方法:一名58岁男性患者积极吸烟,因严重高碳酸血症急性呼吸衰竭和持续的双侧胸片混浊在3个月内两次入住三级转诊胸中心的重症监护病房(ICU)。患者患有肥胖症(体重指数,36),3期血管性慢性肾功能不全,和用氟哌啶醇治疗的精神分裂症,卡马西平,还有cyamemazine.他报告劳累时出现慢性呼吸困难,恶化了6个月。在第二次ICU入院时,病人发热,通过非再呼吸面罩进行6L/min氧气治疗时,血压为160/72mmHg,脉搏血氧饱和度为93%。体格检查显示呼吸衰竭的迹象,伴有喘息和腹部活跃的呼气,双侧肺裂无胸痛,咯血,俱乐部,或者心力衰竭的迹象.患者没有周围淋巴结肿大,也没有脾脏肿大。血气(6L/min氧气)显示呼吸性酸中毒(pH,7.15[正常范围,7.38-7.42];PaO2水平,67mmHg[正常范围,80-100mmHg];PaCO2水平,102mmHg[正常范围,38-42mmHg];碳酸氢盐[HCO3-],29mmol/L[正常范围,22-27mmol/L])。开始无创通气。在第二次ICU住院期间进行的成像包括胸部CT和MRI,无对比增强,和氟18(18F)氟脱氧葡萄糖(FDG)PET/CT。
A 58-year-old male patient with an active smoking status was admitted twice to the intensive care unit (ICU) of a tertiary referral thoracic center for severe hypercapnic acute respiratory failure and persistent bilateral chest radiograph opacities that were unchanged over the course of the two ICU admissions within a 3-month period. The patient had obesity (body mass index, 36), stage 3 vascular chronic renal insufficiency, and hebephrenic schizophrenia treated with haloperidol, carbamazepine, and cyamemazine. He reported chronic dyspnea on exertion, which worsened for 6 months. At the second ICU admission, the patient was afebrile, with a blood pressure of 160/72 mm Hg and pulse oximetry of 93% on 6 L/min oxygen therapy through a nonrebreathing mask. Physical examination showed signs of respiratory failure with wheezing and active abdominal expiration, and bilateral pulmonary crackles without chest pain, hemoptysis, clubbing, or signs of cardiac failure. The patient had no peripheral lymphadenopathy and no enlarged spleen. Blood gases (on 6 L/min oxygen) showed respiratory acidosis (pH, 7.15 [normal range, 7.38-7.42]; PaO2 level, 67 mm Hg [normal range, 80-100 mm Hg]; PaCO2 level, 102 mm Hg [normal range, 38-42 mm Hg]; bicarbonate [HCO3-], 29 mmol/L [normal range, 22-27 mmol/L]). Noninvasive ventilation was initiated. Imaging performed during the second ICU hospitalization included CT and MRI of the chest without contrast enhancement, and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT.