腹腔灌洗联合前列地尔治疗重症急性胰腺炎疗效观察

目的：了解腹腔灌洗联合前列地尔对重症急性胰腺炎的疗效。方法：回顾分析内科保守治疗组(A组18例)、腹腔灌洗组(B组12例)、腹腔灌洗前列地尔联合治疗组(C组15例)三组间腹痛缓解时间、消失时间，血淀粉酶恢复正常时间，C反应蛋白(CRP)浓度变化，急性肺损伤(ALI)的发生率，死亡率的差异。结果：C组血淀粉酶恢复正常时间短于A组和B组；C组CRP浓度、ALI的发生率均低于A组和B组。腹痛缓解时间、消失时间B组和C组均短于A组(P＜0．05，但B、C两组间比较差异无统计学意义。腹腔灌洗和前列地尔有降低死亡率的趋势，但3组间死亡率差异无统计学意义(P＞0．05)。结论：腹腔灌洗联合前列地尔治疗重症急性胰腺炎优于单纯的保守治疗和腹腔灌洗。     

结肠癌切除术中吻合器吻合与手法缝合临床资料分析

目的探讨结肠癌切除术中吻合器吻合与手法缝合的疗效。方法1998~2005年收治91例患者,根据临床表现分为梗阻组(观察组)41例,无梗阻组(对照组)50例,术中肠道灌洗后各组均分别进行吻合器吻合和手法缝合。结果两组均未发生吻合口漏。观察组:吻合器吻合出现2例切口感染,手法缝合出现4例吻合口狭窄。对照组:吻合器吻合出现1例切口感染,2例吻合口出血;手法缝合出现2例吻合口狭窄,3例切口感染。结论手法缝合与吻合器吻合均安全可靠,但前者更经济实惠,易被广大普通患者所接受。     

奥曲肽治疗大鼠急性坏死性胰腺炎并急性肺损伤的实验研究

目的探讨奥曲肽对急性坏死性胰腺炎并急性肺损伤治疗影响。方法选日龄21 dSD大鼠为实验对象,并随机分为实验组(E组,n=6)、治疗组(T组,n=6)和对照组(C组,n=6)。采用十二指肠结扎胰管注射5%牛磺胆酸钠法建立急性坏死性胰腺炎并发急性肺损伤动物模型。E组在胰管中注入5%牛磺胆酸钠,C组注入生理盐水,T组在注入5%牛磺胆酸钠前1 h静脉注入生长抑素类药物奥曲肽。0、2、4、6 h分别取动脉血作血气分析,取静脉血作淀粉酶测定,6 h后取右肺进行支气管肺泡灌洗,灌洗液做中性粒细胞计数、分类和白蛋白含量分析。然后取左肺做肺湿重和肺干重称重,计算两者比值。结果注射5%牛磺胆酸钠2 h后,E组动物PaO2升高,4 h开始下降,6 h下降更明显,C组各时段变化无显著性,而T组变化规律与E组相似,但变化幅度明显减小。血淀粉酶都表现出相似的特征。支气管肺泡灌洗液白蛋白、中性粒细胞计数和分类,E组与C、T比较有显著性差异,C组与T组比较无显著性差异。结论生长抑素类药物奥曲肽能明显降低急性坏死性胰腺炎并肺损伤大鼠的肺泡炎性渗出,从而减轻肺损伤。     

大面积烧伤伴吸人性损伤的治疗

目的 总结大面积烧伤并吸人性损伤患者的治疗经验,以探索最佳治疗方法.方法 分析2004年至2007年收治的20例大面积烧伤伴吸入性损伤患者的临床资料.结果 20例患者中治愈18例;死亡2例;治愈率90%.结论 早诊断,早治疗,防止并发症出现,可提高此类患者的治愈率.     

Nasogastric aspiration/lavage in patients with gastrointestinal bleeding: a review of the evidence

Introduction: The usefulness of nasogastric aspiration and nasogastric lavage in patients with gastrointestinal bleeding is controversial, as evidenced by conflicting recommendations, both among and within society guidelines.

