肺泡出血综合征

进修医生 教授,什么是肺泡出血综合征(alveolar hemorrhageic syndromes,AHS)? 教授 AHS是指在病因作用下,肺微血管的血液进入肺泡内即发生弥漫性肺泡出血,当血液聚集于肺实质内时,临床可出现呼吸困难、咯血、贫血等症状,X线胸片显示双侧弥漫性肺泡浸润.     

19例造血干细胞移植术后弥漫性肺泡出血患者的护理

总结造血干细胞移植术后弥漫性肺泡出血患者的护理经验。分析2014年3月~2015年11月本院重症医学科收治的19例造血干细胞移植术后弥漫性肺泡出血患者的临床资料,对护理进行回顾性总结。在这19例患者中,死亡6人,转回病患当地医院继续治疗4人,转回病房继续治疗9人。认为造血干细胞移植术后弥漫性肺泡出血患者死亡率很高,辅助有效的护理是患者救治成功的重要保证。     

慢性支气管炎合并弥漫性肺泡出血综合征患者的护理

<正>弥漫性肺泡出血综合征(Diffuse alveolar hemorrhage syndrome,DAHS)是一种以肺泡毛细血管基底膜广泛破坏,终末细支气管及肺腺泡内广泛出血,充满含铁血黄素的巨噬细胞在间质内堆积为特征的临床综合征~([1])。DAHS主要表现有咯血、低氧血症、贫血、发热等症状,临床比较少见,但一旦发作,病情凶     

支气管肺泡灌洗在儿童感染性肺不张治疗中的应用及护理

目的探讨经纤维支气管镜行支气管肺泡灌洗术在儿童感染性肺不张治疗中的作用与围术期的护理对策。方法对55例感染性肺不张的住院患儿,应用支气管肺泡灌洗术进行治疗,观察其疗效及不良反应,同时认真做好围术期护理。结果55例感染性肺不张患儿中37例复张,16例好转,2例无变化;无1例发生肺水肿、出血、气胸等并发症。结论支气管肺泡灌洗有利于肺不张的恢复,及时采取恰当的护理措施是支气管肺泡灌洗术治疗感染性肺不张取得良好疗效的保证。     

支气管肺泡灌洗在儿童感染性肺不张治疗中的应用及护理

目的 探讨经纤维支气管镜行支气管肺泡灌洗术在儿童感染性肺不张治疗中的作用与围术期的护理对策.方法 对55例感染性肺不张的住院患儿,应用支气管肺泡灌洗术进行治疗,观察其疗效及不良反应,同时认真做好围术期护理.结果 55例感染性肺不张患儿中37例复张,16例好转,2例无变化;无1例发生肺水肿、出血、气胸等并发症.结论 支气管肺泡灌洗有利于肺不张的恢复,及时采取恰当的护理措施是支气管肺泡灌洗术治疗感染性肺不张取得良好疗效的保证.     

1例弥漫性肺泡出血病人的护理

弥漫性肺泡出血（diffuse alvedar hemorrhage，DAH）是以咯血、呼吸困难、缺铁性贫血和X线胸片呈弥漫性肺泡浸润或实变为特征的临床综合征。DAH临床少见，但病情凶险，常威胁病人生命。2007年1月我院收治了1例弥漫性肺泡出血的病人，经过抢救治疗及相应的护理，于2007年3月出院，现将护理报告如下。     

成人特发性肺含铁血黄素沉着症一例

特发性肺含铁血黄素沉着症(IPH)多见于儿童,成人IPH罕见,临床上极易误诊.该文报道1例成人IPH患者的诊治经过.该例患者有咯血症状,结合实验室检查及影像学检查可明确肺泡出血,且可排除继发性因素所致肺泡出血,支气管及肺泡活组织检查(活检)示肺泡内出血,肺泡和间质内可见红细胞及含铁血黄素的巨噬细胞,最终诊断为IPH,给予糖皮质激素治疗后患者咯血症状明显好转,复查X线胸片提示肺部渗出明显吸收.该例诊治提示肺活检及排他性诊断是诊断IPH的关键,IPH治疗首选糖皮质激素.     

