复杂性感染致重症肺炎1例并文献复习  

Severe pneumonia caused by complex bacterial infections:a case report and literature review

作　　者：张娟[1] 张琳琳[1] 凌萌 Zhang Juan;Zhang Linlin;Ling Meng(Department of Critical Care Medicine,Anhui Provincial Cancer Hospital,West Branch of Anhui Provincial Hospital,Hefei 230003,Anhui Province,China)

机构地区：[1]安徽省肿瘤医院安徽省立医院西院重症医学科,合肥230003

出　　处：《中国基层医药》2022年第3期335-339,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的通过对1例重症肺炎患者的临床资料进行分析和总结,对不明原因的复杂性感染所致重症肺炎的诊断思路及治疗进行探讨。方法以安徽省肿瘤医院重症医学科2018年治疗成功的重症肺炎患者1例为研究对象,采用描述性方法对该病例资料进行分析,同时结合诊疗过程中的各项检查资料进行文献复习。结果该患者系34岁男性,2017年12月出现胸闷气喘,辗转就诊省外多家三级甲等医院呼吸科及重症医学科,胸部CT提示右肺不张、实变,双侧胸腔积液,实验室检查提示广泛耐药鲍曼不动杆菌、曲霉菌、念珠菌等感染,心脏彩超提示肺动脉高压,反复出现呼吸衰竭,行机械通气,并出现感染性休克,符合重症肺炎诊断。后因呼吸衰竭及休克难以纠正,遂经120护送由广州转至安徽省肿瘤医院重症医学科。患者在住院期间,发现其存在误吸,予以鼻饲。同时经积极抗感染、营养支持、气道管理等处理后,患者病情好转,但呼吸衰竭仍不能完全缓解,予以试验性抗痨治疗后患者好转出院。该患者抢救治疗102 d。结论青壮年患者,社区获得性重症肺炎可能非单一致病菌或单一致病因素。在重症患者的诊疗过程中,实验室检查对患者的判断有一定的指导意义,但不能完全依赖于实验室检查结果,尤其是结核等非特异性病原体,需紧密结合临床,详细询问病史,仔细观察病情变化,重视细节,寻找病因,对因处理。Objective To investigate the diagnosis and treatment of severe pneumonia caused by unexplained complex infections by analyzing and summarizing the clinical data of one patient with severe pneumonia.Methods We included one case of severe pneumonia who was cured in the Department of Critical Care Medicine of Anhui Provincial Cancer Hospital in 2018.We used descriptive methods to analyze the case data and reviewed pieces of literature related to clinical data collected during diagnosis and treatment.Results The 34-year-old male patient had chest tightness and asthma attacks in December 2017.He received treatment in Departments of Respiratory Medicine and Critical Care Medicine,Class III Grade A hospitals outside Anhui Province.Chest CT scans showed atelectasis and consolidation of the right lung,and bilateral pleural effusion.Laboratory test results suggested widespread drug-resistant Acinetobacter baumannii,Aspergillus,and Candida infections.Cardiac color Doppler ultrasound images suggested pulmonary hypertension.He had recurrent respiratory failure.After mechanical ventilation,he had septic shock.These findings indicated severe pneumonia.Later,he was escorted by a 120 ambulance hospital transportation car from Guangzhou to the Department of Critical Care Medicine,Anhui Provincial Cancer Hospital to alleviate respiratory failure and shock.During hospitalization,the patient underwent nasal feeding because of an aspiration mistake.He was also subject to an active anti-infection,nutritional support,and airway management.The patient's condition improved,but respiratory failure could not be completely alleviated.After experimental anti-tuberculosis treatment,the patient was discharged because his condition improved.The patient was treated for a total of 102 days.Conclusion A single pathogen or a single pathogenic factor is involved in community-acquired severe pneumonia in young and middle-aged patients.During diagnosis and treatment of severe pneumonia,laboratory test results have a guiding significance for judging the

关 键 词：肺炎 肺不张 胸腔积液 重叠感染 呼吸功能不全 误吸 淋巴瘤 结核 肺 病例报告 

分 类 号：R563.1[医药卫生—呼吸系统]