经鼻导管高流量吸氧与经鼻气道正压通气在重症毛细支气管炎呼吸支持中的应用价值比较

目的：比较经鼻导管高流量吸氧（HFNC）与经鼻气道正压通气（nCPAP）在重症毛细支气管炎呼吸支持中的应用价值，为临床治疗方案的选择提供参考。方法：选取2016年12月至2018年12月我院儿科收治的重症毛细支气管炎患儿90例，采用随机数字表法分为观察组和对照组各45例。两组患儿入院后均给予常规综合治疗以保证呼吸道通畅，在此基础上观察组采用HFNC治疗，对照组采用nCPAP治疗，比较两组患儿治疗前和治疗24 h后呼吸频率、经皮血氧饱和度（TcSO2）、呼吸窘迫评分体系（CSS）评分、动脉血氧分压（PaO2）等呼吸相关指标及治疗前后临床症状体征改善情况。结果：两组患儿治疗24 h后呼吸频率、CSS评分均降低，且观察组降低程度更大，TcSO2、PaO2于治疗24 h后升高，观察组升高幅度较对照组明显；治疗后两组患儿咳嗽及肺部湿啰音、肺部炎症情况均改善，观察组症状体征消失时间早于对照组，差异均有统计学意义（P<0.05）。结论：重症毛细支气管炎患儿采用HFNC治疗可明显改善通气功能和临床症状，治疗效果优于nCPAP治疗，可扩大样本量进一步观察。     

64层螺旋CT在糖尿病下肢动脉硬化闭塞症中的诊断价值

目的评价64层螺旋CT下肢动脉成像在诊断糖尿病下肢动脉硬化闭塞症中的临床价值。方法对90例可疑下肢血管病变的Ⅱ型糖尿病患者进行64层螺旋CT血管造影检查,对所有扫描原始数据行容积再现(VR),最大密度投影(M IP),冠状、矢状面多平面重组(MPR)以及曲面重建(CPR)。结果64层螺旋CT下肢血管造影检查可以清晰显示自髂总至足背整个动脉系统病变的准确部位、范围及侧枝血管。90例患者中67例(77%)患者血管呈不同程度粥样硬化表现。其中轻或中度狭窄49例(56.3%),重度狭窄18例(20.7%),7例(8%)完全闭塞患者可见侧枝循环血管形成。结论64层螺旋CT下肢血管造影,对糖尿病下肢动脉硬化闭塞症的诊断和治疗具有重要价值。     

Nasal lavage leukotrienes in infants with RSV bronchiolitis

Respiratory syncytial virus (RSV) bronchiolitis is a very common infection in infants and, after the acute phase, a number of patients develop a reactive airway disease that lasts for years. Although the pathogenesis of the lung damage after RSV bronchiolitis is still largely unknown, previous studies suggest that leukotrienes may play an active part in it. The aim of this study was to measure leukotriene levels in the nasal lavage fluid (NLF) collected in infants during RSV bronchiolitis and 1 month later. Cysteinyl leukotrienes (Cys-LTs) and leukotriene B(4) (LTB(4)) were measured in the NLF of 22 infants with their first episode of RSV bronchiolitis and 16 healthy infants. A second NLF sample was collected to measure leukotriene levels 1 month after the acute disease. NLF Cys-LT levels were significantly higher in infants with RSV bronchiolitis than in healthy controls [950 pg/ml (285.5-2155.9) vs. 110.5 pg/ml (66.5-451.3), p = 0.01], and they remained so a month after the acute infection (p = 0.02). A subanalysis showed no difference in Cys-LTs concentrations, either between bronchiolitis infants with and without a family history of atopy, or between those with and without passive exposure to cigarette smoke. No significant difference was found between the LTB(4) levels measured in the bronchiolitis cases and the control children. Cys-LTs are significantly increased in the NLF of infants with acute RSV bronchiolitis, and remain so at 1-month follow-up, suggesting a possible role of these eicosanoids in the pathogenesis of the disease.     

股深动脉血流重建治疗下肢动脉硬化闭塞症

目的总结股深动脉血流重建治疗下肢动脉硬化闭塞症的经验。方法选择FontaineⅢ、Ⅳ期下肢动脉硬化闭塞症共23例。入选标准：膝上无理想的用于旁路术的流出道，股深动脉主干长度达到或超过股骨干中点且与胭动脉间有侧支血管，近端动脉病变导致股深动脉内无正常动脉血流。采用旁路术、取栓术及股深动脉成形术重建股深动脉血流。结果全部FontaineⅢ期病例于术后肢体静息痛消失；9例FontaineⅣ期病例中术后肢体静息痛消失7例，6例于术后10d行截足（趾）术，1例于术后1周行膝上截肢术。手术后踝／肱血压指数显著增加（P〈0．01）。术后22例随访2个月至6年，移植血管3年通畅率为82％。结论股深动脉血流重建治疗严重肢体缺血简单、安全、有效。     