血液病患儿行支气管肺泡灌洗术的安全护理

目的：探讨血液病患儿行支气管肺泡灌洗术的安全护理。方法对20例行支气管肺泡灌洗术的血液病患儿做好心理护理、合适的禁食时间、保护性隔离、熟练操作、术中支持、术中监护、术后严密观察。结果20例患儿均安全完成支气管肺泡灌洗术，无出血、缺氧或交叉感染发生。经支气管肺泡灌洗术后，其中10例患儿肺炎好转出院，择日回院化疗。10例患儿肺炎好转后继续血液病的治疗。结论个性化的围手术期安全护理为血液病患儿行支气管肺泡灌洗术提供了安全保障，促进患儿舒适，有效预防出血、交叉感染等并发症。     

1例弥漫性肺泡出血病人的护理

弥漫性肺泡出血(diffuse alvedar hemorrhage,DAH)是以咯血、呼吸困难、缺铁性贫血和X线胸片呈弥漫性肺泡浸润或实变为特征的临床综合征[1]。DAH临床少见,但病情凶险,常威胁病人生命。2007年1月我院收治了1例弥漫性肺泡出血的病人,经过抢救治疗及相应的护理,于2007年3月出院,现将护理报告如下。1病历介绍病人,男,61岁,以“Ⅰ型呼吸衰竭,咯血待查”于2007年1月27日收入呼吸监护病房治疗。入院后查体口唇甲床、睑结膜苍白,听诊肺呼吸音减弱,左肺呼吸音粗,可闻及少量湿口罗音。行胸片检查显示右中肺阴影;胸部CT提示右肺病变,肺出血样改变;…     

噬血细胞综合征肺泡出血死亡2例临床分析

目的探讨噬血细胞综合征(HPS)并发肺泡出血的临床表现与诊断。方法对2009年我科收治的2例因肺泡出血死亡的HPS临床表现和实验室检查进行回顾性分析。结果 2例HPS患者在疾病后期均出现严重喘憋,经影像学表现及气管插管后于气道内吸出大量血性分泌物确诊为弥漫性肺泡出血,实验室检查示纤维蛋白原及血小板顽固性减低,最终死亡。结论由低纤维蛋白血症及低血小板血症引起的凝血功能障碍所致肺泡出血是HPS的致死原因之一。注重影像学检查及监测凝血功能有助于及时诊断。早期补充纤维蛋白原、新鲜冰冻血浆及血小板可能有助于改善预后。     

Pulmonary capillaritis in IgA nephropathy

Pulmonary capillaritis presenting as diffuse alveolar hemorrhage is a rare manifestation in patients with IgA nephropathy. A 20-year-old male with hemodialysis dependent, end-stage renal failure presented with recurrent hemoptysis and respiratory failure. A histologic diagnosis of pulmonary capillaritis was established by transbronchial lung biopsy. He was successfully treated with intravenous methylprednisone and plasma exchange followed by oral prednisone and cyclophosphamide. This report highlights the independent renal and pulmonary manifestations of IgA nephropathy and the management of the resultant diffuse alveolar hemorrhage with aggressive immunosuppression.     

