每日一题_2023.08.04

A 95-year-old woman presented with a 4-week history of dyspnea and dry cough. She had not previously reported these symptoms to her doctor. For the past 6 months, she had been taking nitrofurantoin daily to prevent recurrent urinary tract infections. Her oxygen saturation was 83% on room air. Physical examination showed inspiratory crackles in the upper lung fields but no jugular venous distention or edema. Laboratory studies showed neutrophilic leukocytosis but no eosinophilia or elevations in aminotransferase levels. A sputum culture and viral respiratory panel were negative. Chest radiograph and computed tomography of the chest are shown. What is the most important element of the management of this condition?

患者女，95岁，因”呼吸困难、干咳4周”就诊。患者此前未向其医生报告这些症状。在过去的6个月里，她一直每天服用呋喃妥因以预防复发性尿路感染。在空气中氧饱和度为83%。体格检查示上肺野吸气性爆裂声，但无颈静脉扩张或水肿。实验室检查显示中性粒细胞增多，但无嗜酸性粒细胞增多或转氨酶水平升高。痰培养和呼吸道病毒检测结果均为阴性。胸片和胸部计算机断层扫描显示。治疗这种疾病最重要的因素是什么?

A. Antibiotics 抗生素

B. Cessation of nitrofurantoin 停用呋喃妥因

C. Glucocorticoids 糖皮质激素

D. Intravenous loop diuretics 静脉袢利尿剂

E. Scheduled nebulized bronchodilators 使用雾化支气管扩张剂

答案解析：

结合患者的影像学表现和长期呋喃妥因暴露，诊断为慢性呋喃妥因所致肺损伤。停用呋喃妥因，并给予泼尼松减量治疗。2个月后，患者症状缓解，支气管扩张稳定。

正确答案：B