弹簧支架在下肢动脉硬化性狭窄和闭塞治疗中的应用

目的总结使用弹簧支架对下肢动脉硬化性狭窄和闭塞行介入球囊扩张、支架术的临床经验和近、远期疗效。方法对23例患者的29条肢体的下肢动脉硬化性病变行球囊扩张后置入弹簧支架（Introcoil）。结果成功完成29条肢体的治疗，无术中并发症。置入后即时造影示病变处管径明显增大，血流通畅。所有患者均获2～36个月随访，平均随访20个月。6例患者的6条肢体（20．7％）因重新出现动脉闭塞而行搭桥手术，其他患者下肢原有症状消失，20条足背动脉搏动恢复，超声示支架处血流通畅。结论弹簧支架置入是一种有效的下肢动脉狭窄和闭塞的介入治疗方法。     

穿琥宁联合病毒唑治疗小儿喘息性肺炎

目的 :观察穿琥宁联合病毒唑治疗小儿喘息性肺炎的疗效。方法 :65例喘息性肺炎患者随机分治疗组和对照组 ,治疗组 3 0例用穿琥宁、病毒唑静脉点滴 7天 ,对照组 3 5例用病毒唑、青霉素静脉点滴 7天。结果 :穿琥宁组的临床治愈率为 83 .3 % ,总有效率 96.7%。对照组临床治愈率为 5 7.1% ,总有效率 71.4%。经统计分析 ,两组疗效有显著性差异 ,χ2 =7.90 ,P <0 .0 1。结论 :穿琥宁联合病毒唑治疗喘息性肺炎治愈率高 ,疗效满意。     

Broncho-alveolar Lavage Matrix Metalloproteases as a Sensitive Measure of Bronchiolitis Obliterans

Bronchiolitis obliterans (BO) is a survival-limiting factor in lung transplantation. There are no common BO markers in use. Since BO is associated with extracellular matrix remodeling, we asked whether matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs) could serve as BO markers. In 72 lung transplant patients (34 BO syndrome (BOS) 0, 15 BOS 0-p, and 23 BOS 1) serum and broncho-alveolar lavage (BAL) MMP and TIMP levels were examined by ELISA. The BAL cell counts were additionally analyzed. The serum MMP-2, MMP-8, MMP-9 and TIMP-2 levels were not different in all groups. In contrast, the BAL MMP-8, -9 and TIMP-1 levels were significantly elevated in BOS 0-p (p = 0.003; p = 0.007; p = 0.0003, respectively) and BOS 1 (p = 0.003; p = 0.001; p = 0.0004, respectively) as compared to BOS 0 patients. The BAL MMP-8, -9 and TIMP-1 levels were significant predictors of BOS 0-p (p = 0.01; p = 0.01; p = 0.01, respectively) and BOS-1 (p = 0.007; p = 0.01; p = 0.006, respectively) in receiver operating characteristic analysis. Except for BAL macrophages that were significantly decreased in BOS 0-p versus BOS 0 patients; other cell counts were not different between the groups. BAL MMP-8, -9 and TIMP-1 might be useful markers to detect BO in lung transplant patients.     

Clinical Impact of Community-Acquired Respiratory Viruses on Bronchiolitis Obliterans After Lung Transplant

Community-acquired viral respiratory tract infections (RTI) in lung transplant recipients may have a high rate of progression to pneumonia and can be a trigger for immunologically mediated detrimental effects on lung function. A cohort of 100 patients was enrolled from 2001 to 2003 in which 50 patients had clinically diagnosed viral RTI and 50 were asymptomatic. All patients had nasopharyngeal and throat swabs taken for respiratory virus antigen detection, culture and RT-PCR. All patients had pulmonary function tests at regular intervals for 12 months. Rates of rejection, decline in forced expiratory volume (L) in 1 s (FEV-1) and bacterial and fungal superinfection were compared at the 3-month primary endpoint. In the 50 patients with RTI, a microbial etiology was identified in 33 of 50 (66%) and included rhinovirus (9), coronavirus (8), RSV (6), influenza A (5), parainfluenza (4) and human metapneumovirus (1). During the 3-month primary endpoint, 8 of 50 (16%) RTI patients had acute rejection versus 0 of 50 non-RTI patients (p=0.006). The number of patients experiencing a 20% or more decline in FEV-1 by 3 months was 9 of 50 (18%) RTI versus 0 of 50 non-RTI (0%) (p=0.003). In six of these nine patients, the decline in FEV-1 was sustained over a 1-year period consistent with bronchiolitis obliterans syndrome (BOS). Community-acquired respiratory viruses may be associated with the development of acute rejection and BOS.     

硫酸镁治疗毛细支气管炎92例疗效观察

目的观察硫酸镁治疗毛细支气管炎的临床效果。方法选择毛细支气管炎患儿186例,随机分成两组,治疗组92例,对照组94例,两组均给予抗炎、吸氧,维持水电解质酸碱平衡等综合治疗。治疗组在综合治疗的基础上加用25%硫酸镁(0.2～0.4ml/kg/d),每天1次,连用2～4d,比较两组的显效率和总有效率。结果治疗组和对照组显效率分别是45.7%及21.3%,总有效率分别是96.7%及73.4%。两组比较有显著性差异(P<0.05)。结论硫酸镁治疗毛细支气管炎安全有效,值得临床推广使用。