Fatal acute pulmonary injury associated with everolimus

OBJECTIVE : To report a case of fatal alveolar hemorrhage associated with the use of everolimus in a patient who underwent a solid organ transplant. CASE SUMMARY : In a 71-year-old cardiac transplant patient, cyclosporine was replaced with everolimus because of worsening renal function. Over the following weeks, the patient developed nonproductive cough and increasing dyspnea. His condition deteriorated to acute respiratory failure with hemoptysis, requiring hospital admission. Bilateral patchy alveolar infiltrates were apparent on chest X-ray and computed tomography. Cardiac failure was ruled out and empiric antimicrobial therapy was initiated. Additional extensive workup could not document opportunistic infection. Everolimus was discontinued and high-dose corticosteroid therapy was initiated. Despite this, the patient required invasive mechanical ventilation and died because of refractory massive hemoptysis. Autopsy revealed diffuse alveolar hemorrhage. DISCUSSION : Everolimus is a mammalian target of rapamycin inhibitor approved for use as an immunosuppressant and antineoplastic agent. Its main advantage over calcineurin inhibitors (tacrolimus and cyclosporine) is a distinct safety profile. Although it has become clear that everolimus induces pulmonary toxicity more frequently than initially thought, most published cases thus far represented mild and reversible disease, and none was fatal. Here, we report a case of pulmonary toxicity developing over weeks following the introduction of everolimus, in which a fatal outcome could not be prevented by drug withdrawal and corticosteroid treatment. The association of everolimus and this syndrome was probable according to the Naranjo probability scale. CONCLUSIONS : This case indicates that with the increasing use of everolimus, clinicians should be aware of the rare, but life-threatening manifestation of pulmonary toxicity.     

Functions of the endothelium and its role in hematopoietic cell transplantation

The endothelium is a single-layered structure that responds to physical and chemical signals with various factors it synthesizes. In the early days of its discovery, as the inner wall of the vessels, the endothelium was thought to be a simple barrier that lays on the surface. Over time it is discovered that endothelium maintains body homeostasis with the molecules it synthesizes, despite its simple single-layer structure. It has been accepted as an important organ that contributes to the maintenance of vascular tone, cell adhesion, inflammation, vascular permeability and coagulation. Any imbalance in these physiological and pathological events causes endothelial dysfunction. This can cause many diseases such as atherosclerosis, hypertension, diabetes, or it can occur because of these. Endothelial related disorders may also complicate hematopoietic stem cell transplantation (HSCT), which is used to treat various hematologic and neoplastic diseases. These life-threatening complications include graft-versus-host disease, hepatic veno-occlussive disease, transplant-associated thrombotic microangiopathy and diffuse alveolar hemorrhage. They share a similar pathophysiology involving endothelial cells with different clinical presentations. Therefore, current researche on the issue is putting the endothelium under the spotlight for novel markers and treatment options that should be used to monitor or treat at least some of these complications following HSCT.     

Lung injury in acute pancreatitis: mechanisms,prevention, and therapy

Lung injury is the most pertinent manifestation of extra-abdominal organ dysfunction in pancreatitis. The propensity of this retroperitoneal inflammatory condition to engender a diffuse and life-threatening lung injury is significant. Approximately one third of patients will develop acute lung injury and acute respiratory distress syndrome, which account for 60% of all deaths within the first week. The variability in the clinical course of pancreatitis renders it a vexing entity and makes demonstration of the efficacy of any specific intervention difficult. The distinct pathologic entity of pancreatitis-associated lung injury is reviewed with a focus on etiology and potential therapeutic maneuvers.     

Diffuse alveolar hemorrhage syndrome due to 'silent' mitral valve regurgitation

A variety of clinical diseases are associated with diffuse alveolar hemorrhage. Although mitral valve disease can cause hemoptysis, it rarely is associated with diffuse alveolar hemorrhage at presentation. A 49-year-old woman was admitted to the hospital with the abrupt onset of fever, anemia, dyspnea, azotemia, and diffuse alveolar infiltrates. Two-dimensional echocardiography done several months earlier to evaluate atypical chest pain had been unremarkable. Fiberoptic bronchoscopy 2 days after admission to the hospital revealed fresh blood throughout the tracheobronchial tree. The infiltrates resolved rapidly and completely during systemic steroid therapy only to reappear as the steroids were tapered, suggesting a beneficial therapeutic response. Results of serologic evaluation were negative. Transbronchial biopsies showed inflammation and hemosiderin-laden macrophages; no specific diagnosis was established. The patient was scheduled for open lung biopsy. The surgeon was concerned about the history of chest pain and requested placement of a pulmonary artery catheter, which revealed severe pulmonary hypertension. Transesophageal echocardiography and subsequent cardiac catheterization showed severe mitral regurgitation. Mitral valve replacement resulted in complete elimination of symptoms.     

Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report

BACKGROUNDUnilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations. Negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE). CASE SUMMARYA 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression. The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier. We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery. Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors, anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.CONCLUSIONBecause diffuse alveolar hemorrhage accompanied by NPPE can occur, anesthesiologists should take care not to induce airway irritation.     

大剂量甲泼尼龙联合连续性血液净化治疗蜂毒所致多脏器功能障碍

目的观察大剂量甲泼尼龙联合连续性血液净化(CBP)治疗蜂毒所致多脏器功能障碍综合征(MODS)的疗效。方法23例重症蜂蜇伤患者入院后每天行CBP治疗,其中1例联用血浆置换(PE)。此外,所有患者静脉滴注甲泼尼龙1 g/d,连用3～7 d。结果20例患者治疗2～5 d后溶血得到控制,脏器功能逐渐好转;1例合并腹膜炎者腹痛消失;8例合并消化道出血者出血停止;3例死亡,病死率13%。结论静脉注射大剂量甲泼尼龙联合CBP是抢救蜂毒所致MODS有效措施,对并发症消化道出血及腹膜炎也是有效和安全的。     

Intestinal pseudo-obstruction as the initial manifestation of systemic lupus erythematosus

Small bowel obstruction is common in emergency departments. However, the exact cause of intestinal pseudo-obstruction (IPO) is often misdiagnosed. IPO is considered a severe manifestation of systemic lupus erythematosus (SLE). However, IPO is rare as the initial manifestation of SLE. This paper reports a female patient who presented with IPO as the initial manifestation and was ultimately diagnosed with SLE. The 31-year-old female was definitively diagnosed with SLE after IPO symptoms for 1?month. She then presented multiple organ dysfunction syndrome (MODS) leading to a poor prognosis. Patients with unexplained SBO symptoms should be aware of systemic diseases. Early diagnosis and prompt medical treatment are crucial to avoid unnecessary surgery and obtain satisfactory outcomes.     

Does Disseminated Intravascular Coagulation Lead to Multiple Organ Failure?

Microvascular dysfunction with its associated impaired regional oxygen transport and use is believed to be the final common pathway in the development of multiple organ failure. The precise mechanisms underlying this dysfunction, however, are uncertain. Activation of the coagulation system is a key feature in the pathogenesis of sepsis, but whether it is also the cause of multiple organ failure is unclear. This article discusses the evidence for and against a key role for disseminated intravascular coagulation in the pathogenesis of multiple organ failure.     

不同急性胰腺炎凝血功能紊乱的临床研究

目的 探讨急性胰腺炎时凝血功能的变化.方法 选择急性胰腺炎患者55例,其中仅有局部表现的患者20例(局部症状组),有全身炎症反应综合征(SIRS)而无器官功能障碍的患者20例(SIRS组),出现器官功能障碍的患者10例(器官功能障碍组),死亡患者5例(死亡组).择期胆囊切除术术前检查凝血功能正常的同期住院患者10例(对照组).检测上述患者的血小板计数、凝血酶原时间、活化部分凝血酶时间和纤维蛋白原.结果 局部症状组血小板计数、凝血酶原时间、活化部分凝血酶时间和纤维蛋白原与对照组比较差异均无统计学意义;SIRS组、器官功能障碍组和死亡组血小板计数显著低于对照组,凝血酶原时间、活化部分凝血酶时间显著长于对照组,纤维蛋白原显著高于对照组.结论 急性胰腺炎发展到SIRS、器官功能障碍和死亡阶段时,凝血功能表现为紊乱状态.