住院精神病患者伴发肺结核临床诊疗与X线影像动态变化特点分析

Analysis of characteristics of the clinical diagnosis and treatment and the dynamic changes of X-ray image of psychotic inpatients with pulmonary tuberculosis

目的:了解住院精神病患者伴发肺结核的临床诊疗情况与X线影像动态变化特点,提高对X线影像检查在其规范化诊疗中价值的认识。方法:回顾性分析我院影像资料完整的63例住院精神病患者伴发肺结核的临床诊疗情况与X线影像动态变化特点。结果:①住院精神病患者感染肺结核以院内感染为主,临床症状多不典型,诊断主要依靠X线影像检查和诊断性治疗相结合,通过细菌学检查确诊有其局限性;②X线影像特点多异,以Ⅲ型肺结核为主,合并症较多,早期随疗程影像好转较明显,后期恢复缓慢;③临床化疗疗程普遍长于肺结核规范化治疗推荐疗程,缺乏有效停药标准,存在停药后加重病例;④X线影像转归以病灶钙化和纤维化为主。结论:住院精神病患者伴发肺结核的规范化诊疗需要进一步加强,X线影像检查动态比较是判断肺结核疗效的主要方法。

Objective： To understand the characteristics of the clinical diagnosis and treatment and the dynamic changes of X - ray image of psychotic inpatients with pulmonary tuberculosis, as well as deepen the understanding of the value of X - ray image examination in standardized treatment. Methods： Retrospective analysis of 63 cases of the characteristics of clinical diagnosis and treatment and dynamic change of X - ray image of psychotic in- patients with pulmonary tuberculosis in our hospital. Results：（1）The cases for psychotic inpatients to be infected with tuberculosis mostly happen during their hospitalization without typical clinical symptom. The diagnosis mainly depends on the combination of X - ray image and diagnostic treatment, and the limitation is diagnosed by bacteriological examination. （2）The features of X - ray images vary differently. Type III tuberculosis is the main type while ac- companying with complication. With the progress of treatment in the early period, obvious improvement can be seen from X - ray image, however, the re- covery slows down in the latter part of treatment. （3）Generally speaking, clinical course of tuberculosis chemotherapy is much longer than that of the stand- ardized pulmonary tuberculosis treatment. Meanwhile, there is the lack of effective criteria for drug withdrawal and a likelihood of aggravating patientg illness after discontinuation. （~）X - ray image prognosis is mainly showed as calcification and fibrosis. The standardized diagnosis and treatlnelat of psychotic inpatients with pulmonary tuberculosis should be improved. Dynamic comparative analysis of X - ray images is the primary method to determine the efficacy of pulmonary tuberculosis treatment.