340例儿童急性呼吸道感染常见病毒病原的检测

目的: 了解小儿急性呼吸道感染(acute respiratory tract infection ARTI)中病毒感染状况,为预防和治疗疾病提供依据?方法:收集2009年5月~2010年4月期间340例确诊为ARTI住院患儿的深部鼻咽分泌物(NPS)临床标本,采用逆转录聚合酶链反应(RT-PCR)法检测常见的7种呼吸道病毒:呼吸道合胞病毒(RSV)?流感病毒(IFV)?副流感病毒(PIV)?人类偏肺病毒(HMPV)?腺病毒(ADV)?鼻病毒(HRV)和肠道病毒(EV)?统计分析各种病毒所致ARTI的临床特点及流行特征?结果:340例标本中共检出212例阳性,阳性率为62.35%?其中RSV感染为132例,阳性率为62.3%;IFV感染为45例?阳性率为21.3%;PIV感染为13例,阳性率为6.1%; HMPV感染为13例,阳性率为6.1%;ADV感染为4 例,阳性率为1.9%; HRV感染为2例,阳性率为0.9%; EV感染为7例,阳性率为3.3%?结论:本地区诊断为ARTI住院儿童中病毒感染率为62.35%,其中以RSV为主?     

关于外加死腔和气流阻力复合负荷的心理生理效应研究

以20名健康男性青年为被试者,观察了外加死腔和呼吸阻力联合作用对呼吸功能和呼吸阻力感觉的影响。结果表明,在外加阻力条件下,外加死腔使反映通气功能和呼吸型式的参数值增加,且对反映呼吸功的参数具有相互增强的作用。当外加死腔增大时,呼吸阻力感觉阈限提高,相同的呼吸阻力值引起更强的呼吸感觉。上述结果讨设计制作呼吸防护装备具有参考价值。     

不同时相呼吸阻力负荷生理、心理效应的比较

以17名健康男性青年为对象,采用两因素(总阻力值×阻力负荷时相)6×3析因实验设计,以多级估量量表(MES)评量呼吸感觉量。对不同程度、不同时相的呼吸阻力负荷的生理、心理效应进行了系统的考察与比较。主要结果如下:①在三种负荷时相下,面罩腔压力波动幅度(P)、总外呼吸功率(W_T)与总阻力值(R_T)间均呈凹向下型式函数关系;②呼吸感觉量(S_(MES))与物理刺激量之间只是间接关系,与生理刺激量呈直接关系;③不同负荷条件下,生理刺激量与S_(MES)间均呈凹向上型式关系。以上结果提示在制订RPE外加阻力标准时,除规定总阻力值外,在“中度”负荷水平时,还应有匹配条件的限制。     

轻,中度体力负荷下外加呼吸阻力对呼吸型式的影响

以6名健康男性青年为被试者,在静坐及轻、中度(250,500kgm·min~(-1)体力负荷下,以0.28～1.62kPa·L~(-1)·s的吸气阻力(IR)范围测出的5个辨别阈(JND)梯级为感觉单位,并以各JND梯级所对应的IR值及与2、4 JND等感的不同匹配的联合阻力(CR)值为物理刺激量,分别测出呼吸气体流率及心率变化。结果表明:在静坐及轻、中度运动条件下,IR负荷对呼吸型式影响的趋势基本一致;施加CR时,静坐与轻度运动的呼吸型式变化大体相似,而中度运动其变化更加明显;心率只随体力负荷强度而增加,阻力负荷对其无明显影响。     

肺通气功能与呼吸阻抗的临床研究

目的 探讨常规肺通气功能测定指标与脉冲振荡法测定的呼吸阻抗对几种常见呼吸系统疾病的临床诊断价值.方法 测定并分析正常人(对照组)、慢性阻塞性肺疾病(COPD)、肺癌、胸腔积液患者的肺通气功能与呼吸阻抗的主要指标及其相关关系.结果 对照组、肺癌组FVC显著高于慢阻肺组与胸腔积液组(P＜0.01,P＜0.05),呼吸阻抗显著低于慢阻肺组(P＜0.01,P＜0.05);对照组通气功能指标与Zrs、Fres、R20、X5成负相关关系,与R5成正相关关系.结论 呼吸阻抗能较好地反映气道阻力及肺顺应性,判断阻塞部位,测定方法简单,能更客观、全面的反映呼吸功能的改变,具有较高的临床应用价值.     

306例儿童急性呼吸道感染鼻咽分泌物病毒病原检测

目的:总结2003年春季温州地区306例儿童急性呼吸道感染(ARI)的鼻咽分泌物病毒直接免疫荧光法检测结果,分析比较各个年龄组和各种急性呼吸道疾病的病毒检出情况.方法:选择2003年1月～2003年3月因急性下呼吸道感染而在温州医学院附属育英儿童医院住院治疗的儿童,取其鼻咽分泌物做免疫荧光检测筛查七项呼吸道病毒抗原,分析其结果.结果:306例患儿送检标本,阳性190例(占62.1%).阳性标本中呼吸道合胞病毒(RSV)155例(占81.6%)、腺病毒(ADV)4例(占2.1%)、流感病毒A型(ⅣA)5例(占2.6%)、流感病毒B型(ⅣB)2例(占1.1%)、副流感病毒Ⅲ型(PⅣⅢ)19例(占10%)、RSV和ⅣA混合感染3例(占1.6%)、RSV和PⅣⅢ1例(占0.5%)、RSV和PIV 1例(占0.5%).结论:今年春季温州地区引起儿童急性呼吸道感染以RSV为主,RTVIII次之.在各自组别中0～6个月年龄组和毛细支气管炎患儿组的病毒检出率最高,分别为67.1%和70.1%.     

