老年气管切开患者罹患卡氏肺孢子虫肺炎的临床分析  

A clinical analysis of diagnosis and treatment of pneumocystis carinii pneumonia in elderly patients with long-term tracheotomy

作　　者：何洁[1] 林江涛[1] 郑知刚[1] 

机构地区：[1]中日友好医院呼吸科,北京100029

出　　处：《北京医学》2006年第7期393-395,共3页Beijing Medical Journal

摘　　要：目的提高临床对非人类免疫缺陷病毒(HIV)感染者罹患卡氏肺孢子虫肺炎(PCP)的认识。方法对5例长期住院的老年气管切开患者感染PCP的临床资料进行回顾性分析。结果5例患者平均90岁,有多种严重基础疾病,平均住院时间为548d,均反复发生肺部感染并因呼吸衰竭而开放气道,长期大量使用广谱抗生素,发病时均有发热(37.3～39.0°)及肺部感染的临床表现;X线胸片示肺内有纹理增加或新出现的浸润影;痰涂片找卡氏肺孢子虫(PC)及PCR查PC均阳性;乳酸脱氢酶(LDH)为91～489U/ml;血清HIV检测阴性;在应用原治疗的基础上加用复方磺胺甲恶唑(SMZco)治疗后有效,5例复查痰涂片找PC及PCR查PC均阴性;在治愈后1～6个月,2例又出现PCP。结论老年人伴有多种严重基础疾病,其机体免疫功能降低,长期反复使用广谱抗生素,气道开放,即使无HIV的感染,也有可能发生PCP。Objective To incite the awareness of pneumocystis carinii pneumonia（PCP） in non-human immunodeficiency virus（HIV）infected patients. Methods 5 elder patients with PCP who were admitted for long term tracheotomy were retrospectively analyzed. Results Five elder male patients with severe predisposing diseases, had been admitted repeatedly for lung infection. Thus they were treated with tracheotomy and multiple antibiotics. Fever was present in all patients together with respiratory symptoms. X-ray showed increased lung markings or diffuse patchy infiltration. Sputum P carinii was found by smear staining as well as PC PCR. All the patients had a serum HIV-negtive test, After treating with SMZco, their sputum smear staining as well as PC PCR turned to be negative, Two patients had PC 1-6 months after curation, Conclusions PCP can occur during prolonged tracheotomy, particularly in aged patients with severe predisposing diseases,or treated with broad spectrum antibiotics even without HIV infection.

关 键 词：卡氏肺孢子虫肺炎 气管切开 

分 类 号：R563.1[医药卫生—呼吸系统]