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目的分析血行播散性肺结核临床特点。方法回顾分析鞍山市千山医院1998—2007年住院患者362例血行播散性肺结核患者临床特点、治疗、预后等。结果以青壮年为多,占62.0%,老年患者有上升趋势,占21.0%。临床症状发热占86.1%,呼吸道症状以咳嗽、乏力、气促、盗汗、胸痛等症状居多,伴有结脑者有头痛、恶心、呕吐等。临床确诊时间:30 d以内占50.3%,少数病人至4个月以上确诊。痰菌阳性率37.8%。PPD试验阳性反应58.6%,血清抗结核抗体阳性44.8%。急性血行播散性肺结核68.5%,亚急性和慢性血行播散性肺结核31.5%。胸部X线典型粟粒性肺结核阴影占68.5%,并发肺外结核占40.0%。非结核并发症占68.2%。经联合抗结核治疗同时治疗并发症。除结脑脑疝死亡2例外,余者均好转。结论血行播散性肺结核症状严重,常合并其他脏器结核病,必须给予高效、敏感抗结核药治疗,并对肺外结核病、并发症亦予以积极治疗,并辅以营养与支持疗法,能获得满意疗效。
Objective To analyze the clinical characteristics of hematogenous disseminated pulmonary tuberculosis. Methods The clinical features, treatment and prognosis of 362 hematogenous disseminated pulmonary tuberculosis patients from 1998 to 2007 in Qianshan Hospital of Anshan City were retrospectively analyzed. The results were mostly young adults, accounting for 62.0%. Elderly patients showed an upward trend, accounting for 21.0%. Clinical symptoms accounted for 86.1% of fever, respiratory symptoms to cough, fatigue, shortness of breath, night sweats, chest pain and other symptoms mostly, accompanied by knot brain have headache, nausea, vomiting and so on. Clinical diagnosis time: 50.3% within 30 d, a small number of patients to more than 4 months confirmed. The positive rate of sputum bacterium was 37.8%. PPD test positive reaction 58.6%, serum anti-TB antibody positive 44.8%. 68.5% of acute hematogenous disseminated tuberculosis, 31.5% of subacute and chronic hematogenous disseminated tuberculosis. Chest X-ray typical miliary tuberculosis shadow accounted for 68.5%, concurrent pulmonary tuberculosis accounted for 40.0%. Non-tuberculosis complications accounted for 68.2%. Combined anti-TB treatment of complications. In addition to knot brain herniation 2 cases of death, the rest were improved. Conclusion Severe hematogenous disseminated tuberculosis is often associated with tuberculosis in other organs and must be treated with highly effective and sensitive antituberculosis drugs. Patients with tuberculosis and complications of pulmonary hemorrhage should also be actively treated and supplemented with nutrition and supportive therapy. Efficacy.