目的探讨艾滋病(AIDS)合并巨细胞病毒性肺炎(CMP)伴急性呼吸窘迫综合征(ARDS)的临床特点、治疗与转归。方法对ICU收治的12例艾滋病合并巨细胞病毒性肺炎伴ARDS患者的临床表现、影像学特点、血清学指标、T淋巴细胞亚群、治疗及预后进行分析。结果 12例患者均表现为发热、咳嗽、气促症状,呼吸困难进行性加重,肺部听诊可闻及少量湿性罗音,外周血淋巴细胞计数减少,血清白蛋白16～31g/L,CD4+T淋巴细胞绝对计数9～42/μl,乳酸脱氢酶、血乳酸增高,CMV抗体检测阴性,血气分析表现为严重进行性加重的低氧血症,X线胸片检查为两下肺弥漫分布的网状或小结节斑片状淡薄阴影,病灶迅速发展为大片状致密影,经气管插管、呼吸机辅助通气治疗,低氧血症能得到不同程度的改善,但抗巨细胞病毒治疗不能有效阻止病情的进展,病灶很快波及全肺,死亡率高。结论艾滋病合并巨细胞病毒性肺炎出现ARDS预后差,建议对于CD4+T淋巴细胞计数<50/μl的艾滋病患者应常规预防性使用更昔洛韦口服,防治CMP的发生。 Objective To investigate the clinical features, treatment and outcome of AIDS complicated with acute respiratory distress syndrome (CMDS) combined with cytomegalovirus pneumonia (CMP). Methods The clinical manifestations, imaging features, serological parameters, T lymphocyte subsets, treatment and prognosis of 12 patients with AIDS complicated with cytomegalovirus pneumonia and ARDS were analyzed in the ICU. Results All the 12 patients showed fever, cough, shortness of breath symptoms, progressive dyspnea, pulmonary auscultation and a small amount of wet rales, decreased peripheral blood lymphocyte counts, serum albumin 16-31g / L, CD4 + T lymphocytes absolute count 9 ~ 42 / μl, lactate dehydrogenase, increased blood lactate, CMV antibody negative, blood gas analysis showed severe progressive hypoxemia, X-ray examination for the two diffuse distribution of the lungs Of the mesh or small nodular patchy light shadows, the rapid development of large lesions dense lesions, tracheal intubation, ventilator-assisted ventilation, hypoxemia can be improved to varying degrees, but anti-cytomegalovirus Treatment can not effectively prevent the progression of the disease, the disease spread to the lungs soon, high mortality. Conclusions The AIDS patients with cytomegalovirus pneumonia have a poor prognosis of ARDS. It is suggested that ganciclovir should be given routinely and prophylactically in patients with AIDS with CD4 + T lymphocyte count <50 / μl.