Ando T, Kimura K, Kawabata S, Koh K J, Nakagawa J, Makise Y, Sato K, Kikui M, Kameda K
Kekkaku. 1989 Aug;64(8):519-27.
In seven patients with tuberculosis required ventilatory assistance, in our IRCU at the Habikino Hospital, we found worsening of the findings on chest X-ray film and clinical status during initial phase of chemotherapy, although their sputum became negative for acid-fast bacilli. On admission, six of them had large infiltration with cavities and discharged a large number of bacilli with elevation of ESR and hypoalbuminemia. We could get four patents off ventilator after start of PEEP therapy and high dose corticosteroid therapy. But three of them died at last, because they developed severe respiratory failure again. Pulmonary histology was available in five patients. We found interstitial and intra-alveolar pulmonary edema, intra-alveolar organization, hyperplasia of alveolar wall, and hyaline membrane formation. These findings were compatible with diffuse alveolar damage.
在羽曳野医院的重症监护病房（IRCU），7例需要通气支持的肺结核患者在化疗初始阶段，胸部X光片检查结果和临床状况出现恶化，尽管他们的痰液抗酸杆菌检测转为阴性。入院时，其中6例有大片浸润伴空洞，排出大量杆菌，血沉升高且伴有低白蛋白血症。在开始呼气末正压通气（PEEP）治疗和大剂量皮质类固醇治疗后，4例患者撤机。但其中3例最终死亡，因为他们再次出现严重呼吸衰竭。5例患者进行了肺组织学检查。我们发现存在间质性和肺泡内肺水肿、肺泡内机化、肺泡壁增生以及透明膜形成。这些发现符合弥漫性肺泡损伤。
