22例急性间质性肺炎的诊治分析

Clinical Features of 22 Cases of Acute Interstitial Pneumonia

目的:探讨急性间质性肺炎(AIP)的临床表现、诊断与治疗,提高对该病的诊治率。方法:通过对上海长征医院ICU和厦门大学附属中山医院院急诊科近年来临床诊断的22例AIP病例进行回顾总结性分析。结果:22例临床表现均有咳嗽和不同程度的呼吸困难,15例伴发热。胸部X线检查14例出现双肺中下野磨玻璃影,6例出现上中肺野磨玻璃影。高分辨率CT(HRCT)在渗出期主要表现为磨砂玻璃影,16例肺悬垂部分出现支气管扩张和肺实变;在纤维化期,14例HRCT最显著的表现为非肺悬垂部分出现蜂窝状影和牵拉性肺支气管扩张,5例出现非肺悬垂部分的肺实变。15例患者经过积极治疗1-5周后治愈或明显好转出院,但均有不同程度肺纤维化,其中1例好转出院后复发而再次入院治疗1个月,最终好转出院;7例死亡患者治疗效果不明显,入院后迅速并发严重呼吸衰竭而死亡。结论:早期诊断AIP,早期使用激素,早期保护性机械通气,早期有效控制肺间质水肿对改善AIP的预后至关重要。

Objective： To explore the clinical manifestations, diagnosis and treatment of acute interstitial pneumonia （AIP） in order to improve the accurate rate for AIP diagnosis. Methods： In this pa- per, 22 AIP cases were collected from ICU of Shanghai Changzheng Hospital and emergency de- partment of Zhongshan Hospital of Xiamen University for retrospective study. Results： All the patients appeared cough and different degrees of difficult breathing, and 15 patients had fever. Chest X-ray examination showed ground-glass opacities in bilateral in lower lung of 14 patients and on the upper field of lung in 6 cases. In exudative phase, the major signs of HRCT were ground-glass opacities, and overhanging part of lung of 16 patients displayed bronchiectasis and lung consolidation. In fibrosis stage, HRCT of 14 cases showed honeycomb signs and bronchiectasia and 5 patients showed lung consolidation in non-overhanging part of lung. After 1 to 5 weeks~ treatment, 15 patients were cured but remained with different degrees of pulmonary fi- brosis~ 7 patients died of severe respiratory failure. Conclusion. Early （during pulmonary inter- stitial edema） diagnosis of AIP, early use of hormones, early protective mechanical ventilation, early and effective control of interstitial pulmonary edema are essential to improve the prognosis of AIP.