床旁纤维支气管镜在治疗慢性阻塞性肺疾病合并呼吸衰竭中的应用价值研究

目的观察采用床旁纤维支气管引导下经鼻气管插管及支气管肺泡灌洗在治疗慢性阻塞性肺疾病合并呼吸衰竭患者中的临床应用价值。方法 36例慢性阻塞性肺疾病合并呼吸衰竭患者采用床旁纤维支气管镜引导下经鼻气管插管、支气管肺泡灌洗等气道管理治疗,观察其疗效。结果 36例慢性阻塞性肺疾病合并呼吸衰竭患者均为1次性插管成功,插管时间2min,及时的支气管肺泡灌洗可以清除气道分泌物、获得病原学诊断,无严重并发症发生。结论床旁纤支镜引导下经鼻气管插管并支气管肺泡灌洗在治疗慢性阻塞性肺疾病合并呼吸衰竭的患者中具有重要的应用价值,值得推广应用。     

纤维支气管镜在呼吸系统疾病中的应用进展

1897年德国K illian首次从气管内取出骨性异物,开创了硬式内镜进行气管和支气管操作的历史。1967年由日本池田(Ikeda)研制的纤维支气管镜(简称纤支镜)于70年代迅速在我国普及。本文综述如下。1肺癌纤支镜是目前国内外诊断肺癌最常用的方法,包括直视、支气管肺泡灌洗、支气管刷检、支气管肺活检等。对支气管内病变诊断阳性率达70%~100%,对周围性病变为40%~80%。60岁以上老年患者进行纤支镜检查,其肺癌阳性率达53.7%,纤支镜刷检结合钳检阳性率达90%~93%[1]。支气管肺泡灌洗(bronch ial alveolar lavage,BAL)是纤支镜向局部支气管肺泡注入生…     

难治性肺炎纤维支气管镜检查35例分析

目的探讨纤维支气管镜(纤支镜)对难治性肺炎的诊断价值。方法对2001年8月至2009年3月临床诊断为难治性肺炎患者35例行纤支镜检查。结果35例原诊断为肺炎,经纤支镜检查后确诊为气管、隆突癌2例;肺癌6例;肺结核5例;支气管异物7例;分泌物堵塞支气管13例;左侧声带麻痹1例;支气管黏膜异常1例。对支气管黏膜正常的这例患者行支气管肺泡灌洗液培养示:军团菌。经使用阿奇霉素及左氧氟沙星联合抗感染治愈。结论对难治性肺炎应尽早行纤支镜检查,既可达到病原学诊断,又可早期明确病因,避免误诊、误治。     

经纤支镜检查77例临床资料分析

目的 探讨纤支镜应用的临床价值.方法回顾分析2007年2月至2012年4月经纤支镜检查的病例资料.结果 确诊肺癌61例,其中多数为鳞癌,28/61例,气管错构瘤1例,内膜结核2例,肺炎9例,肺脓肿2例,气管内异物2例.结论 纤支镜应用于临床,不仅可早期发现、诊断肺癌,为治疗提供依据,而且结合镜下治疗,可缓解气道阻塞或行肺泡灌洗术治疗肺脓肿,疗效较好,临床应用价值较高.     

纤支镜及支气管肺泡灌洗术在儿童迁延性肺炎的临床应用

目的探讨纤维支气管镜(纤支镜)及支气管肺泡灌洗术在儿童迁延性肺炎诊治过程中的应用价值。方法选择迁延性肺炎患儿96例,66例行纤支镜检查及肺泡灌洗术的患儿为灌洗组,另外30例为对照组,比较两组的疗效。结果 66例灌洗组患儿纤支镜检查显示均有支气管内膜感染,其中单纯支气管内膜炎25例(37.9%);气管中下段狭窄5例(7.6%);左右支气管狭窄3例(4.5%);气管软化13例(19.7%);右上叶开口异常4例(6.1%);支气管发育不良2例(3.0%);陈旧性肺出血2例(3.0%);会厌畸形2例(3.0%);气管支气管异物10例(15.2%)。治疗2周后,灌洗组疗效达100%,明显优于对照组70%(21/30),差异有统计学意义(P0.05)。结论纤支镜检查及支气管肺泡灌洗术对明确儿童迁延性肺炎病因及治疗具有重要价值。     