Detection of abnormalities in dyspneic patients using a new lung imaging modality

Background Although chest radiography is a useful examination tool,it has limitations.Because not all chest conditions can be detected on a radiograph,radiography cannot necessarily rule out all irregularities in the chest.Therefore,further imaging studies may be required to clarify the results of a chest radiograph,or to identify abnormalities that are not readily visible.The aim of this study was to compare traditional chest radiography with acoustic-based imaging （vibration response imaging） for the detection of lung abnormalities in patients with acute dyspnea.Methods The current investigation was a pilot study.Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique.Consecutive patients who presented to the emergency department with acute dyspnea and a normal chest radiograph on admission were enrolled and underwent imaging at the time of presentation.Dynamic and static images of vibration （breath sounds） and a dynamic image score were generated,and assessments were made using an evaluation form.Results In healthy volunteer controls （n=61）,the mean dynamic image score was 6.3±1.9.In dyspneic patients with normal chest radiographs （n=51） and abnormal chest radiographs （n=48）,the dynamic image scores were 4.7±2.7 and 5.1±2.5,respectively （P ＜0.05）.The final assessment of the vibration images indicated abnormal findings in 15％,86％ and 90％ of the participants in the above groups,respectively （P ＜0.05）.Conclusions In patients with acute dyspnea who present with normal chest radiographs,respiratory sound analyses often showed abnormal values.Hence,the ability of acoustic-based recordings to offer objective and noninvasive measurements of abnormal sound transmission may be useful in the clinical setting for patients presenting with acute dyspnea.     

Clinical status and its associated early warning per emerging infectious respiratory disease in China

In the past ten years, we had experienced a series of .emerging severe acute respiratory infections （SARI）.Some of them became serious public health emergent events, such as severe acute respiratory syndrome （SARS） and novel A/H7N9 avian influenza. Tracing back to 2003, SARS originated from Guangdong province and spread to 29 countries and regions until it was completely controlled. Out of 8 096 probable SARS cases world-wide, 774 patients died; the mortality was 9.6%.1 There were 5 327 patients with SARS in China, and 1 002 （19%） of them were health care workers （HCW）. Nearly all the HCW got hospital acquired infection since there was no efficient preventive and protective system.     

外加呼吸阻力容许水平的测定

研究阻力性呼吸机械负荷的生理、心理影响,测出不同使用条件下呼吸防护装备(RPD)外加阻力容许水平,具有实际意义。我们以56名健康男性青年为实验对象,用概率单位分析方法,测出轻度体力负荷时外加呼吸阻力的容许水平。     

Effects of respiratory syncytial virus infection on the airway neuronal plasticity and its relationship to the bronchial hyperresponsiveness in rats

Despite intense research efforts, the specific pathogenic mechanisms that underlie the link between respiratory syncytial virus （RSV） and childhood asthma remain unclear. Recent researches suggest that changes in the structure and function of the nerves themselves in response to changing conditions, a phenomenon known as neuronal plasticity, may also contribute to the pathophysiology of airway diseases. Therefore.     

小儿呼吸道感染常见病毒性病因及其与患儿体液免疫功能关系调查

目的了解小儿呼吸道感染常见病毒性病因及其与患儿体液免疫功能的关系。方法用酶联免疫吸附试验对144例呼吸道感染患儿进行6种呼吸道病毒IgM抗体检测,对各组进行统计分析。其中72例病毒IgM抗体阳性血清并作非特异性免疫球蛋白IgG、IgA、IgM的检测。结果6种病毒IgM抗体总的阳性率为62.5%。流感病毒A型IgM抗体阳性率为52.78%,居病毒感染种类的首位。两种或以上病毒混合感染占41.11%。各年龄组病毒感染总阳性率无显著性差别。上呼吸道感染、支气管炎和肺炎3种疾病的病毒IgM总阳性率未见有显著差别。非特异性免疫球蛋白:1～3岁的患儿的IgG低于参考范围,1～12岁的患儿IgM均高于参考范围。结论小儿呼吸道感染以呼吸道病毒为主,其中以流感病毒A型最为常见,病毒混合感染亦占有相当比例;病毒检出与呼吸道疾病种类、患儿年龄无关。病毒感染所致机体免疫功能改变未明。     

