胺碘酮致弥漫性间质性肺炎1例报告并文献复习

Amiodarone caused 1 case of diffuse interstitial pneumonia report and literature review

目的探讨胺碘酮致弥漫性间质性肺炎的临床特点和诊断治疗。方法回顾性分析1例胺碘酮致弥漫性间质性肺炎的临床表现、影像特点、治疗及预后。结果本例老年男性患者,不规律使用胺碘酮治疗1年后出现咳嗽、咳血,伴气短、发热,呼吸困难,肺部爆裂音。胸部CT示:双肺片状浸润影、磨玻璃样变、弥漫索条及网格状。病程急剧发展,出现Ⅰ型呼吸衰竭、呼吸停止,经对症处理给予机械通气、激素、抗生素并停用胺碘酮等治疗后,临床症状消失,胸部CT影像学改变基本吸收。结论胺碘酮致弥漫性间质性肺炎的诊断应根据病史、结合临床及影像学表现,治疗中应及时停用胺碘酮,对于急危重症患者给予激素及机械通气是治疗成功的关键。

Objective To analyse the clinical features and diagnosis and treatment of amiodarone-caused diffuse interstitial pneumonia.Methods Retrospective analysis of one case of diffuse interstitial pneumonia caused by amiodarone clinical manifestations,imaging features,treatment and prognosis.Results The elderly male patient appeared to have symptoms of cough,hemoptysis,shortness of breath,fever,dyspnea and pulmonary crackles after no regular use of amiodarone in the treatment for 1 year.Chest CT showed：bilateral pulmonary patchy infiltration,ground-glass appearance,diffuse streaks and the grid.Course of disease was rapid development,and type Ⅰ respiratory failure and respiratory arrest occurred.After amiodarone was discontinued and the patient was symptomatic treatment with mechanical ventilation,corticosteroid and antibiotics,clinical symptoms disappeared and the changes of chest CT imaging were fundamental absorption.Conclusions Amiodarone induced diffuse interstitial pneumonia diagnosis should be based on history,clinical and imaging findings.Discontinuing Amiodarone,corticosteroid and mechanical ventilation is the key to successful treatment in critical cases.