哮喘患者纤维支气管镜检查、支气管肺泡灌洗和支气管粘膜活检的安全性

<正> 对哮喘患者进行支气管镜检要谨慎,因关系到气道高反应性病人的安全。作者报告了一组哮喘患者纤支镜检查的经验。评价了哮喘患者纤支镜检查、支气管肺泡灌洗和支气管粘膜活检的安全性,并与健康人及特应性非哮喘患者比较,通过测定肺功能的三个生理学指标:FEV、HbO_2sat、气道反应性(PC_(20)乙酰甲胆硷激发试验),提供这一操作安全性的客观评价。共91人进行了纤支镜检查。作者详细分析了哮喘患者20名,健康人8名,特应性非哮喘8名支气管镜检的生理学效应。结果:91人行纤支镜检查,仅一人(系“脆性哮     

支气管肺泡灌洗术在支气管哮喘中的应用简

目的 探讨应用支气管镜行支气管肺泡灌洗术治疗支气管哮喘的作用.方法 将常规治疗无效的61例支气管哮喘患者随机分成两组,对照组继续采用支气管舒张剂等常规治疗,支气管镜肺灌洗组在常规治疗基础上加用支气管肺泡灌洗术.治疗前及治疗后48小时观察患者的临床表现,检测第1 秒用力呼气容积（FEV1）、呼气峰流速（PEF）等,选用改良英国MRC呼吸困难指数（mMRC）进行病情评估.并对两组患者住院天数进行比较.结果 两组患者治疗后哮喘症状、体征好转,肺功能指标及mMRC均得到改善,两组比较,经支气管镜肺灌洗组显著优于对照组,且住院天数缩短,差异具有统计学意义（ P ＜ 0.05）.结论经支气管镜行肺泡灌洗术能清除支气管内黏性分泌物,通畅气道,改善气道的炎症反应,是治疗由黏液栓引起的哮喘急性发作最有效手段,且见效快.     

支气管肺泡灌洗术治疗重症支气管哮喘30例

目的观察经支气管镜肺泡灌洗治疗重症支气管哮喘的临床应用价值。方法对常规治疗无效的30例重症支气管哮喘患者,行支气管肺泡灌洗治疗。结果 22例患者支气管黏膜明显充血、肿胀,管腔狭窄,腔内可见中等量到大量粘稠分泌物,段支气管可见痰栓形成,其痰液粘稠非常容易堵塞支气管镜,需退出支气管镜冲洗后再次进镜清理,最多1例反复进镜8次才清理干净,一般1-2次即可;5例患者黏膜表面有白色膜状物附着;2例可见支气管异物,为尖椒皮,分别卡在右中叶及左舌叶,并伴有轻度肉芽组织增生;1例由于长期吸入糖皮质激素并发支气管结核,经抗结核治疗后症状缓解。灌洗液培养阳性率66.7%,使后续目标治疗成为可能。结论支气管镜下灌洗治疗重症支气管哮喘可以起到:清理粘液栓,改善通气,缩短抗生素的使用时间;灌洗液培养结果,可指导临床治疗;发现影像学阴性的支气管异物;发现早期支气管结核;可以减少重症哮喘患者对机械通气的需求。而且不良反应少,患者可耐受,改变了以往认为重症支气管哮喘不能行支气管镜检查的观念。因此,对于常规治疗无效的重症支气管哮喘患者,行支气管镜肺泡灌洗治疗可改善预后,值得临床推广应用。     

