中西医结合治疗重症黏液型铜绿假单胞菌性肺炎1例并文献回顾

Treatment of Severe Mucoid Pseudomonas Aeruginosa Pneumonia with Combination of Traditional Chinese and Western Medicine:A Case Report and Literature Review

总结1例重症黏液型铜绿假单胞菌性肺炎患者的中西医诊疗过程,分析探讨铜绿假单胞菌性肺炎的中医诊疗思路。患者因“反复咳嗽、咳痰、气促10余年,再发加重10 d”来诊,诊断为慢性阻塞性肺疾病急性加重期(AECOPD)Ⅱ型呼吸衰竭、支气管哮喘、支气管扩张、2型糖尿病,遂入院治疗。入院后因病情危重,予气管插管接呼吸机辅助通气,又因肺泡灌洗液高通量基因测序示铜绿假单胞菌序列数73659,加用抗感染治疗。以气管插管接呼吸机辅助通气联合抗感染治疗至氧合指数正常后,拔除气管插管,予高流量湿化氧疗续贯。之后患者再发呼吸急促、高热、烦躁,伴口干、汗少,考虑抗感染治疗已持续近2周,可能出现抗生素诱导的发热等不良反应,遂暂停使用抗生素,先后应用大青龙汤、大承气汤(灌肠)、白虎加人参汤进行中医治疗。经中医治疗后,患者发热症状逐渐消退,痰培养提示黏液型铜绿假单胞菌(全敏),最终病情平稳出院。以往中医药治疗铜绿假单胞菌感染多采用清肺化痰、泻热通腑法,对扶正关注较少。根据上述病例治疗情况,笔者认为在以中药治疗铜绿假单胞菌性肺炎过程中,应加强对正气的关注,根据正气强弱及时调整治疗方案。

In this article,the diagnosis and treatment process of a severe case of mucoid Pseudomonas aeruginosa pneumonia using both Chinese and western medicine is summarized.Additionally,the Chinese medical diagnostic and treatment approach for Pseudomonas aeruginosa pneumonia is analyzed and discussed.The patient came for consultation due to“repeated coughing,sputum production,and shortness of breath for over 10 years,with worsening symptoms in the past 10 days”.The diagnosis was acute exacerbation of chronic obstructive pulmonary dis⁃ease(AECOPD)typeⅡrespiratory failure,bronchial asthma,bronchiectasis,and type 2 diabetes.Conse⁃quently,the patient was admitted for treatment.After admission,due to the critical condition,endotracheal intubation was performed and a ventilator was used for respiratory support.Additionally,the anti-infective treatment was given because high-throughput gene sequencing of bronchoalveolar lavage fluid revealed a sequence count of 73659 for Pseudomonas aeruginosa.After achieving a normal oxygenation index through the use of endotracheal intubation and assisted ventilation with a ventilator,the endotracheal tube is removed and high-flow humidified oxygen therapy is continued.Subsequently,the patient experienced recurrent rapid breathing,high fever,restlessness,accompanied by dry mouth and decreased sweating.Considering that the anti-infection treatment had lasted for nearly 2 weeks,there might be adverse reactions such as antibiotic-induced fever,so the use of antibiotics was temporarily suspended and traditional Chinese medicine treatments including Daqinglong Decoction(大青龙汤),Dachengqi Decoction(大承气汤),and Baihu Jia Renshen Decoction(白虎加人参汤)were successively applied.After treatment with traditional Chinese medicine,the patient’s fever symptom gradually subsided.The sputum culture indicated mucoid Pseudomonas aeruginosa(sensitive to all antibiotics).Eventually,the condition stabilized and the patient was discharged.In the past,traditional Chinese medicine often used methods such as clearing lung and resolving phlegm,purging heat and promoting bowel movement to treat Pseudomonas aeruginosa infections,with less emphasis on reinforcing healthy qi.According to the treatment situation of the above case,the author believes that in the process of treating Pseudomonas aeruginosa pneumonia with traditional Chinese medicine,it is necessary to pay more attention to healthy qi and adjust the treatment plan timely based on the strength of healthy qi.