中药痰热清注射液治疗老年肺挫伤疗效及对血清SP-A和炎症因子水平的影响

目的 探讨中药痰热清注射液治疗老年肺挫伤的疗效及对血清肺表面活性蛋白(SP)-A和炎症因子水平的影响。方法 老年肺挫伤患者100例随机分为对照组(n=50)和观察组(n=50);对照组予以常规治疗，观察组在常规治疗基础上予以痰热清注射液治疗(20 ml/次，1次/d),连续用药7 d后评价疗效。于治疗前后行血清SP-A和C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平；比较两组血气指标、X线评分、急性生理及慢性健康评估(APACHE)Ⅱ评分、肺挫伤简易评分、症状消失时间和并发症情况、病死率。结果 治疗后，观察组血清SP-A和CRP、IL-6、TNF-α水平显著低于对照组(P<0.05)。治疗后，观察组血氧分压(PaO₂)、二氧化碳分压(PaCO₂)、氧合指数[PaO₂/吸入氧浓度(FiO₂)]均显著高于对照组(P<0.05),X线评分、APACHEⅡ评分和肺挫伤简易评分显著低于对照组(P<0.05)。相比对照组，观察组气促、胸痛和肺部湿啰音消失时间均明显...     

乌司他丁联合胸腺肽治疗重症肺炎患者临床效果分析

目的探讨乌司他丁联合胸腺肽治疗重症肺炎患者的临床效果。方法选择2018年5月至2019年5月我院收治的重症肺炎患者86例为研究对象,采用随机数字法分为两组,每组43例。对照组患者给予常规治疗,观察组患者在对照组患者治疗的基础上给予乌司他丁及胸腺肽治疗,疗程10 d。比较两组患者治疗前后的动脉血气分析结果、炎症指标水平以及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。结果治疗前,两组患者的动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)和动脉血氧饱和度(SaO₂)比较,差异无统计学意义(P>0.05);治疗10 d后,两组患者的PaO₂、PaCO₂、SaO₂水平均显著升高,观察组患者的水平显著高于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者的降钙素原、C反应蛋白(CRP)、血清淀粉样蛋白-A(SAA)和白介素6(IL-6)水平比较,差异无统计学意义(P>0.05);治疗10 d后,两组患者的降钙素原、CRP、SAA、IL-6水平均显著下降,观察组患者的水平显著低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者的APACHEⅡ评分比较,差异无统计学意义(P>0.05);治疗10 d后,两组患者的APACHEⅡ评分均显著降低,观察组患者的评分显著低于对照组,差异有统计学意义(P<0.05)。结论在常规治疗的基础上,加用乌司他丁及胸腺肽治疗重症肺炎患者,可有效改善呼吸功能、显著降低炎症因子水平、明显减轻病情、改善预后,值得推广应用。     

异丙托溴铵对COPD并发呼吸衰竭BiPAP患者的影响

目的分析异丙托溴铵对慢性阻塞性肺疾病(COPD)并发呼吸衰竭双水平气道正压力通气(BiPAP)辅助通气患者免疫功能、血清降钙素原(PCT)表达、活动耐量的影响。 方法选择2019年1月至2021年4月我院收治的86例COPD并发呼吸衰竭患者,随机分为对照组44例和观察组42例,对照组在常规治疗基础上给予BiPAP辅助通气,观察组在对照组基础上采用异丙托溴铵治疗,比较两组治疗前后T淋巴细胞亚群、免疫球蛋白、PCT水平、肺功能、病情严重程度及活动耐量差异,并分析PCT与肺功能、CAT评分、mMRC评分、6MWD相关性。 结果治疗后两组CD4⁺、CD4⁺/CD8⁺、IgA、IgM、IgG均升高,CD8⁺均降低(P>0.05);治疗后两组PCT、CAT评分、mMRC评分均下降,FEV₁、FEV₁/FVC均升高,且观察组改善优于对照组(P<0.05);治疗后观察组6MWD高于对照组(P<0.05);Pearson相关性分析显示,PCT与FEV₁、FEV₁/FVC、6MWD呈负相关(r<0,P<0.05),与CAT评分、mMRC评分呈正相关(r>0,P<0.05)。 结论异丙托溴铵可能通过抗炎作用提高COPD并发呼吸衰竭BiPAP辅助通气患者肺功能及活动耐量,降低PCT表达。     

