摘要
目的探讨应用机械通气的老年患者非结核分枝杆菌(NTM)肺病的临床特征。方法回顾性分析解放军总医院4例老年机械通气合并NTM肺病患者的病历资料,并复习相关文献。结果 4例患者均合并慢性阻塞性肺疾病、特发性间质性肺炎、支气管扩张症等慢性肺部基础病,确诊前均曾被疑诊为肺结核。临床症状无特异性,均有发热和咯痰,1例合并痰中带血。胸部CT表现多样,呈结节影、片状实变影和胸腔积液等,未出现典型的结节支气管扩张型和纤维空洞型征象。分枝杆菌培养均可见快速生长分枝杆菌,菌种鉴定1例为龟分枝杆菌,3例为脓肿分枝杆菌。1例脓肿分枝杆菌肺病患者接受药物治疗,其余3例因多器官功能障碍而未行抗分枝杆菌治疗,4例均死于多器官功能衰竭。结论 NTM是导致老年呼吸机相关肺炎的病原菌,感染症状无特异性,典型NTM肺病影像特征并不常见。对痰抗酸杆菌染色阳性的老年机械通气患者应重视NTM的培养和菌种鉴定。
Objective To study the clinical characteristics of non-tuberculous mycobacterial （NTM） pulmonary diseases in elderly patients with mechanical ventilation. Methods Four elderly patients with mechanical ventilation who companied with NTM pulmonary disease were selected, and a retrospective analysis was made with literature review. Re-sults The underlying structural lung diseases were common among these subjects and included chronic obstructive pul-monary disease （COPD）, pulmonary fibrosis, old tuberculosis and bronchiectasia. All of these patients were suspected to have tuberculosis before the final diagnosis. Clinical symptoms were non-specific,including fever, expectoration, and haemoptysis occurred in one patient. The CT findings were not characteristic, including nodules, patchy infiltrations and pleural effusion, and absence of the classical fibrocavitary and nodular bronchiectatic patterns. Mycobacteria cultures were positive with the rapid growth of mycobacteria. Bacteria type identifications had been performed with Mycobacterium ab-scessus （3 cases） and Mycobacterium chelonei （1 case）. Only one patient with Mycobacterium abscess was treated with chemotherapy, while the other 3 patients were not treated due to multi-organ dysfunction. All these patients died of multiple organ failure. Conclusion NTM, especially rapidly progressive mycobacteria infection, is one of the causes of ventilator associated pneumonia in elderly patients. Symptoms may be non-specific and imaging features of typical NTM lung disease is uncommon. Mycobacteria cultures and accurate NTM species identification should be performed in order to avoid misdiagnosis.
出处
《北京医学》
CAS
2014年第3期180-183,共4页
Beijing Medical Journal
基金
江西省卫生厅科技计划(20121064)
解放军总医院临床科研扶持基金(2012FC-CXYY-4001)
关键词
机械通气
非结核分枝杆菌
肺部感染
Mechanical ventilation
Non-tuberculous mycobacterium
Pulmonary infection
