 cases ZHAO Wei-ye WEI Feng-qin LIU Xue-dong Department of Respiratory Diseases, Qingdao Municipal Hospital; Abstract： Objective To investigate the clinical feature and image manifestation of nephrotic syndrome (NS) complicating pneumocystis carinii pneumonia (PCP) with pneumothorax and to sum up the imaging features and the experience of diagnosis and treatment.Method Clinical data of the 3 cases of NS complicating PCP with pneumothorax were retrospective analyzed and the pertinent literatures were reviewed.Result Diagnosis of nephrotic syndrome in all patients were clear, and all showed first symptom as fever, cough, progressive dyspnea, and iconography showed diffuse ground glass opacity in double lungs、reticulonodular shadow、crazy paving sign、pneumonocele and complicating pneumothorax;2 cases complicated respiratory failure, and they were closed drainage of thoracic cavity and trachea intubation and mechanical ventilation;3 cases all found pneumocystis carinii in bronchoalveolar lavage;drugs included Sulfamethoxazole and Trimethoprim, clindamycin、primaquine、caspofungin and glucocorticoid;2 cases were cured, 1 case died.Conclusion When NS complicating PCP with pneumothorax, it has classic symptom in iconography.It is more serious and has poor prognosis, so early diagnosis and treatment is very important. Keyword： Nephrotic syndrome; Pneumocystis carinii