不同氧流量氧疗对高原肺水肿的治疗效果分析

目的　探讨不同氧流量氧疗对高原肺水肿的临床治疗效果。方法　 75例高原肺水肿患者随机分成 3组 ,在常规治疗的基础上分别给予不同氧流量吸氧治疗 ,观察比较其治疗后肺部音消失时间、胸片阴影消失时间、临床治愈时间。结果　高氧流量氧疗组肺部音消失时间、胸片阴影消失时间、临床治愈时间明显短于低氧流量氧疗组。结论　根据高原肺水肿的病理生理特点 ,及时诊断、积极给予吸氧治疗可明显提高高原肺水肿的治愈率。     

小儿高原肺水肿临床特点及治疗

目的 :探讨小儿高原肺水肿的临床特点及治疗方法。方法 :对 86例高原肺水肿患儿在患病年龄、发病时间、诱因、临床表现及治疗后患儿肺部音消失时间、胸片阴影消失时间、临床治愈时间进行观察分析。结果 :在本组 86例患儿中 ,上呼吸道感染、过度活动是小儿高原肺水肿的主要诱因 ,小儿高原肺水肿多发生在进入高原前 3天 ,年长儿的肺部音消失时间、胸片阴影消失时间及临床治愈时间明显短于婴幼儿 (P <0 0 5 ,或 0 0 1)。结论 :对小儿高原肺水肿及时诊断 ,针对小儿的病理生理特点 ,进行积极的治疗 ,是提高小儿高原肺水肿的救治水平的有效方法     

吸入低浓度一氧化氮治疗高原肺水肿对比观察

目的观察低浓度一氧化氮（ＮＯ）吸入对高原肺水肿的治疗作用。方法６５例男性高原肺水肿患者，随机分为３组。常规治疗组（１９例）接受吸氧、静脉注射速尿、氨茶碱和地塞米松治疗；硝苯吡啶组（２４例）在常规治疗的基础上加服硝苯吡啶１０ｍｇ，３次／日；ＮＯ组（２２例）在硝苯吡啶治疗的基础上，一次性吸入１０ｐｐｍＮＯ３０分钟。比较各组病例肺部音、Ｘ线胸片阴影消失时间以及病程长短。结果ＮＯ组肺部音消失时间为０４±０３天，Ｘ线胸片阴影消失时间为０６±０２天，病程１８±０７天，与硝苯吡啶组（分别为２４±１４天，４１±１７天，６８±１８天）和常规治疗组（分别为３７±１２天，５５±１８天，９６±３１天）比较差异均有显著性。结论在常规治疗与硝苯吡啶治疗的基础上，吸入低浓度ＮＯ是治疗高原肺水肿比较有效的方法。     

重组人脑利钠肽治疗顽固性心力衰竭的疗效观察

目的探讨重组人脑利钠肽(rtBNP)治疗顽固性心力衰竭的疗效。方法将60例顽固性心力衰竭患者按治疗方案分为脑利钠肽组(30例)和硝普钠组(30例),硝普钠组在常规治疗基础上使用硝普钠治疗,脑利钠肽组在常规治疗基础上使用脑利钠肽治疗,比较两组患者的临床疗效及对心功能的影响。结果脑利钠肽组临床疗效总有效率达83.3%,优于硝普钠组的56.7%(P0.05);治疗后左室射血分数(LVEF)较治疗前有明显改善,且脑利钠肽组治疗后LVEF较硝普钠组有明显改善,差异有统计学意义(P0.05)。结论 rtBNP治疗顽固性心力衰竭疗效确切。     

注射用丹参(冻干)治疗慢性阻塞性肺病的疗效观察

目的探讨丹参对慢性阻塞性肺病的辅助治疗作用。方法选择2009年10月—2011年9月以慢性阻塞性肺病(急性加重期)住院患者78例,随机分为治疗组和对照组。观察并记录咳嗽、咳痰、喘息、肺部啰音及胸片阴影的消失时间。结果治疗组在咳嗽、咳痰、喘息、肺部啰音消失时间即有效率、住院时间方面均较对照组差异有统计学意义(P<0.01)。结论慢性阻塞性肺病(急性加重期)应用常规治疗基础上加用注射用丹参(冻干)疗效确切。     

