支气管哮喘合并侵袭性肺曲霉病3例并文献复习  

Literature review of three cases of bronchial asthma patients complicated with invasive pulmonary aspergillosis

作　　者：朱勇[1] 刘敬禹[2] 张鹏[2] 邸金娜[2] 

机构地区：[1]辽宁医学院附属第三医院重症医学科,辽宁锦州121001 [2]辽宁医学院附属第三医院呼吸科,辽宁锦州121001

出　　处：《中华医院感染学杂志》2014年第3期642-644,共3页Chinese Journal of Nosocomiology

基　　金：辽宁省自然科学基金项目(201102133)

摘　　要：目的加强临床医师对支气管哮喘合并侵袭性肺曲霉病(IPA)的临床表现、诊断和治疗的认识,减少误诊,提高救治成功率。方法结合文献复习,对3例支气管哮喘合并IPA的病例进行临床分析。结果 3例患者均具备应用激素及广谱抗菌药物的高危因素,入院时胸部影像学基本正常,2例患者痰液中检出曲霉菌属感染临床确诊,1例临床拟诊;1例影像学进展迅速并出现呼吸衰竭及多脏器功能障碍而死亡,2例在取得初步证据后立即开始联合抗曲霉菌属治疗,病变吸收而治愈。结论支气管哮喘合并IPA临床表现不典型,如能早期发现、及早开始经验性治疗,可提高患者的生存率。OBJECTIVE To enhance the clinicians; cognition of clinical manifestations, diagnosis, and treatment of the bronchial asthma complicated with invasive pulmonary aspergillosis （IPA） so as to reduce the misdiagnosis and improve the success rate of treatment. METHODS Combined with literature review, three cases of bronchial asthma patients complicated with IPA were observed. RESULTS The use of hormones or broad spectrum antibiotics was the high risk factor for all the three patients, the chest imaging was basically normal at the admission. Two cases were clinically conformed with Aspergillus isolated from sputum and 1 case clinically diagnosed; 1 case with rapid progression of imaging died due to the respiratory failure and multiple organ dysfunction, and 2 cases were cured through the evidence-based combined anti-aspergillosis therapy and lesions absorption. CONCLUSION The clinical manifestations of the bronchial asthma patients complicated with IPA are atypical, and the survival rate can be improved through early diagnosis and empirical treatment.

关 键 词：支气管哮喘 侵袭性真菌病 诊断 治疗 

分 类 号：R181.32[医药卫生—流行病学]