急性弥漫性肺浸润性改变的临床特征  

Clinical features of acute diffuse pulmonary exudative disorders

作　　者：糜丽云 班承钧[1] 刘艳[1] 包娜[1] 孙兵 朱敏 任雁宏[2] 代华平[2] 

机构地区：[1]北京市呼吸疾病研究所首都医科大学附属北京朝阳医院呼吸与危重症医学科,100020 [2]中日友好医院呼吸与危重症医学科

出　　处：《中华医学杂志》2017年第44期3445-3449,共5页National Medical Journal of China

基　　金：国家自然科学基金（81430001）

摘　　要：目的分析急性弥漫性肺浸润性改变的临床特征。方法收集2009年1月至2011年12月住首都医科大学附属北京朝阳医院呼吸与危重症监护室（RICU）患者临床资料，选取病程急性、呼吸窘迫、影像学表现双肺弥漫浸润影[类似急性呼吸窘迫综合征（ARDS）]者进行病因分析，总结其临床特点。结果急性弥漫性肺浸润性改变患者共86例，其中男62例（72．1％），年龄（58．6±16．4）岁；女24例（27．9％），年龄（48．2±18．3）岁。发病距就诊时间（11．5±5．2）d，住RICU时间（15．5±9．5）d。死亡35例，病死率40．7％。平均住院费用10．1万元人民币。其中确诊病因为感染者53例（61．6％）（病毒21例、细菌14例、真菌11例、肺孢子菌15例、其他3例，其中11例为混合感染）；病因为非感染者33例（38．4％），其中间质性肺炎12例（特发性间质性肺炎9例：隐源性机化性肺炎3例、特发性肺纤维化急性加重3例，非特异性间质性肺炎1例，急性间质性肺炎2例；结缔组织病相关间质性肺炎3例：类风湿关节炎1例、皮肌炎1例、系统性红斑狼疮1例），吸入性肺炎10例，急性左心衰6例，肺外源性ARDS5例。结论急性弥漫性肺浸润性改变患者最主要病因为感染及问质性肺炎，感染者以病毒及肺孢子菌感染为主；患者病死率及住院费用较高。Objective To analyze the clinical features of acute diffuse pulmonary exudative disorders. Methods The data were collected from patients who were hospitalized in respiratory intensive care unit （RICU） of Beijing Chaoyang Hospital affiliated to the Capital Medical University during January 2009 to December 2011, and had acute clinical course with imaging findings of diffuse pulmonary infiltrated shadows （ similar to acute respiratory distress syndrome （ ARDS ） ） . The causes of disease and clinical features were analyzed. Results A total of 86 patients with acute diffuse pulmonary exudative disorders were included. Sixty-two （72. 1% ） were males, with a mean age of （58. 6 ± 16. 4） years old; 24（27. 9% ） were females, with a mean age of （48. 2 ± 18.3 ） years old. The duration of the disease before administration was （ 11.5 ± 5.2） days, and RICU stay was （ 15.5 ± 9. 5 ） days, with hospital mortality of 40. 7% and the average hospitalization cost of 101 thousand RMB. The main cause was infection, which occurred in 53 cases （61.6%） （virus in 21 cases, bacteria in 14 cases, fungus in 11 cases, pneumoeystis in 15 cases and others in 3 cases, mixed infection in I 1 cases）. Interstitial pneumonia occurred in 12 cases （idiopathic interstitial pneumonia in 9 cases： cryptogenie organizing pneumonia in 3 cases, the acute exacerbation of idiopathic pulmonary fibrosis in 3 cases, nonspecifie interstitial pneumonia in 1 case, acute interstitial pneumonia in 2 cases, and connective tissue disease in 3 cases） , aspiration pneumonia in 10 cases, acute left heart failure in 6 cases, and exogenous pulmonary ARDS in 5 cases. Conclusions The main cause of acute diffuse pulmonary exudative disorders is pulmonary infection, followed by interstitial pneumonia. The hospital mortality and hospitalization cost are high.

关 键 词：急性呼吸窘迫综合征 感染 肺疾病 间质性 弥漫性肺浸润 疾病特征 

分 类 号：R563[医药卫生—呼吸系统]