经纤支镜支气管肺泡灌洗术治疗急性呼吸衰竭在重症监护病房的临床应用

目的 探讨经纤维支气管镜支气管肺泡灌洗术治疗急性呼吸衰竭在重症监护病房的临床应用效果.方法 选择胸科术后、颅脑术后、创伤昏迷、慢性阻塞性肺疾病患者共35例,均有明显的气道分泌物排出困难、肺不张、肺部感染伴呼吸衰竭、急性呼吸衰竭的表现,均经常规氧疗、抗感染、解痉、平喘、化痰或机械通气等治疗无效后,在重症监护病房采用床旁纤支镜气管吸引及支气管肺泡灌洗、局部注射药物治疗,并监测心电、血压、呼吸、血氧饱和度变化及进行血气分析.结果 所有病例经治疗后,临床症状改善,血气分析PaO2、SaO2与治疗前相比有明显增高(P<0.05).结论 纤支镜气道吸引、支气管肺泡灌洗、局部注射药物的疗法效果确切,能迅速缓解患者因气道阻塞所致肺不张、呼吸困难,有利于气道管理和肺部感染的控制,明显缩短了患者留住重症监护病房的时间及住院周期,降低了住院费用,值得临床推广.     

无异物吸入主诉的成人支气管异物的临床分析

目的总结无异物吸入主诉的成人支气管异物的诊断及纤支镜的应用体会,提高对成人支气管异物的诊断水平。方法对22例无异物吸入主诉的成人支气管异物患者的临床资料进行回顾性分析。结果22例无异物吸入的患者中均出现咳嗽,胸闷呼吸困难肺部啰音等呼吸道症状,胸部影像学检查可提供良好的依据,纤支镜检查可明确诊断。结论成人的支气管异物大都无异物吸入主诉,对于无异物吸入主诉的患者应结合临床症状胸部影像学尽早行纤支镜检查。纤支镜是确诊支气管异物的金标准。     

妊娠时间与肺结核复发的相关性研究及诊治对策

目的 分析肺结核史患者妊娠时间和肺结核复发间相关性.方法 选取我院收治的有肺结核史的妊娠妇女576例作为研究对象,对其妊娠前肺结核治疗、治愈后妊娠时间、妊娠后复发肺结核等进行分析,总结有肺结核史育龄女性的妊娠时间和肺结核复发之间的关系.结果 肺结核治愈后不同时间段妊娠者的结核复发率比较,差异具有显著性（P＜0.05）,停药后间隔时间越久妊娠,肺结核复发的几率越小.结论 加强孕期痰菌检查,及早发现复发肺结核,提高母婴安全.     

我国骨关节结核诊治的回顾与展望

骨关节结核是危害人们健康的严重感染性疾病,近95％由他处结核病继发而来.罹患骨关节结核疾病后几乎均将致残,严重影响人们的健康、工作和生活.建国以来在党和国家的关心和支持下,骨关节结核的诊治水平取得了长足进步.时至今日,由于多种原因,学科发展和被重视程度受到一定的制约,同整个医疗行业的发展不相适应.回顾过去,展望未来,我们需要重新审视骨关节结核的诊治方法,努力推进骨关节结核诊疗技术的科学发展.     

Effect of phosphorylation of MAPK and Stat3 and expression of c-fos and c-jun proteins on hepatocarcinogenesis and their clinical significance

