呼吸重症监护病房中以呼吸衰竭为突出表现的肺结核临床特点

Clinical features of pulmonary tuberculosis patients manifesting respiratory failure in respiratory intensive care unit

目的：总结14例呼吸重症监护病房（RICU）中肺结核合并呼吸衰竭患者的临床特点，为早期诊断和治疗提供参考。方法：回顾分析2003年1月-2013年5月在北京朝阳医院RICU住院确诊的14例肺结核合并呼吸衰竭患者资料。结果：14例患者平均确诊时间10．8±7．0d，其中8例经人工气道吸引物萋-尼抗酸染色涂片确诊．6例经支气管镜刷检、粘膜活检或外科肺活检等组织病理学确诊，临床最常见症状为咳嗽、呼吸困难、发热、咯痰，化验以低氧及低白蛋白血症最明显，胸部影像学大多呈弥漫性实质性肺疾病表现，12例有创通气，最终失败6例，死亡率42．9％。结论：在RICU，肺结核并发呼吸衰竭患者病情重，临床表现不典型，影像学呈实变、磨玻璃样变等改变，需支气管镜、刷检或外科肺活检组织病理学确诊，预后较差。

Objective：To describe the clinical features of 14 pulmonary tuberculosis patients manifesting respi- ratory failure in respiratory intensive care unit （RICU）and estimate its value for early diagnosis and treatment. Methods：Retrospective study of 14 pulmonary tuberculosis patients manifesting respiratory failure in RICU of Beijing Chaoyang Hospital from January 2003 to May 2013.Results：The average diagnosis time was 10.8±7.0 days,among these patients,8 cases were diagnosed by sputum or bronchial alveolar lavage fluid Ziehl-Neelsen acid-fast staining,6 cases were diagnosed through bronchoscopy or surgical histopathology.The most common symptoms were cough,dyspnea,fever and expectoration.Marked characteristics of latortory tests were lower oxygenation index,hypoalbumienmia,most of their imaging were like diffuse parenchymal lung disease.Twelve cases were treated by intermittent positive-pressure ventilation,6 cases were ultimately failed and dead.Conchision：Pulmonary tuberculosis patients manifesting respiratory failure in RICU were critical and their symptoms and manifestations often was asymptomatic,of which the diagnosis usually needs bronchoscopy or surgical histopathology and the prognosis was poor.