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目的:总结和分析临床治疗系统性红斑狼疮(Systemic lupus erythematosus,SLE)合并弥漫性肺泡出血的主要特点及其治疗手段,供临床诊治该病提供参考。方法:采用回顾性分析研究方法对我院2009年7月至2013年7月间收治的系统性红斑狼疮合并弥漫性肺泡出血患者30例的病历记录资料做总结分析,对该疾病的主要临床特点、诊断要点及其治疗方法做分析。结果:本次研究所收集的30例患者均为女性,平均年龄34.3岁,临床表现以咳嗽咳痰、咯血或咯粉红色泡沫痰、低氧血症伴或不伴呼吸困难、血红蛋白降低、红细胞压积减小为主,多数患者可同时合并有狼疮性肾炎;诊断主要是建立在系统性红斑狼疮基础上,结合临床表现和肺部X线片机CT检查可确诊;治疗上主要使用泼尼松龙联合环磷酰胺做冲击治疗,同时通过呼吸机来改善呼吸状况,支气管镜肺泡灌洗的应用大大提高了治疗疗效,同时可采用成分输血及其静脉输注丙种免疫球蛋白做支持治疗;该病预后较差,本组30例患者4例死于呼吸衰竭。结论:系统性红斑狼疮合并弥漫性肺泡出血是SLE一个极为严重的并发症,发病不是很多见,但后果比较严重,很多患者极容易因为呼吸衰竭而死亡,是SLE一个急危重症,通过呼吸机的辅助呼吸及其他辅助治疗可以有效提高患者生存率,改善预后。
OBJECTIVE: To summarize and analyze the main characteristics of clinical treatment of systemic lupus erythematosus (SLE) combined with diffuse alveolar hemorrhage and its treatment methods for the clinical diagnosis and treatment of the disease. Methods: A retrospective analysis of the method of our hospital from July 2009 to July 2013 admitted to the treatment of systemic lupus erythematosus patients with diffuse alveolar hemorrhage in 30 cases of patient records to do summary analysis of the main clinical features of the disease , Diagnosis and treatment methods to do analysis. Results: All the 30 patients collected in this study were female. The mean age was 34.3 years old. The clinical manifestations were cough and expectoration, hemoptysis or pink foam sputum, hypoxemia with or without dyspnea, decreased hemoglobin, red blood cells Pressure reduction to reduce the majority of patients with concurrent lupus nephritis; diagnosis is mainly based on systemic lupus erythematosus, combined with clinical manifestations and lung CT X-ray CT diagnosis can be confirmed; the treatment mainly prednisone In combination with cyclophosphamide for treatment of attack, meanwhile respiratory status is improved through ventilator. The application of bronchoalveolar lavage can greatly improve the curative effect, meanwhile, component blood transfusion and intravenous infusion of immunoglobulin C can be used to support the treatment. The poor prognosis of the disease, the group of 30 patients died of respiratory failure in 4 patients. Conclusion: Systemic lupus erythematosus combined with diffuse alveolar hemorrhage is a very serious complication of SLE, the incidence is not a lot see, but the consequences are more serious, many patients very easily died of respiratory failure, is an acute critically ill SLE, through the ventilator Assisted breathing and other adjuvant therapy can effectively improve patient survival and improve prognosis.