AIM To study the effect of phosphorylation ofMAPK and Stat3 and the expression of c-fos andc-jun proteins on hepatocellular carcinogenesisand their clinical significance.METHODS SP immunohistochemistry was usedto detect the expression of p42/44~(MAPK), p-Stat3,c-fos and c-jun proteins in 55 hepatocellularcarcinomas (HCC) and their surrounding livertissues.RESULTS The positive rates and expressionlevels of p42/44~(MAPK), p-Stat3, c-fos and c-junproteins in HCCs were significantly higher thanthose in pericarcinomatous liver tissues (PCLT).A positive correlation was observed between theexpression of p42/44~(MAPK) and c-fos proteins, andbetween p-Stat3 and c-jun, but there was nosignificant correlation between P42/44~(MAPK) and p-Stat3 in HCCs and their surrounding livertissues.CONCLUSION The abnormalities of Ras/Raf/MAPK and JAKs/ Stat3 cascade reaction maycontribute to malignant transformation ofhepatocytes. Hepatocytes which are positive forp42/ 44~(MAPK), c-fos or c-jun proteins may bepotential malignant pre-cancerous cells.Activation of MAPK and Stat3 proteins may be anearly event in hepatocellular carcinogenesis.     

Effect of phosphorylation of MAPK and Stat3 and expression of c-fas and c-jun proteins on hepatocarcinogenesis and their clinical significance

AIM To study the effect of phosphorylation ofMAPK and Stat3 and the expression of c-fos andc-jun proteins on hepatocellular carcinogenesisand their clinical significance.METHODS SP immunohistochemistry was usedto detect the expression of p42/44MAPK, p-Stat3,c-fos and c-jun proteins in 55 hepatocellularcarcinomas (HCC) and their surrounding livertissues.RESULTS The positive rates and expressionlevels of p42/44MAPK, p-Stat3, c-fos and c-junproteins in HCCs were significantly higher thanthose in pericarcinomatous liver tissues (PCLT).A positive correlation was observed between theexpression of p42/44MAPK and c-fos proteins, andbetween p-Stat3 and c-jun, but there was nosignificant correlation between p42/44MAPK and p-Stat3 in HCCs and their surrounding livertissues.CONCLUSION The abnormalities of Ras/Rat/MAPK and JAKs/ Stat3 cascade reaction maycontribute to malignant transformation ofhepatocytes. Hepatocytes which are positive forp42/ 44MAPK, c-fos or c-jun proteins may bepotential malignant pre-cancerous cells.Activation of MAPK and Stat3 proteins may be anearly event in hepatocellular carcinogenesis.     

Replication and Inhibitors of Enteroviruses and Parechoviruses

The Enterovirus (EV) and Parechovirus genera of the picornavirus family include many important human pathogens, including poliovirus, rhinovirus, EV-A71, EV-D68, and human parechoviruses (HPeV). They cause a wide variety of diseases, ranging from a simple common cold to life-threatening diseases such as encephalitis and myocarditis. At the moment, no antiviral therapy is available against these viruses and it is not feasible to develop vaccines against all EVs and HPeVs due to the great number of serotypes. Therefore, a lot of effort is being invested in the development of antiviral drugs. Both viral proteins and host proteins essential for virus replication can be used as targets for virus inhibitors. As such, a good understanding of the complex process of virus replication is pivotal in the design of antiviral strategies goes hand in hand with a good understanding of the complex process of virus replication. In this review, we will give an overview of the current state of knowledge of EV and HPeV replication and how this can be inhibited by small-molecule inhibitors.     

心电图、心电向量图与冠状动脉造影结果对比分析

目的:通过分析心电图(Electrocardiogram,ECG)和心电向量图(Vectorcardiogram,VCG)的改变与冠脉造影（CAG）结果进行对比,探讨ECG、VCG在冠状动脉病变中的诊断价值。方法: 选择2008年1月~2009年12月临床拟诊断为冠心病患者108例,行常规ECG、VCG检查,并于1周内进行CAG,对检查结果依据各自的诊断标准进行判定,以CAG为标准诊断法,利用四格表法,计算相关评价真实性的指标并进行比较。结果: ①VCG检测的灵敏度、特异度、准确度显著高于ECG(P<0.05,P<0．01)。②ECG、VCG阳性率与冠脉病变支数组间比较:在单支病变、双支病变中,VCG阳性率明显高于ECG(P<0.05),左主干或三支病变无统计学意义;组内比较:ECG组左主干或三支病变组较单支病变、双支病变阳性率高(P<0.05,P<0.01);VCG组左主干或三支病变组较单支病变阳性率高(P<0.05);与双支病变阳性率比较无统计学意义;③ECG、VCG阳性率与冠脉病变程度组间比较:冠脉病变狭窄50%～69%的VCG阳性率明显高于ECG (P<0.05),其他两组阳性率比较无统计学意义;组内比较:ECG组冠脉病变狭窄≥90%较50%～69%、70%～89%的阳性率高(P<0.05,P<0.01); VCG组狭窄≥90%较50%～69%阳性率高（P<0.01),其他无统计学意义。结论: VCG对冠心病检测价值显著高于ECG。     

