中西医结合治疗多重耐药菌合并结核菌感染反复发热患者1例
A Case of Multi-drug Resistant Bacteria Combined with Tuberculosis Infection Treated by Combination of Traditional Chinese and Western Medicine
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1.南陵县中医医院,安徽省芜湖市,241300
2.六合区人民医院,南京,210025
3.南京中医药大学附属医院感染科,南京,210000
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余金花,赵成军,乔飞.中西医结合治疗多重耐药菌合并结核菌感染反复发热患者1例[DB/OL].(2023-12-18)[2023-12-18].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46082779&Fpath=home&index=0&lang=zh
YU Jinhua,ZHAO Chengjun,QIAO Fei.A Case of Multi-drug Resistant Bacteria Combined with Tuberculosis Infection Treated by Combination of Traditional Chinese and Western Medicine[J].,
余金花,赵成军,乔飞.中西医结合治疗多重耐药菌合并结核菌感染反复发热患者1例[DB/OL].(2023-12-18)[2023-12-18].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46082779&Fpath=home&index=0&lang=zh DOI:
YU Jinhua,ZHAO Chengjun,QIAO Fei.A Case of Multi-drug Resistant Bacteria Combined with Tuberculosis Infection Treated by Combination of Traditional Chinese and Western Medicine[J]., DOI:.
病史摘要,2,患者老年男性,因“发热3天”入院。患者反复高热伴咳嗽咳痰,Tmax 39.2 ℃,多次查血常规提示白细胞(WBC)计数下降,中性粒细胞(NE)比值升高,C反应蛋白(CRP)升高,胸部CT提示:两肺间质性感染;两肺上叶钙化灶;两肺多发结节;两肺肺气肿、肺大泡;右肺门钙化灶;纵隔淋巴结钙化。多次痰培养+药敏提示:肺炎克雷伯菌(广泛耐药)、铜绿假单胞菌。痰找抗酸杆菌:结核分枝杆菌检测 阳性。经抗感染及抗结核治疗后仍有反复低热,畏寒,咳嗽咳痰,并出现双下肢皮疹,加用中药“益气养阴、清热化痰”为主要治法治疗后,患者病情明显改善,体温恢复正常。中医诊断 风温肺热病:痰热郁肺、气阴两虚证。西医诊断 多重耐药菌感染,肺结核,高血压病,冠心病,类风湿性关节炎干预措施 西医治疗:抗感染,抗结核及对症支持治疗。中药:益气养阴、清热化痰治法为主,处方为生黄芪、生地黄、炒白术、党参、苦杏仁、枇杷叶、前胡、女贞子、墨旱莲、枸杞子、香附、白茅根、芦根、北沙参、南沙参、麦冬、知母、当归、丹参、藿香、厚朴、茯苓、川贝粉、苦参。疗效转归 患者体温恢复正常,咳嗽咳痰消失,皮疹消退,复查血常规提示白细胞、中性粒细胞计数正常范围,C反应蛋白等炎性指标恢复正常范围。
Summary of case history, The elderly men were admitted to the hospital for "3 days of fever".Patients repeatedly have high fever with cough and sputum, Tmax 39.2° C, and repeatedly checked the blood cells for many times that white blood cells (WBC) counting decrease, neutrophil (NE) ratio increased, C-reactive protein (CRP) increased,Chest CT showed interstitial infection of both lungs. Please refer to the clinic. Calcification foci in upper lobe of both lungs; Multiple nodules in both lungs; Two lungs emphysema, pulmonary bulla; Calcification of right pulmonary hilum; Mediastinal lymph node calcification.Multiple sputum cultures and drug susceptibility suggested: Klebsiella pneumoniae (extensively drug-resistant), Pseudomonas aeruginosa. Sputum found acid-fast bacilli: Positive for Mycobacterium tuberculosis.After anti -infection and anti -tuberculosis treatment, there are still repeated fever, chills, cough and sputum, and double limb rash.When we added chinese medicine treatment ,the patient's condition improved significantly and his temperature returned to normal.,TCM diagnosis, wind-warmth disease with lung-heat:phlegm-heat obstructing lung syndrome,qi-yin deficiency syndrome,Western medicine diagnosis, multidrug-resistant infections, tuberculosis, hypertension, coronary heart disease, rheumatoid arthritis,Therapeutic methods, western medicine treatment: anti -infection treatment, anti -tuberculosis treatment and symptomatic support treatment.Traditional Chinese medicine such as raw astragalus, raw ground yellow by clearing heat and eliminating phlegm,Qi-enriching and Yin-nourishing method.,Clinical outcomes, The patient's body temperature returned to normal, the cough and sputum disappeared, and the rash subsided. The reexamination of blood routine showed that the white blood cells and neutrophil counts were in the normal range, and CRP and other inflammatory indicators were in the normal range.
多重耐药菌肺结核发热皮疹益气养阴中西医结合治疗
multiple drug resistancetuberculosisfeverrashnourishing qi nourishing yincombination of traditional Chinese and western medicine
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