Staszewski H
Hematology Service, Winthrop-University Hospital, Mineola, NY 11501.
Postgrad Med. 1993 Jul;94(1):69-72, 75-8.
Management of immunocompromised patients with diffuse pulmonary infiltrates remains a common and stubbornly difficult problems. The range of diagnostic possibilities is wide, noninvasive diagnostic procedures have little utility, and the drugs available for empirical therapy have toxic effects that are sometimes severe. Although guidelines for management have been developed, they may be predicated on data from a single institution or depend on diagnostic procedures and laboratory support that are not necessarily available to physicians in all locations. Controversy exists as to whether making a definitive diagnosis in these patients has an impact on overall outcome. An individualized approach must consider local resources, the patient's age and prognosis, type of immunosuppression, opinions of patient and family regarding invasive measures and heroic support, and previous patterns of infection in the institution. Before invasive procedures are performed, thought must be given to what changes in treatment may be made when results are known. Familiarity with and critical appraisal of the literature on pulmonary infiltration in immunocompromised patients can contribute to a clear diagnostic and management plan.
免疫功能低下患者出现弥漫性肺部浸润的管理仍然是一个常见且顽固的难题。诊断可能性范围广泛，非侵入性诊断程序效用不大，用于经验性治疗的药物具有有时很严重的毒性作用。尽管已经制定了管理指南，但这些指南可能基于单个机构的数据，或者依赖于并非所有地方的医生都能获得的诊断程序和实验室支持。对于在这些患者中做出明确诊断是否会对总体结果产生影响存在争议。个体化方法必须考虑当地资源、患者年龄和预后、免疫抑制类型、患者及其家属对侵入性措施和积极支持的看法，以及该机构以前的感染模式。在进行侵入性程序之前，必须考虑到当结果已知时治疗可能会发生哪些变化。熟悉并批判性评估关于免疫功能低下患者肺部浸润的文献有助于制定清晰的诊断和管理计划。
