协和医学杂志

2020, v.11(04) 479-485

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皮疹,心力衰竭,肾功能不全,嗜酸性粒细胞增多:一例高龄衰弱老年患者
Rash, Heart Failure, Renal Insufficiency, and Hypereosinophilia in an Elderly Frail Male

苏琳凡;张宁;王倩;张路;杨德彦;夏鹏;邵池;朱鸣雷;张莉;康军仁;孙晓红;刘晓红;李军;李潇;
SU Lin-fan;ZHANG Ning;WANG Qian;ZHANG Lu;YANG De-yan;XIA Peng;SHAO Chi;ZHU Ming-lei;ZHANG Li;KANG Jun-ren;SUN Xiao-hong;LIU Xiao-hong;LI Jun;LI Xiao;Department of Internal Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medi

摘要(Abstract):

一例高龄老年患者,多器官功能储备差,嗜酸性粒细胞增多致心、肾慢性功能不全且急性加重,经激素及免疫抑制剂治疗后嗜酸性粒细胞恢复正常、皮疹消退,但后期出现卡氏肺孢子菌肺炎,抗感染治疗疗效不理想,最终患者因感染性休克死亡。本例患者基础情况复杂,诊治过程一波三折,经多学科团队共同参与讨论,一步步解决患者诊疗决策中的难题,体现了多学科协作在疑难病诊疗中的意义。临床上应认识到,衰弱、谵妄亦是老年患者不良预后的危险因素,老年人机体代偿能力弱,不良反应耐受性差,易出现不良结局。在临床诊疗工作中,需权衡治疗并发症、远期收益、预期生存时间等多方面因素,作出正确的治疗决策。
This patient was an elderly male with poor basal multi-organ function reserve, increased eosinophils leading to acute exacerbation of chronic heart and kidney dysfunction. After treatment with hormones and immunosuppressants, eosinophils were normal and the rash subsided. However,pneumocystis carinii pneumonia appeared in the later stage, and the anti-infective treatment was not ideal. Eventually the patient died of septic shock. In this case, the basic situation of the patient was complex, the diagnosis and treatment process was twists and turns, and the multidisciplinary team participated in and discussed to solve the problems in thediagnosis and treatment decision-making of the patient step by step, which embodied the significance of multidisciplinary cooperation in the diagnosis and treatment of difficult diseases.Based on the poor prognosis of the disease, it should be recognized clinically that weakness and delirium are also risk factors for poor prognosis in elderly patients. The elderly have weak compensatory ability, poor tolerance to adverse reactions, and are prone to adverse outcomes.In clinical diagnosis and treatment, the choice of plan needs to be considered in consideration of various factors such as treatment complications, long-term benefits, and expected survival time.

关键词(KeyWords): 高嗜酸粒细胞增多综合征;老年;衰弱
hypereosinophilic syndrome;elderly;frailty

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作者(Author): 苏琳凡;张宁;王倩;张路;杨德彦;夏鹏;邵池;朱鸣雷;张莉;康军仁;孙晓红;刘晓红;李军;李潇;
SU Lin-fan;ZHANG Ning;WANG Qian;ZHANG Lu;YANG De-yan;XIA Peng;SHAO Chi;ZHU Ming-lei;ZHANG Li;KANG Jun-ren;SUN Xiao-hong;LIU Xiao-hong;LI Jun;LI Xiao;Department of Internal Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medi

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