Detection and characterization of the product of hydroethidine and intracellular superoxide by HPLC and limitations of fluorescence

Here we report the structural characterization of the product formed from the reaction between hydroethidine (HE) and superoxide (O(2)(.-)). By using mass spectral and NMR techniques, the chemical structure of this product was determined as 2-hydroxyethidium (2-OH-E(+)). By using an authentic standard, we developed an HPLC approach to detect and quantitate the reaction product of HE and O(2)(.-) formed in bovine aortic endothelial cells after treatment with menadione or antimycin A to induce intracellular reactive oxygen species. Concomitantly, we used a spin trap, 5-tert-butoxycarbonyl-5-methyl-1-pyrroline N-oxide (BMPO), to detect and identify the structure of reactive oxygen species formed. BMPO trapped the O(2)(.-) that formed extracellularly and was detected as the BMPO-OH adduct during use of the EPR technique. BMPO, being cell-permeable, inhibited the intracellular formation of 2-OH-E(+). However, the intracellular BMPO spin adduct was not detected. The definitive characterization of the reaction product of O(2)(.-) with HE described here forms the basis of an unambiguous assay for intracellular detection and quantitation of O(2)(.-). Analysis of the fluorescence characteristics of ethidium (E(+)) and 2-OH-E(+) strongly suggests that the currently available fluorescence methodology is not suitable for quantitating intracellular O(2)(.-). We conclude that the HPLC/fluorescence assay using HE as a probe is more suitable [corrected] for detecting intracellular O(2)(.-).     

Overweight and Obesity and Progression of ADPKD

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大鼠骨髓间充质干细胞的分离培养和外源基因的导入

目的探讨绿色荧光蛋白基因转染骨髓间质干细胞的可行性。方法采用F icoll-PaqueTMP lus淋巴细胞分离液,根据细胞密度梯度原理,分离大鼠骨髓间充质干细胞(rM SC s)并进行体外原代培养和传代扩增,倒置相差显微镜观察细胞生长情况,免疫细胞化学法对其初步鉴定。流式细胞仪分析转染效率。结果原代和传代培养的细胞呈现梭形外观,具有较强的生长增殖能力;细胞均一表达CD44、CD54、CD106、CD29抗原。电穿孔法转染rM SC s转染率为32.8%±3%。结论采用比重为1.077 g/L的F icoll-PaqueTMP lus能分离获得大鼠骨髓间充质干细胞,经原代培养和传代培养能够迅速扩增。电穿孔法具有较高的介导外源基因表达于rM SC s的效率。     

血清C-反应蛋白和红细胞分布宽度在AECOPD与稳定期的变化及意义

目的观察慢性阻塞性肺疾病(COPD)患者急性加重期入院、出院时血清C-反应蛋白(CRP)和红细胞分布宽度(RDW)与正常人的差异。方法分别检测健康老年组(年龄≥65岁)、COPD急性加重期患者入院、出院时CRP和RDW水平,比较组间各指标的差异。结果急性加重期患者入院、出院时CRP和RDW水平均高于健康老年组,入院时CRP水平高于出院时(P0.01),入院、出院时RDW水平无统计学差异。结论 CRP和RDW可一定程度评估COPD病情及反映病情变化。