观察比较硝普钠与酚妥拉明静脉滴注急诊治疗冠心病合并心力衰竭的临床疗效

目的观察比较硝普钠与酚妥拉明静脉滴注急诊治疗冠心病合并心力衰竭的临床疗效。方法择取我院进行治疗的100例冠心病合并心力衰竭患者,将其随机分为硝普钠组和酚妥拉明组,每组各50例。酚妥拉明组采用酚妥拉明静脉滴注治疗方式,硝普钠组采用硝普钠静脉滴注治疗方式。结果硝普钠组的总有效率(92.00%)明显优于酚妥拉明组(70.00%)。同时硝普钠组的治疗不良反应发生率为(4.00%)明显低于酚妥拉明组(16.00%),经统计学分析,两组对比结果有意义(P0.05)。结论采用硝普钠静脉滴注急诊方式治疗冠心病合并心力衰竭患者有着很好的临床疗效,能够明显改善患者的心功能状态,减少治疗后的不良反应出现,值得在临床上推广应用。     

喜炎平注射液联合头孢哌酮钠舒巴坦钠对老年社区获得性肺炎患者的影响

目的探讨喜炎平注射液联合头孢哌酮钠舒巴坦钠对老年社区获得性肺炎(CAP)患者的影响。方法选取2015年4月—2017年3月惠州市中医医院收治的老年CAP患者84例,采用随机数字表法分为对照组和观察组,每组42例。对照组患者予以头孢哌酮钠舒巴坦钠治疗,观察组患者予以喜炎平注射液联合头孢哌酮钠舒巴坦钠治疗;两组均持续治疗2周。比较两组患者临床疗效、临床症状改善时间(胸部阴影吸收时间、血常规检查结果恢复正常时间、肺部啰音消失时间、体温恢复正常时间、咳嗽消失时间)、治疗前后血清降钙素原(PCT)及骨膜蛋白(Periostin)水平、生活质量综合评定量表(GQOLI-74)评分。结果观察组患者临床疗效优于对照组(P0.05)。观察组患者胸部阴影吸收时间、血常规检查结果恢复正常时间、肺部啰音消失时间、体温恢复正常时间、咳嗽消失时间短于对照组(P0.05)。治疗前两组患者血清PCT、Periostin水平比较,差异无统计学意义(P0.05);治疗后观察组患者血清PCT、Periostin水平低于对照组(P0.05)。治疗前两组患者GQOLI-74评分比较,差异无统计学意义(P0.05);治疗后观察组患者GQOLI-74评分高于对照组(P0.05)。结论喜炎平注射液联合头孢哌酮钠舒巴坦钠治疗老年CAP的临床疗效确切,可有效缩短临床症状改善时间,降低血清PCT、Periostin水平,改善患者生活质量。     

硝普钠抢救88例老年心衰急性重症肺水肿的体会

目的老年心衰急性重症肺水肿临床较常见，且病死率高。本文报告用硝普钠抢救８８例的临床体会。方法（１）选择６０～８１岁典型急性肺水肿者，常规抗心衰如用西地兰、速尿、吗啡等治疗。（２）病情危重者７２例立即用硝普钠静滴，另１６例经用硝酸甘油静滴疗效不佳而改用硝普钠。（３）用法和用量：硝普钠２５ｍｇ加入５％葡萄糖液２５０ｍｌ静滴，６～９滴／分（２０～３０μｇ／ｍｉｎ）。合并休克或用药后收缩压低于１２．６ｋＰａ（９５ｍｍＨｇ）者，加多巴胺或多巴酚酊胺２０～４０ｍｇ于２５０ｍｌ液体中静滴，使收缩压维持在１２．６～１３．３ｋＰａ（９５～１００ｍｍＨｇ）。硝普钠一般２５～５０ｍｇ／ｄ，２～３天后停用，改消心痛和巯甲丙脯酸口服。结果本组８６例（９７．７％）在用药后１０分钟至２小时临床症状迅速缓解，肺部罗音消失。结论小剂量硝普钠对老年心衰急性重症肺水肿疗效确切，未发生毒副作用。     

新活素与硝普钠治疗顽固性心衰的临床观察

目的观察新活素（重组人脑利钠肽,rhBNP）与硝普钠治疗顽固性心力衰竭的疗效与安全性。方法将62例顽固性心力衰竭患者随机分为治疗组32例,对照组30例,在常规抗心衰治疗基础上分别给予新活素和硝普钠,连续用药3d后观察疗效。结果两组治疗后临床症状好转率比较差异有统计学意义,治疗组显著优于对照组（P〈0．05）,左室射血分数、每搏输出量、心输出量、心指数及尿量改善治疗组均优于对照组。结论新活素能明显改善顽固性心力衰竭患者的血流动力学,其疗效优于硝普钠,安全性与硝普钠类似。     