血必净注射液治疗耐甲氧西林金黄色葡萄球菌所致肺部感染的临床疗效及安全性研究

目的 分析血必净注射液治疗耐甲氧西林金黄色葡萄球菌(MRSA)所致肺部感染的临床疗效及安全性。方法 选取2014年9月—2016年3月武汉市第十一医院呼吸科收治的MRSA所致肺部感染患者82例,随机分为对照组与观察组,每组41例。在对症治疗基础上,对照组患者予以注射用盐酸万古霉素治疗,观察组患者在对照组基础上加用血必净注射液治疗;两组患者均连续治疗10 d。比较两组患者临床疗效、临床症状及体征消失时间、治疗前后血清C反应蛋白(CRP)和降钙素原(PCT)水平、不良反应发生情况。结果 观察组患者临床疗效优于对照组(P0.05)。观察组患者退热时间、咳嗽和咳痰消失时间短于对照组(P0.05);两组患者肺部啰音消失时间、影像学检查结果恢复正常时间比较,差异无统计学意义(P0.05)。治疗前两组患者血清CRP、PCT水平比较,差异无统计学意义(P0.05);治疗后观察组患者血清CRP、PCT水平低于对照组(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论 血必净注射液治疗MRSA所致肺部感染的临床疗效确切,可快速有效地改善患者临床症状及体征,且安全性较高。     

抗胃食管反流对AECOPD并发Ⅱ型呼吸衰竭无创呼吸机治疗的影响

目的分析抗胃食管反流病对慢性阻塞性肺疾病急性加重期(AECOPD)并发Ⅱ型呼吸衰竭需无创呼吸机治疗患者的影响。 方法选择2019年1月至2019年12月在湖南省长沙市第四医院呼吸科住院的AECOPD需无创呼吸机治疗的患者63例,随机分为观察组33例和对照组30例。对照组给予常规干预和治疗,观察组在对照组基础上给予抗胃食管反流治疗,比较两组患者治疗前后的第一秒用气呼气容积(FEV₁)、用力肺活量(FVC),入院和治疗3 d后的白细胞、超敏C反应蛋白(CRP)、降钙素原(PCT),对比两组患者的住院天数。 结果两组患者治疗前FEV₁、FVC比较,差异无统计学意义(P>0.05);治疗后两组FEV₁、FVC相比,差异无统计学意义(P>0.05);两组患者治疗前白细胞、超敏CRP、PCT比较,差异无统计学意义(P>0.05);治疗第3天后,白细胞、超敏CRP、PCT水平均较常规治疗组下降,差异有统计学意义(P<0.05);观察组患者的住院天数比对照组患者缩短,差异有统计学意义(P<0.05)。 结论对AECOPD并发Ⅱ型呼吸衰竭需无创呼吸机亚组患者,抗胃食管反流不能改善肺功能,但可促进患者感染恢复,增加无创呼吸机配合程度,缩短患者的住院天数,减少医疗费用。     

布地奈德与头孢哌酮舒巴坦钠对小儿重症肺炎的疗效分析

目的分析布地奈德联合头孢哌酮舒巴坦钠对小儿重症肺炎的疗效的影响。 方法选择2019年11月至2021年10月我院收治的63例小儿重症肺炎为对象,以治疗方法不同分为对照组33例,观察组30例。对照组接受头孢哌酮舒巴坦钠治疗,观察组在对照组的基础上接受布地奈德治疗。比较两组临床疗效、退热时间、咳喘消失时间、肺部啰音消失时间、住院时间、治疗时间及不良反应,比较两组治疗前后降钙素原(PCT)、白细胞计数(WBC)、中性粒细胞计数水平。 结果观察组30例中治愈11例,显效11例,有效6例,总有效率(93.33%)较对照组高(72.73%)(P<0.05);观察组退热时间、咳喘消失时间以及肺部啰音消失时间短于对照组(P<0.05);治疗前,两组PCT、WBC、中性粒细胞计数比较差异无统计学意义(P>0.05);治疗7 d后,两组PCT、WBC、中性粒细胞计数降低(P<0.05);观察组住院、治疗时间短于对照组。 结论布地奈德联合头孢哌酮舒巴坦钠治疗小儿重症肺炎疗效好,有效缩短患儿临床症状消失时间、住院时间与治疗时间,减轻机体炎症反应具有意义。     

比阿培南联合莫西沙星对重症肺炎患者疗效、炎性因子及血清CD40L、VACM-1的影响

目的分析比阿培南联合莫西沙星对重症肺炎患者疗效、炎性因子及血清CD40配体(CD40L)、血管细胞黏附分子-1(VACM-1)的影响。 方法选择2019年7月至2021年7月我院收治的57例重症肺炎为对象,依照治疗方法不同分为观察组30例与对照组27例。对照组接受比阿培南,观察组在对照组的基础联合受莫西沙星。对比两组治疗10 d后的疗效,血清超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、氧合指数、动脉血氧分压(PaO₂)、CD40L、VACM-1水平,对比10 d不良反应。 结果观察组总有效率(93.33%)较对照组(74.07%)高(P<0.05);治疗10 d后,两组的血清hs-CRP、PCT水平降低(P<0.05),观察组较对照组低(P<0.05);氧合指数、PaO₂升高(P<0.05),观察组较对照组高(P<0.05);血清CD40L、VACM-1水平低于治疗前(P<0.05),观察组较对照组低(P<0.05)。 结论比阿培南联合莫西沙星治疗重症肺炎疗效确切,可减轻机体炎症反应,改善免疫应答反应与血气指标。     