呼吸衰竭患者呼吸道管理及护理

探讨呼吸衰竭患者的呼吸道管理及人工气道护理方法。通过胸部物理疗法,翻身,拍背,加强气道湿化,注意氧气的温化和湿化。保护支气管粘膜,促进纤毛运动,稀释痰液,以利于呼衰患者的痰液引流,呼吸道炎症的预防和控制,吸痰,加强呼吸功能训练,保持呼吸道通畅是呼衰患者呼吸道管理及护理的关键环节。     

聊城地区呼吸道合胞病毒致小儿下呼吸道感染的临床研究

目的了解呼吸道合胞病毒（RSV）在小儿急性下呼吸道感染中的发生率和临床特征。方法对我院2007年10月-2008年10月临床诊断为急性下呼吸道感染的住院患儿556例行痰直接免疫荧光法检测呼吸道合胞病毒抗原。结果556例患儿中,阳性193例,阳性率34．71％,其中男132例（23．74％）,女61例（10．97％）,男女发病比例为2．16：1。全年均可检出RSV,发病率最高的是11、12、1、2月份（43．06％）,最低的是5～8月份（16．36％）。RSV感染多见于3岁以下,尤以6个月以下忠儿感染率最高（44．50％）。结论呼吸道合胞病毒是引起小儿急性下呼吸道感染的主要病原,特别是婴幼儿感染率最高。     

气管内反向喷射通气

报告一种自行设计制作的“气管内反向喷射通气”装置,设有甲、乙两种反向喷射管。甲种设三个向外喷射孔,一个向内喷射孔,前者用以消灭呼吸道大部分解剖死腔,后者产生呼气末正压,可防止小气道闭塞和肺泡萎陷;乙种仅三个向外喷射孔,用于无需增加呼气末压者。经10条狗实验,各种条件相同,测试PaCO_2水平,证明具有气管内反向喷射通气功能的双向喷射通气,明显低于单独的正向喷射通气。临床价值待验证。     

深圳市儿童呼吸道腺病毒4型暴发流行的病原学研究

目的探讨深圳市某幼儿园一起急性呼吸道感染暴发的流行特征及病因。方法使用荧光定量PCR方法对采集的17份患儿咽拭子进行流感样病例筛查,筛查后的阴性样本进一步进行呼吸道腺病毒核酸检测,对检测出的5份腺病毒阳性标本进行病毒分离,感染Hep-2受体细胞后共获得4份腺病毒稳定细胞毒株,用腺病毒六邻体基因作为靶基因进行序列扩增及测定,测序结果在GenBank上进行序列比较,确定其病毒亚型并进行系统进化分析。结果 17份咽拭子中5份为腺病毒PCR阳性,阳性率为29.4%,用分型引物检测并分析序列确定均为腺病毒4型。结论本次急性呼吸道病毒疫情暴发由腺病毒4型引起。     

Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children

Background  Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS), and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume (V_T) levels of mechanical ventilation, in children  £5 years of age with AHRF and ARDS.

Methods  In 12 consecutive months in 23 pediatric intensive care units (PICU), AHRF and ARDS were identified in those requiring >12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days (VFD) were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome.

Results  In 13 491 PICU admissions, there were 439 AHRF, of which 345 (78.6%) developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively. No association was found in V_T levels during the first 7 days with mortality, nor for V_T at levels <6, 6–8, 8–10, and >10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age <1 year were associated with higher mortality or shorter VFD in AHRF.

Conclusions  The incidence and mortalities of AHRF and ARDS in children £5 years were similar to or lower than the previously reported rates (in age up to 15 years), associated with initial disease severity and other confounders, but causal relationship for the initial V_T levels as the independent factor to the major outcome was not found.

     

高频喷射鼻导管法给氧抢救婴儿严重呼吸衰竭

报告高频喷射鼻导管法给氧成功地抢救婴儿严重呼吸衰竭6例,月龄均在3个月以内,其中3例为新生儿。呼衰原因均为肺炎。该法应用于呼吸功能障碍的婴儿较为安全,尤其适用于普通鼻导管法给氧或而罩给氧无效的小儿,是治疗婴儿呼衰的一种简便易行的方式。     

呼吸重症监护病房中以呼吸衰竭为突出表现的肺结核临床特点

目的：总结14例呼吸重症监护病房（RICU）中肺结核合并呼吸衰竭患者的临床特点,为早期诊断和治疗提供参考。方法：回顾分析2003年1月-2013年5月在北京朝阳医院RICU住院确诊的14例肺结核合并呼吸衰竭患者资料。结果：14例患者平均确诊时间10．8±7．0d,其中8例经人工气道吸引物萋-尼抗酸染色涂片确诊．6例经支气管镜刷检、粘膜活检或外科肺活检等组织病理学确诊,临床最常见症状为咳嗽、呼吸困难、发热、咯痰,化验以低氧及低白蛋白血症最明显,胸部影像学大多呈弥漫性实质性肺疾病表现,12例有创通气,最终失败6例,死亡率42．9％。结论：在RICU,肺结核并发呼吸衰竭患者病情重,临床表现不典型,影像学呈实变、磨玻璃样变等改变,需支气管镜、刷检或外科肺活检组织病理学确诊,预后较差。