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干咳不发烧男子被确诊罕见肺炎

时间:2024-04-29人气:作者: 小编

干咳不发烧男子被确诊罕见肺炎

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一周前,31岁男子张赫(化名)突然感觉到自己透不过气来,被送入上海交通大学医学院附属新华医院急诊抢救室。几个关键性指标让医生也为他捏把汗:吸氧条件下血氧饱和度仅84%(正常标准一般在95%-100%),心率147次/分,呼吸窘迫。胸部CT发现,他的两肺呈“肺水肿”样表现。
急诊医生团队看望患者张赫。上海交通大学医学院附属新华医院 供图
究竟是不是“肺水肿”? 经过仔细询问病史,凭借20多年急重症救治经验,新华医院急诊科副主任、急诊重症监护室EICU主任医师葛勤敏脑海里立即闪现出一种罕见肺炎——耶氏肺孢子菌肺炎。
4月28日,上海交通大学医学院附属新华医院方面透露,这名男子是一个月前来上海求职的,此前一直干咳,由于没有发烧,就没当回事,也没有服药,更没有到医院去就诊过。没想到,突然之间,病情变化,透不过气来,他被送入了急诊抢救室。
入院后,新华医院急诊医生立即为其开通绿色通道,将张赫收入EICU急诊重症监护室,并进行辅助呼吸支持。检查发现,他入院后的真菌葡聚糖和乳酸脱氢酶都远高于正常值,影像学、血生化都指向“耶氏肺孢子菌肺炎”,而且是重症。
抢救当天,专家们凭临床经验,使用治疗剂量的复方磺胺甲噁唑,入院第4天,医生通过纤支镜留取的肺泡灌洗液中找到了耶氏肺孢子菌,验证临床诊断。
万幸的是,由于第一时间使用复方磺胺甲噁唑治疗,患者呼吸衰竭症状、炎症反应逐步得到改善,一周后,他脱离了高流量辅助呼吸机,换成了普通鼻导管吸氧。
何为“耶氏肺孢子菌肺炎”? 葛勤敏介绍,耶氏肺孢子菌最早发现于1909年,到1912年,人类发现这是一种新的类似原虫的病原体,杀虫剂对其有效,因此命名为卡氏肺孢子虫,可引起人类卡氏肺孢子虫肺炎。到1


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