左西孟旦治疗顽固性心力衰竭临床疗效观察

目的观察左西孟旦治疗顽固性心力衰竭的临床疗效。方法选取2011年8月—2013年9月我科收治的顽固性心力衰竭患者40例,将其随机分为左西孟旦组和硝普钠组,各20例。在常规治疗基础上,左西孟旦组加用左西孟旦治疗,硝普钠组加用硝普钠治疗。治疗3 d后评定患者疗效,治疗前及治疗1周后,记录两组患者左室射血分数(LVEF)和血清脑钠肽(BNP)水平。结果左西孟旦组总有效率为90%(18/20),高于硝普钠组的75%(15/20)(P0.05);治疗后左西孟旦组LVEF高于硝普钠组,BNP低于硝普钠组(P0.05)。结论左西孟旦治疗顽固性心力衰竭疗效好,能明显改善患者心脏收缩功能,且不良反应少。     

老年人肺孢子虫所致院内获得性肺炎

目的提高临床对老年人非人类免疫性缺陷病毒（HIV）感染者肺孢子虫所致院内获得性肺炎（HAP）的认识。方法回顾性分析收治的5例非HIV感染者肺孢子虫所致HAP的临床资料。结果5例患者,男性4例,女性1例,年龄84～96岁,均有严重的多种基础疾病,4例因肺部感染诱发严重呼吸衰竭,经人工气道长期应用机械通气,机械通气期间反复发生机械通气相关性肺炎（VAP）,并因此长期反复应用多种广谱抗生素,1例为脑血管病后遗症伴有意识障碍反复多次发生HAP,亦反复应用多种广谱抗生素。5例患者均有长期发热,均伴有明显的呼吸道症状,4例肺部可闻及湿？？音及干鸣音,另1例仅闻及吸气相干鸣音。5例患者中有3例X线胸片显示双肺弥漫性斑片影,1例为右肺大片状阴影,左下肺少许斑片状阴影,另1例为右肺大片状阴影;1例有网状纹理,3例有双侧胸水,1例为单侧胸水。5例患者中3例痰找肺孢子虫和肺孢子虫PCR阳性;另2例为痰肺孢子虫PCR阳性,痰找肺孢子虫阴性。5例患者HIV抗体均阴性;5例患者中有3例辅助性T淋巴细胞（CD4）减少,CD4/CD8比值降低。确诊肺孢子虫肺炎（PCP）后,4例患者中在原有治疗的基础上加用或单用复方磺胺甲恶唑片,3例治愈,复查痰找肺孢子虫和肺孢子虫PCR均阴性,1例应用复方磺胺甲恶唑片3 d后因原有肾功能不全恶化而停用,2个月后因多脏器功能衰竭死亡。1例未治死亡。结论老年、反复应用广谱抗生素、血CD4减少者,即使没有HIV感染,在长期应用呼吸机期间或反复发生HAP,发生肺孢子虫所致重症HAP是可能的,死亡率高。     

抗胆碱药治疗高原肺水肿患者的临床研究

目的评估抗胆碱药对高原肺水肿（ＨＡＰＥ）的临床疗效及探讨其作用机制。方法将海拔４７００～５２６０米地区５８２例高原肺水肿患者分为３９３例抗胆碱药治疗组和１８９例一般疗法治疗的对照组,在治疗前及治疗后２４小时（ｈ）作无创血液动力学检测。结果抗胆碱药组患者的症状、体征、Ｘ线平片肺部阴影消失时间分别为（３３±１７）ｈ、（４６±２２）ｈ、（７５±２９）ｈ,平均住院日为（５３±１９）ｄ,与对照组比较差异有显著性（Ｐ均＜０．００１）,治愈率显著提高（Ｐ＜０．０５）,１４项血液动力学参数的异常改变得到纠正（Ｐ＜０．０５或Ｐ＜０．０１）。结论抗胆碱药具有疗效确切,疗程短,副作用小,治愈率高等突出优点。对血液动力学的作用为其重要的治疗机制之一,可作为高原肺水肿现场治疗的重要药物。     

A case of bronchial foreign body due to citrus fruit seed aspiration showing multiple pulmonary infiltration repeatedly]

We report a case of a bronchial foreign body in a 76-year-old citrus fruit farmer. The patient was detected patchy infiltration (ground-glass attenuation) of the right upper lung field on the chest X-ray on Dec. 26th, 2003. The shadow tended to disappear after treatment with antibiotics. The same shadow was detected again 10 months later and the patient underwent a bronchoscopic examination. A foreign body was found lodged in the center of the right upper bronchus, associated with bronchial stenosis due to mucosal edema. The abnormal shadow disappeared after the foreign body, which we decided was a citrus fruit seed, was removed. From the time course of the present illness and a retrospective evaluation of previous chest X-rays, the patient had aspirated the foreign body 18 months prior to his admission for bronchoscopy. We should be careful of the possibility of foreign bodies even when the elderly do not present a history of foreign body aspiration. It is important to consider the possibility of a bronchial foreign body in patients with repeated pneumonia, and to perform bronchoscopy aggressively.     

Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema

BACKGROUND: The comet-tail technique of chest ultrasonography has been described for the diagnosis of cardiogenic pulmonary edema. This is the first report describing its use for the diagnosis and monitoring of high-altitude pulmonary edema (HAPE), the leading cause of death from altitude illness. METHODS: Eleven consecutive patients presenting to the Himalayan Rescue Association clinic in Pheriche, Nepal (4,240 m) with a clinical diagnosis of HAPE underwent one to three chest ultrasound examinations using the comet-tail technique to determine the presence of extravascular lung water (EVLW). Seven patients with no evidence of HAPE or other altitude illness served as control subjects. All examinations were read by a blinded observer. RESULTS: HAPE patients had higher comet-tail score (CTS) [mean +/- SD, 31 +/- 11 vs 0.86 +/- 0.83] and lower oxygen saturation (O(2)Sat) [61 +/- 9.2% vs 87 +/- 2.8%] than control subjects (p < 0.001 for both). Mean CTS was higher (35 +/- 11 vs 12 +/- 6.8, p < 0.001) and O(2)Sat was lower (60 +/- 11% vs 84 +/- 1.6%, p = 0.002) at hospital admission than at discharge for the HAPE patients with follow-up ultrasound examinations. Regression analysis showed CTS was predictive of O(2)Sat (p < 0.001), and for every 1-point increase in CTS O(2)Sat fell by 0.67% (95% confidence interval, 0.41 to 0.93%, p < 0.001). CONCLUSIONS: The comet-tail technique effectively recognizes and monitors the degree of pulmonary edema in HAPE. Reduction in CTS parallels improved oxygenation and clinical status in HAPE. The feasibility of this technique in remote locations and rapid correlation with changes in EVLW make it a valuable research tool.     

重症急性呼吸综合征影像学变化和临床分期的研究

目的分析重症急性呼吸综合征(SARS)患者临床特点、实验室检测结果和胸部影像学变化,提出临床分期.方法对2003年3～5月间有完整胸部影像学动态变化和实验室检测数据的45例SARS患者进行分析.结果 (1)影像学变化普通型23例肺部出现一侧片状阴影为病程的2～5(2.9±1.0) d;发展到双侧2～11(6.9±2.5) d;出现双肺广泛磨玻璃样变、实变6～19(11.0±2.0) d;开始吸收为10～21(15.0±4.1) d;胸部影像学改变完全吸收为18～46(25.9±7.2) d.重型患者22例发展到双肺广泛磨玻璃样变、实变(9.0±3.2) d,与普通型相比,差异无显著性(P>0.05);开始吸收为(19.0±4.6) d, P=0.009, 胸部影像学改变完全吸收为(36.0±8.1) d, P=0.001, 其中7例死亡患者胸部影像学表现均在7 d内进展到双肺广泛实变.(2)实验室检测早期SARS患者T细胞亚群和淋巴细胞明显降低,38例存活组患者在10～15 d恢复;但7例死亡患者T细胞亚群和淋巴细胞未见恢复.结论 SARS患者可分5期潜伏期2～10 d,前驱期1～3 d,进展期4～7 d,极期8～15 d,恢复期16～24 d.从发病到胸部影像学改变初步吸收时间为10～15 d.1周之内进展到双肺广泛实变且2周左右T细胞亚群和淋巴细胞不能恢复的患者,可能预后极差.     

A long-term study of interstitial lung disease in systemic lupus erythematosus

The clinical course of chronic diffuse interstitial lung disease (ILD) was studied in 14 patients with SLE. The mean duration of follow-up was 7.3 years. All patients had dyspnea on exertion, pleuritic chest pain, chronic cough, and basilar rales. Chest roentgenogram showed diffuse or basilar infiltrates, pleural disease, and elevation of both diaphragms. Systemic corticosteroids were given early in the course of the illness for lung involvement and multisystem disease. Diffusing capacity for carbon monoxide (DLCO) and inspiratory vital capacity (IVC) improved or remained unchanged in the majority of patients. Respiratory complaints improved in all patients; however, two patients died of pulmonary fibrosis and another died of bacterial pneumonia. Alveolar septal deposits of immunoglobulins and complement were found. This study showed that while variability existed among individual subjects, the clinical progression of ILD was slow and tended to improve or stabilize with time.     