肺穿刺引流术治疗肺脓肿的临床效果

目的探讨肺穿刺引流术治疗肺脓肿的临床效果。方法选取2010年12月—2013年12月新余市人民医院收治的肺脓肿患者120例,按患者接受治疗时间顺序分为对照组及观察组,每组60例。对照组患者进行常规体位引流术治疗,观察组患者进行肺穿刺引流术治疗。比较两组患者治疗前及治疗后1、3、5周血清降钙素原(PCT)、C反应蛋白(CRP)水平及其阳性率。结果治疗前两组患者血清PCT、CRP水平比较,差异无统计学意义(P>0.05);治疗后1、3、5周观察组患者血清PCT、CRP水平均低于对照组(P<0.05)。治疗前两组患者PCT、CRP阳性率比较,差异无统计学意义(P>0.05);治疗后1、3、5周观察组患者PCT、CRP阳性率均低于对照组(P<0.05)。结论肺穿刺引流术治疗肺脓肿的临床效果好,能够有效地控制炎症。     

振动排痰机在胸部外科术后并发肺部感染中的应用

目的探讨振动排痰机在胸部外科术后并发肺部感染中的应用。方法 62例胸部外科术后并发肺部感染患者随机分为两组,观察组(n=32例)应用振动排痰机排痰,对照组(n=30例)应用人工拍背排痰。结果观察组治疗总有效率(93.8%)明显高于对照组(80.0%)(P<0.05);观察组患者RR、HR、SpO2和PaO2等指标变化及咳痰消失时间均明显优于对照组(P<0.05)。结论振动排痰机排痰效果显著,可明显提高胸部外科术后并发肺部感染患者的治疗效果。     

头孢哌酮/舒巴坦钠对AECOPD并发呼吸衰竭患者的临床分析

目的分析头孢哌酮/舒巴坦钠对慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭患者的临床疗效。 方法选取2018年1月至2021年12月我院收治的AECOPD并发呼吸衰竭患者73例。随机分为对照组35例,观察组38例。对照组使用盐酸左氧氟沙星注射液治疗,观察组使用头孢哌酮/舒巴坦钠治疗。比较两组患者治疗后临床指标发生情况及病原菌清除率,治疗前后PaO₂、PaCO₂、WBC以及FVC、FEV₁、FEV₁/FVC水平。 结果观察组肺部湿啰音消失时间(5.06±0.68)d、体温恢复正常时间(3.06±0.61)d及气管插管率(6%)明显低于对照组[(18.31±4.12)d、(7.97±1.06)d、(3.97±0.96)d、(20.00%)],差异有统计学意义(P<0.05)。治疗后,观察组PaO₂水平(70.58±10.29)mmHg明显高与对照组(64.65±7.75)mmHg,PaCO₂(45.67±5.41)mmHg、WBC(7.56±1.03)10⁹ G/L明显低于对照组[(52.81±7.32)mmHg、(8.38±2.01)10⁹ G/L](P<0.05)。治疗后观察组肺功能FVC(2.05±0.62)L、FEV₁(1.35±0.41)L、FEV₁/FVC(35.65±8.23)%明显高于对照组[(1.81±0.54)L、(1.13±0.24)L、(31.18±5.92)%](P<0.05)。 结论头孢哌酮钠/舒巴坦钠对AECOPD并发呼吸衰竭患者临床疗效显著,促进恢复,改善肺功能,具有临床意义。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Staging with computed tomography of patients with colon cancer

Purpose

Accurate staging of colonic cancer is important for patient stratification. We aimed to correlate the diagnostic accuracy of preoperative computed tomography (CT) with final histopathology as reference standard.

Methods

Data was collected retrospectively on 615 consecutive patients operated for colonic cancer. Evaluation was based upon T-stage. Patients were stratified into high-risk and low-risk groups, based on the extent of tumor invasion beyond the proper muscle layer of more or less than 5 mm. The Kendall tau correlation coefficient was used to calculate concordance between radiological (r)T-stage obtained at CT imaging and pathological (p)T-stage from the final pathology.

Results

In total, 501 patients were included. We found no significant differences in the Kendall tau values for diagnostic measures between the groups at the 95% confidence interval (CI) level: 49% (95% CI, 43–55) for all individuals, 48% (95% CI, 40–56) for screened individuals, and 47% (95% CI, 37-56) for non-screened individuals. The overall sensitivity and specificity for all individuals in identifying high-risk tumors on CT was 65% (95% CI, 56–73) and 89% (95% CI, 85–92). The risk of ending up in the high-risk group due to overstaging among all individuals was calculated as the number needed to harm 11.7 (95% CI, 9–16).

Conclusions

There is basis for improvement of CT-based preoperative staging of patients with colorectal cancer. Supplementary modalities may be needed for correct staging of patients preoperatively, especially in relation to stratification of patients into neoadjuvant treatments or tailored therapy in patients with early cancers.