继发利福平耐药结核左肺切除术后胸腔出血1例  

Chest hemorrhage after left total pulmonary resection for secondary rifampin-resistant tuberculosis:a case report

作　　者：刘小玉 申磊 戴希勇 金武 颜芬 蒋钰辉 王冰 徐风 刘奇斌 姚利 Liu Xiaoyu;Shen Lei;Dai Xiyong;Jin Wu;Yan Fen;Jiang Yuhui;Wang Bing;Xu Feng;Liu Qibin;Yao Li(Department of Thoracic Surgery,Wuhan Pulmonary Hospital,Wuhan 430030,China;TuberculosisⅣWard,Wuhan Pulmonary Hospital,Wuhan 430030,China;Department of Anesthesiology,Wuhan Pulmonary Hospital,Wuhan 430030,China)

机构地区：[1]武汉市肺科医院外科,武汉430030 [2]武汉市肺科医院结核Ⅳ病区,武汉430030 [3]武汉市肺科医院麻醉科,武汉430030

出　　处：《中华结核和呼吸杂志》2023年第8期806-810,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：湖北省武汉市中青年医学骨干人才项目[No.武卫生计生通(2018)116号]。

摘　　要：本例患者因肺结核经历5次抗结核治疗,前3次药物敏感试验均显示为非耐药肺结核,第4次诊断为利福平耐药结核病(rifampin-resistant tuberculosis,RR-TB),合并慢性阻塞性肺疾病、Ⅱ型呼吸衰竭、肺源性心脏病及心功能不全(Ⅲ级),按照耐药结核病治疗方案8个月后患者自行停药。此次因咳喘、胸闷入院,经吸氧、抗感染、抗结核治疗后症状缓解,因咯血行经导管动脉栓塞术治疗,术后再发大咯血,急诊行胸膜外左全肺切除+胸腔纱布填塞止血术,术后呼吸机、血管活性药物维持生命体征,48 h后拔出纱布并气管切开、鼻饲营养、抗结核等治疗,出院后康复锻炼、口服耐药方案治疗,随访半年余病情平稳。The patient had received five courses of anti-tuberculosis treatment for recurrent tuberculosis.The drug sensitivity test results of the first three courses showed drug-sensitive pulmonary tuberculosis,and the fourth diagnosis was rifampin-resistant tuberculosis(RR-TB),complicated by chronic obstructive pulmonary disease,typeⅡrespiratory failure,pulmonary heart disease,and heart failure(gradeⅢ).The patient stopped taking the anti-tuberculosis drugs on his own in the eighth month of receiving the resistant treatment.After admission,the symptoms improved temporarily after receiving oxygen therapy,anti-infection,and anti-tuberculosis treatment.Because of hemoptysis,the patient underwent arterial embolization by catheterization,but a large amount of hemoptysis occurred shortly thereafter.Emergency left total lung resection and gauze packing for hemostasis were performed.After surgery,the patient′s vital signs were maintained with mechanical ventilation and vasopressors.Forty-eight hours after surgery,the gauze was removed,and the patient underwent tracheotomy,enteral nutrition,and anti-tuberculosis treatment.After discharge,the patient underwent rehabilitative exercise and anti-resistant tuberculosis therapy.The patient′s condition remained stable for more than six months of follow-up.

关 键 词：肺源性心脏病 血管活性药物 心功能不全 气管切开 纱布填塞止血 耐药肺结核 胸膜外 Ⅱ型呼吸衰竭 

分 类 号：R655.3[医药卫生—外科学]