淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件

淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告仲凱勵(lì)中國(guó)軍事醫(yī)學(xué)科學(xué)院附屬307醫(yī)院淋巴瘤科淋巴瘤化療相關(guān)的間質(zhì)性1引言隨著淋巴瘤化療的劑量與強(qiáng)度的增大療效也逐漸提高肺部感染是影響患者完成治療的重要因素。從2006-2007我院共收治淋巴瘤患者例,其中出現(xiàn)間質(zhì)性肺炎10例。解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康引言2Contents患者一般情況2臨床表現(xiàn)3診斷與治療4討論解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康Contents3般情況(n=10)男:女=6:4中位年齡54.5歲(19-72歲)重度吸煙史:1例診斷:9例NHL1例HL無其他相關(guān)病史9例NHL:8例DLBCL+1例T-LBL解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康般情況(n=10)4化療方案化療方案1例ABvD8例BCHOP·表阿錄萊零錄博萊零景·長(zhǎng)春地辛●環(huán)確酰胺甲基卞肼表阿零1例ⅤDLCP長(zhǎng)新堿紅忠錄強(qiáng)的松左旋門塞酰胺酸·環(huán)磷酰胺長(zhǎng)毫新堿解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康化療方案5出現(xiàn)癥狀的時(shí)間病例化療博萊霉素*環(huán)磷酰胺序號(hào)周期數(shù)累積劑量mg)累積劑量(g)120234567897.23.26.45.80008.43.2解放307醫(yī)院淋巴瘤科*BLM中位劑量:60mg關(guān)注淋巴關(guān)受健康出現(xiàn)癥狀的時(shí)間6臨床表現(xiàn)發(fā)熱憋氣咳嗽臨床表現(xiàn)→,乏力輕咳痰查體(-)解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康臨床表現(xiàn)7臨床特點(diǎn)■發(fā)熱常常為首發(fā)癥狀-持續(xù)性,退熱藥物療效差本組以發(fā)熱起病8例(80%):高熱5例中熱3例■臨床癥狀與檢查結(jié)果分離:0T與血?dú)猱惓Ｃ黠@,但患者除發(fā)熱外,無明顯咳嗽、咳痰、氣短而一旦出現(xiàn)呼吸困難,常提示呼吸衰竭,病情危解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康臨床特點(diǎn)8臨床癥狀發(fā)生比例低氧血癥:100%型呼衰:75%■病例數(shù)發(fā)熱憋氣咳嗽咳痰CRF■病例數(shù)8解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)健康臨床癥狀發(fā)生比例9實(shí)驗(yàn)室檢查病例白細(xì)胞粒細(xì)胞比CRF血?dú)?P02例(‰)(<3mg/|)1.7362.4750.3834.212.661133.429.437.591.42-34567892.0177.128.263.6265.735.94490.9368.818.7842.52.1721.744.32.373.5180.7287.31.0171.211.34102.748.513.6解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康實(shí)驗(yàn)室檢查10淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件11淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件12淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件13淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件14淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件15淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件16淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件17淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件18淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件19淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件20淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件21淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件22淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件23淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件24淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件25淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件26淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件27淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件28淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件29淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件30淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件31淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件32淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件33淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件34淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件35淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件36淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件37淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告仲凱勵(lì)中國(guó)軍事醫(yī)學(xué)科學(xué)院附屬307醫(yī)院淋巴瘤科淋巴瘤化療相關(guān)的間質(zhì)性38引言隨著淋巴瘤化療的劑量與強(qiáng)度的增大療效也逐漸提高肺部感染是影響患者完成治療的重要因素。從2006-2007我院共收治淋巴瘤患者例,其中出現(xiàn)間質(zhì)性肺炎10例。解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康引言39Contents患者一般情況2臨床表現(xiàn)3診斷與治療4討論解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康Contents40般情況(n=10)男:女=6:4中位年齡54.5歲(19-72歲)重度吸煙史:1例診斷:9例NHL1例HL無其他相關(guān)病史9例NHL:8例DLBCL+1例T-LBL解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康般情況(n=10)41化療方案化療方案1例ABvD8例BCHOP·表阿錄萊零錄博萊零景·長(zhǎng)春地辛●環(huán)確酰胺甲基卞肼表阿零1例ⅤDLCP長(zhǎng)新堿紅忠錄強(qiáng)的松左旋門塞酰胺酸·環(huán)磷酰胺長(zhǎng)毫新堿解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康化療方案42出現(xiàn)癥狀的時(shí)間病例化療博萊霉素*環(huán)磷酰胺序號(hào)周期數(shù)累積劑量mg)累積劑量(g)120234567897.23.26.45.80008.43.2解放307醫(yī)院淋巴瘤科*BLM中位劑量:60mg關(guān)注淋巴關(guān)受健康出現(xiàn)癥狀的時(shí)間43臨床表現(xiàn)發(fā)熱憋氣咳嗽臨床表現(xiàn)→,乏力輕咳痰查體(-)解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康臨床表現(xiàn)44臨床特點(diǎn)■發(fā)熱常常為首發(fā)癥狀-持續(xù)性,退熱藥物療效差本組以發(fā)熱起病8例(80%):高熱5例中熱3例■臨床癥狀與檢查結(jié)果分離:0T與血?dú)猱惓Ｃ黠@,但患者除發(fā)熱外,無明顯咳嗽、咳痰、氣短而一旦出現(xiàn)呼吸困難,常提示呼吸衰竭,病情危解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康臨床特點(diǎn)45臨床癥狀發(fā)生比例低氧血癥:100%型呼衰:75%■病例數(shù)發(fā)熱憋氣咳嗽咳痰CRF■病例數(shù)8解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)健康臨床癥狀發(fā)生比例46實(shí)驗(yàn)室檢查病例白細(xì)胞粒細(xì)胞比CRF血?dú)?P02例(‰)(<3mg/|)1.7362.4750.3834.212.661133.429.437.591.42-34567892.0177.128.263.6265.735.94490.9368.818.7842.52.1721.744.32.373.5180.7287.31.0171.211.34102.748.513.6解放307醫(yī)院淋巴瘤科關(guān)注淋巴關(guān)受健康實(shí)驗(yàn)室檢查47淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件48淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件49淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件50淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件51淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件52淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件53淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件54淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件55淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件56淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件57淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件58淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件59淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件60淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件61淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件62淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件63淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件64淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件65淋巴瘤化療相關(guān)的間質(zhì)性肺炎10例報(bào)告課件66淋巴瘤化療相關(guān)的間質(zhì)性