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患者,男,57岁,兽医.因咳嗽,乏力,纳差于93年8月21日入院.患者于去年因咳嗽,咳痰就诊于他院,确诊为Ⅲ型肺结核,曾给予异烟肼、利福平、链霉素和对氨水杨酸处理.用药1个月后,患者突感呼吸困难、胸闷、面色微红,给予地塞米松注射及吸氧后好转.停用利福平,续用其他三药,未见出现异常情况.返家后,断续服用异烟肼和对氨水杨酸.近1月来又出现咳嗽、乏力而入我院.痰涂片检查结核杆菌阳性,确诊为Ⅲ型肺结核.考虑到利福平应用时间短,又系结核复治,决定给予利福平0.45g/次,1次/d;异烟肼0.3g/次,1次/d;吡嗪酰胺0.5g/次,3次/d.用药2h后,患者出现呼吸急促、胸闷不适,咯粉红色泡沫样痰.体检:T37℃,HR140次/min,BP 12/11kPa;急促,半卧位,心律齐,两肺底可闻及湿性罗音.考虑为肺水肿,即刻输氧、肌注呋喃苯胺酸及地塞米松注射剂.处理后情况有所好转,7h后恢复到服药前状况.此后服用乙胺丁醇和吡嗪酰胺2个月.未出现类似现象.
The patient, male, 57 years old, was admitted to hospital on August 21, 1993 due to cough, weakness and anorexia.The patient was diagnosed with type III tuberculosis due to cough and phlegm in the past year, was given isoniazid, Rifampicin, streptomycin and p-aminosalicylic acid treatment.After 1 month of treatment, the patient suddenly felt difficulty breathing, chest tightness, looking reddish, given dexamethasone injection and oxygen after the improvement. With other three drugs, no abnormalities were seen.After returning home, intermittent use of isoniazid and p-aminosalicylic acid.Also appeared in recent months, cough, fatigue and into our hospital.Spitaneous sputum smear positive Mycobacterium tuberculosis, confirmed For type Ⅲ pulmonary tuberculosis .In view of the short application of rifampicin, but also the Department of tuberculosis relapse, decided to give rifampicin 0.45g / times, 1 / d; Isoniazid 0.3g / times, 1 / d; pyrazine Amide 0.5g / time, 3 times / d. 2h after treatment, patients with shortness of breath, chest discomfort, slightly pink foam-like sputum Physical examination: T37 ℃, HR140 times / min, BP 12 / 11kPa; , Heart rhythm Qi, the lungs can be heard at the end and wet rales. Considered pulmonary edema, immediate oxygen, intramuscular injection of furosemide and dexamethasone injection. After treatment, the situation has improved, after 7h to return to pre-medication condition. Ethambutol and pyrazinamide were used for 2 months, a similar phenomenon did not occur.