论文部分内容阅读
1例82岁男性患者行肺部肿瘤放射治疗(疗程44 d),同时口服吉非替尼250 mg,1次/d。第19天出现皮疹;第38天出现发热;第47天诊断放射性肺损伤,给予抗生素及糖皮质激素治疗后痊愈;第70天出现呼吸困难,呼吸32次/min,伴有咳嗽。实验室检查:白细胞计数4.0×109/L,中性粒细胞计数3.7×109/L。血气分析示pH 7.06,二氧化碳分压(PaCO2)36 mm Hg(1 mm Hg=0.133 kPa),氧分压(PaO2)45 mm Hg,氧饱和度0.55。结合X线胸片与临床表现考虑为吉非替尼相关间质性肺炎。立即停药,行气管插管并呼吸机机械通气,同时静脉滴注美罗培南和甲泼尼龙,1周后患者症状改善。间隔1周后,患者再次出现呼吸困难,血气分析示pH 7.43,PaCO234 mm Hg,PaO240 mm Hg,在短期内相继出现左侧心力衰竭、上消化道出血、Ⅱ型呼吸衰竭、肝肾功能不全、急性心肌梗死。虽经保肝、利尿等治疗,患者终因多器官功能衰竭死亡。
A 82-year-old male patient underwent radiotherapy for lung tumors (44 days after treatment) and received gefitinib 250 mg once daily. A rash on day 19; fever on day 38; radioactive lung injury on day 47, recovery after antibiotic and glucocorticoid treatment; breathlessness on day 70, breathing 32 breaths / min with cough. Laboratory tests: white blood cell count 4.0 × 109 / L, neutrophil count 3.7 × 109 / L. Blood gas analysis showed pH 7.06, PaCO2 36 mm Hg (1 mm Hg = 0.133 kPa), oxygen partial pressure (PaO2) 45 mm Hg, and oxygen saturation 0.55. Combined with X-ray and clinical manifestations of gefitinib-related interstitial pneumonia considered. Immediate withdrawal, tracheal intubation and ventilator mechanical ventilation, intravenous infusion of Meropenem and methylprednisolone, 1 week after the patient’s symptoms improved. After a lapse of one week, the patient again experienced dyspnea. Blood gas analysis showed pH 7.43, PaCO2 34 mm Hg, and PaO2 40 mm Hg. Left heart failure, upper gastrointestinal bleeding, type II respiratory failure, liver-kidney dysfunction, Acute myocardial infarction. Although the liver, diuretic and other treatment, patients eventually died of multiple organ failure.