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目的探讨静脉应用毒品致脓毒性肺栓塞(SPE)的临床特点和诊治经过,提高对该病的诊断和治疗水平。方法回顾性分析1994年1月至2006年12月收治的22例静脉应用毒品致脓毒性肺栓塞患者的临床表现、胸部影像学特点、血培养结果、超声心动图结果和诊治经过。结果临床表现为发热(22/22)、呼吸困难(20/22)、咳嗽(18/22)、胸痛(10/22)和咯血(8/22)。X 线胸片和CT 表现为结节(15/22)、局灶浸润影(12/22)、楔型阴影(5/22)、气囊(18/22)、空洞(11/22)及胸膜病变(11/22)。病灶分布在外周或胸膜下(20/22),CT 较 X 线胸片可更清晰地显示病灶。血标本可培养出金黄色葡萄球菌(22/22)。超声心动图可见三尖瓣赘生物(22/22)。所有患者静脉使用2～4周耐酶青霉素、丁胺卡那霉素、万古霉素或左氧氟沙星,同时分别给予呼吸、循环支持和胸腔闭式引流。14例患者痊愈出院,8例好转出院。结论病情隐匿,缺乏特异性。高危人群如静脉吸毒者出现发热、影像学表现为多发和散在的胸膜下或周边气囊、结节影伴或不伴有空洞形成提示本病。早期诊断、及时给予抗生素治疗、控制肺外感染灶、给予呼吸支持,多数患者预后良好。
Objective To investigate the clinical features, diagnosis and treatment of septic pulmonary embolism (SPE) by intravenous drug use and to improve the diagnosis and treatment of the disease. Methods The clinical manifestations, thoracic imaging features, blood culture results, echocardiographic results and diagnosis and treatment of 22 patients with septic pulmonary embolism admitted from January 1994 to December 2006 were analyzed retrospectively. Results The clinical manifestations were fever (22/22), dyspnea (20/22), cough (18/22), chest pain (10/22) and hemoptysis (8/22). X-ray and CT showed nodules (15/22), focal infiltrates (12/22), wedges (5/22), air balloons (18/22), cavities (11/22) Lesions (11/22). Lesions are located in the periphery or subpleural (20/22), CT than X-ray can be more clearly show lesions. Staphylococcus aureus can be cultivated in blood samples (22/22). Echocardiography showed tricuspid valve vegetation (22/22). All patients received intravenous 2 ~ 4 weeks of resistant enzyme penicillin, amikacin, vancomycin or levofloxacin, while breathing, circulatory support, and thoracic closure drainage. Fourteen patients were cured and discharged and eight were discharged. Conclusions The condition is obscure and lacks specificity. High-risk groups such as intravenous drug users who have fever, radiographic manifestations of multiple and scattered pleural or peripheral balloon, nodular shadow associated with or without the formation of voids prompted the disease. Early diagnosis, timely antibiotic treatment, control of extrapulmonary lesions, respiratory support, the majority of patients with good prognosis.