Areas covered: Considering these controversies, we reviewed the evidence regarding the following questions: 1) Can nasogastric lavage stop or slow down the bleeding and improve subsequent endoscopic visualization? 2) Is nasogastric aspiration helpful for the localization of bleeding? 3) Can nasogastric aspiration identify high risk patients that might benefit from earlier endoscopy? 4) Is there evidence for benefit in terms of outcomes from using nasogastric aspiration? 5) Is nasogastric intubation safe in patients with possible esophageal varices? Our review was conducted according to PRISMA guidelines.

Expert commentary: Based on the available literature, nasogastric lavage or aspiration cannot be routinely recommended unless a large properly designed randomized trial (which is currently lacking) proves otherwise. It is a painful and time-consuming procedure with no demonstrated benefit for the patient in terms of outcomes. Other clinical and laboratory parameters, and risk scores, are less invasive and are effective for guiding the stratification and management of patients, while pre-endoscopic erythromycin infusion is a good if not better alternative for improving visualization of the stomach.     

A case of pulmonary alveolar proteinosis treated with whole lung lavage

Pulmonary alveolar proteinosis represents a rare syndrome characterized by the accumulation of proteinaceous phospholipid-laden material in the alveoli. This leads to impaired gas exchange and arterial hypoxemia of varying degrees. The diagnosis is confirmed by lung biopsy. Sequential whole-lung lavage (WLL) first described in 1963 is the standard of care. We report a case of a male diagnosed of having pulmonary alveolar proteinosis (PAP) on transbroncial lung biopsy (TBLB). He was treated with sequential WLL (Left followed by right, Left being more involved on chest X-ray) followed by recombinant GM-CSF, with good result.     

Utility of galactomannan antigen detection in bronchoalveolar lavage fluid in immunocompromised patients

Diagnosis of invasive pulmonary aspergillosis (IPA) is a challenging process in immunocompromised patients. Galactomannan (GM) antigen detection in bronchoalveolar lavage (BAL) fluid is a method to detect IPA with improved sensitivity over conventional studies. We sought to determine the diagnostic yield of BAL GM assay in a diverse population of immunocompromised patients. A retrospective review of 150 fiberoptic bronchoscopy (FOB) with BAL for newly diagnosed pulmonary infiltrate in immunocompromised patients was performed. Patient information, procedural details and laboratory studies were collected. BAL and serum samples were evaluated for GM using enzyme‐linked immunoassay. Of 150 separate FOB with BAL, BAL GM was obtained in 143 samples. There were 31 positive BAL GM assays. In those 31 positive tests, 13 were confirmed as IPA, giving a positive predictive value of 41.9%. There was one false negative BAL GM. Of the 18 false positive BAL GM, 4 were receiving piperacillin–tazobactam and 11 were receiving an alternative beta‐lactam antibiotic. BAL GM assay shows excellent sensitivity for diagnosing IPA. There was a significant number of false positive BAL GM assays and several of those patients were receiving beta‐lactam antibiotics at the time of bronchoscopy.     

纤维支气管镜诊治儿童呼吸道疾病的临床疗效分析

目的 探讨纤维支气管镜术诊治儿童呼吸道疾病的临床应用价值。方法选择在柳州市妇幼保健院住院的815例行纤维支气管镜术的临床病例资料进行回顾性分析。结果815例患儿，共行纤维支气管镜术872次，其中，气管、支气管炎590例，呼吸道解剖结构异常159例，支气管异物62例，肺含铁血黄素沉着症3例，肺泡蛋白沉着症1例；590例行支气管肺泡灌洗，支气管肺泡灌洗液定量培养主要病原菌支气管肺泡灌洗为肺炎克雷伯菌，阳性率41．72％。131例重症肺炎患儿经治疗后，有效98例（74．81％）。并发症发生率17．54％，均为一过性，程度轻。结论纤维支气管镜术在诊断和介入治疗儿童呼吸道疾病中具有重要意义。