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本研究旨在分析并发呼吸衰竭的艾滋病(acquired immune deficiency syndrome,AIDS)合并卡氏肺孢子菌肺炎(Pneumocystis carinii pneumonia,PCP)患者的临床特点、影像学表现以及治疗情况。回顾性分析我院呼吸内科和感染科2016年1月至2016年7月确诊的AIDS合并PCP患者中以呼吸衰竭为首发症状的21例患者的临床资料,包括病史、体征、实验室检查、胸部CT检查、治疗及预后等资料,并进行分析和总结。21例患者中氧合指数(oxygenation index,OI)大于300 mm Hg 3例,201~300 mm Hg 9例,101~200 mm Hg 7例,小于100 mm Hg 2例。主要治疗措施:21例患者均口服复方磺胺甲噁唑(compound sulfamethoxazole,SMZco)(100%),18例给予糖皮质激素(85.7%),16例给予呼吸机辅助呼吸(76.2%),其中无创呼吸机11例,有创呼吸机5例,观察无创通气治疗前及治疗后2 h、24 h、72 h OI的变化情况,治疗24 h、72 h后OI均较治疗前明显改善(p<0.05),而且治疗后72 h OI较治疗后2 h进一步改善(p<0.05)。21例患者中16例病情得到明显缓解,2例病情恶化死亡,3例自动出院,死亡患者OI均在100 mm Hg以下。AIDS合并PCP常有典型的临床特点、实验室指标与胸部影像学表现,血气分析能够帮助判断病情严重程度,尽早明确诊断并给予SMZco治疗,对于吸氧后OI仍然在300 mm Hg以下的患者应给予糖皮质激素及呼吸支持治疗,大部分可临床缓解。
This study aimed to analyze the clinical features, imaging findings and treatment of patients with acquired immune deficiency syndrome (AIDS) complicated with pneumocystis carinii pneumonia (PCP). The clinical data of 21 patients with respiratory failure as the first symptom in AIDS-diagnosed PCP patients from January 2016 to July 2016 were retrospectively analyzed, including their medical history, physical signs, laboratory tests, chest CT examination, treatment and prognosis and other data, and analysis and summary. Among the 21 patients, Oxygen Index (OI) was greater than 300 mm Hg in 3 cases, 201-300 mm Hg in 9 cases, 101-200 mm Hg in 7 cases and less than 100 mm Hg in 2 cases. MAIN TREATMENTS: All 21 patients received oral compound sulfamethoxazole (100%), 18 patients received glucocorticoid (85.7%), and 16 patients received ventilator assisted breathing (76.2%), of which non-invasive 11 cases of ventilator and 5 cases of invasive ventilator. The changes of OI before and after 2 h, 24 h, 72 h after non-invasive ventilation were observed. The OI of 24 h and 72 h after treatment were significantly improved (P < 0.05), and the OI at 72 h after treatment was further improved 2 h after treatment (p <0.05). Among the 21 patients, 16 cases were significantly relieved, 2 cases were deteriorated and 3 cases were discharged. The OI of patients died was below 100 mm Hg. AIDS with PCP often have typical clinical features, laboratory parameters and chest imaging findings, blood gas analysis can help determine the severity of the disease, as soon as possible a clear diagnosis and given SMZco treatment for patients with OI after oxygen is still below 300 mm Hg Given glucocorticoid and respiratory support therapy, most of the clinical remission.