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-  2017 

肺毛霉病两例报告并文献复习

DOI: doi:10.7507/1671-6205.201607021

Keywords: 肺毛霉病, 临床特点, 治疗

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Abstract:

目的 探讨肺毛霉病(PM)的临床特点和治疗措施,提高医务人员对该病的认识,降低病死率。 方法 回顾性分析济宁医学院附属医院呼吸科收治的 2 例 PM 患者的病历资料,同时进行相关文献复习。以“肺毛霉菌病”为检索词检索中国知网(CNKI)数据库,以“pulmonary mucormycosis”为检索词检索 Pubmed 数据库,检索时间为 2000 年 1 月到 2016 年 6 月。 结果 患者 1,男性,2014 年 2 月 7 日以“咳嗽、咳痰伴憋喘 5 d”收入院。胸部计算机断层成像(CT)提示:右肺上叶结节,邻近右肺上叶尖段支气管截断。2014 年 2 月 16 日行电子支气管镜检查,活检病理组织中见毛霉菌,确诊后给予两性霉素 B 治疗好转出院。患者 2,女性,2015 年 1 月 16 日以“咳嗽、咳痰伴发热 10 + d”收入院。胸部 CT 示双肺纹理增强、紊乱,双肺内见多发大小不等的圆形结节、空洞,边界清楚,其中最大空洞直径约 1.8 cm,部分空洞内见软组织密度影。行 CT 引导下肺穿刺,穿刺病理组织回示大部分为坏死性肉芽组织,其中见真菌菌丝,符合毛霉菌感染。确诊后给予两性霉素 B、伏立康唑、泊沙康唑治疗,效果欠佳,患者自动出院,1 周后死亡。文献检索经过严格筛选,最终收集病历资料完整的 6 篇文献进行 PM 临床特点及治疗措施的归纳总结。PM 患者临床表现无特异性,多合并基础疾病,从出现症状到确诊约需要 37.5 d。CT 以及组织病理学检查有助于早期诊断,及时抗真菌治疗有助于改善预后。 结论 PM 是一种罕见的侵袭性真菌病,病死率高,临床表现无特异性,早期诊断、及时治疗是降低病死率的关键

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