Multiple intrapulmonary rheumatoid nodules]

A 66-year-old woman who had been treated at a nearby hospital since 1977 for rheumatoid arthritis complained of cough. Chest X-ray films disclosed multiple nodular shadows with cavitation in the fields of both lungs. The patient was admitted to our hospital and a thoracoscopic lung biopsy was performed. Histologically, the nodule consisted of necrotizing granuloma, indicating a necrobiotic nodule. Rheumatoid nodule was diagnosed because the patient exhibited rheumatoid arthritis. The chest X-ray shadow disappeared without medication. Rheumatoid nodules without coniosis are uncommon, but should be considered in the differential diagnosis of lung nodular lesions in patients with rheumatoid arthritis.     

Analysis of chest radiographs of culture positive Legionella pneumonia in Japan, 1980-1990. Working Party for Legionellosis, Japanese Ministry of Health and Welfare]

We analyzed the initial and follow-up chest radiographs of 28 patients with culture-positive Legionella pneumonia, and developed a scoring system to quantitate the severity of radiological findings for pneumonia. Intrapulmonary shadows were observed on the initial chest radiograph in 26 patients, but pleural effusion was noted in only one. In one patient the initial chest radiograph had probably been obtained too early to reveal any pulmonary change. Alveolar shadows were noted on the initial radiograph in 21 (81%) patients, and interstitial shadows in 5 (19%). In ten (38%) patients shadows were present in both lung fields. Shadows were prominent in the middle and lower lung fields. A cavity was noted in only one patient, and pleural effusion was also noted at some time during the clinical course in 19 (70%). A large amount of pleural effusion was observed in four patients. The average pneumonia severity score was 3.3 in the 9 patients who survived, and 5.1 in the 17 who died (p > 0.05). The mortality rate was 53% in the 17 patients with pneumonia severity score of 5 or less and 89% in the 9 patients with a score of 6 or more (p > 0.05). Twelve patients died within one week after the initial chest radiograph was obtained. There were no differences among patients with community-acquired infection with or without underlying disease and those with nosocomial infection in characteristic and extension of shadow, presence of pleural effusion, or pneumonia score. The chest radiograph of Legionella pneumonia include bilateral shadow findings characteristic, pleural effusion and rapid progression of shadow, and are clinically useful for diagnosis.     

A clinicopathological study of lung cancer patients with occupational exposure to chrysotile asbestos fibers.

OBJECTIVE: To summarize the features of asbestos-related lung cancer. PATIENTS: Thirty-one lung cancer patients with occupational exposure to chrysotile asbestos fibers. They worked or had worked in one asbestos factory or its subcontracters. RESULT: All patients were male with mean age of 60.6 when diagnosed, and all except one were current or ex-'heavy' smokers. Histological types were fairly evenly divided into adeno-, squamous and small cell carcinoma and 24 (78%) of patients showed 'peripheral type' lung cancers. Regarding clinical stages, 20 patients (65%) were classified as III or IV (advanced stage). Tumor shadow(s) was detected on chest X-ray in 22 patients (71%), and in 5 patients with 'negative' chest X-ray, chest CT was necessary to recognize a primary tumor. Seventeen patients (55%) did not undergo periodical check-ups. CONCLUSION: Occupational asbestos exposure is interpreted as one of the important risks for lung cancer and frequent and accurate observation is necessary.     

31例肺曲霉菌病误诊为肺结核原因分析

目的　分析肺曲菌病患者的临床特征及误诊原因。方法 对误诊为肺结核并经手术病理证实为肺曲菌病的31例病例进行回顾性分析。结果 男性20例,女性11例,年龄17～55岁,平均35.8岁,病程6月～20年,平均36.8月。主要症状为咳嗽、咯痰28例次,占90.3%,咯血29例次,占93.5%,发热9例次,占29%。胸部X线表现为团块或结节影12例,占38.7%,均为单发;形态各异的片状、条索状阴影17例,占54.8%;一侧肺损毁2例,占6.45%;有典型“新月征”表现18例,占58%。病变位于上叶尖后段、下叶背段及一侧肺24例,占77%。所有病例痰结核菌检查均阴性,经正规抗结核及抗炎治疗,其中6例术前曾抗真菌治疗,病情变化不明显。结论 误诊原因主要是肺曲霉菌病与肺结核病的临床表现及X线表现相似,痰曲霉菌检查阳性率低。部分病例既往有肺结核病史,如病情有变化,易认为是结核复发。因此对反复咯血、抗结核治疗效果不佳或X线胸片有“新月征”表现者应想到肺曲霉菌病,如果有条件者及时手术治疗。