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心得体会:在规律抗感染治疗>72 h临床症状未得到改善且胸部影像学未见改变或进展时, 气管镜检查及超声支气管镜检查用于检测支气管内病变或证实非感染疾病可优先作为侵入性诊疗手段。肺弥漫性病变或怀疑特殊菌感染者建议应用气管镜检查及支气管肺泡灌洗刷检及留取灌洗液行病原学、灌洗液常规等检测[13]。当气管镜下未见异常时, 应根据影像学特点选择进行超声支气管镜检查和(或)气管镜超声小探头探查及活检, 以排除非感染性疾病, 本研究确诊的病例中, 大多数病例经过气管镜或超声支气管镜检查确诊。在极少数情况下, 手术[开放式或电视辅助胸腔镜手术(VATS)]活检在鉴别非感染性疾病是必需的。早期的诊断和适当的治疗将有可能降低患者的发病率和死亡率。
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[收稿日期:2018-11-12]
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