无创序贯机械通气对重症肺炎合并呼吸衰竭患者血浆ANP、NTproBNP的影响

【摘要】 目的 探讨有创 无创序贯机械通气对重症肺炎合并呼吸衰竭患者血浆心钠肽(ANP)、B型氨基端利钠肽原(NT proBNP)水平的影响。方法 根据不同机械通气方法将98例重症肺炎合并呼吸衰竭患者分为序贯组(有创 无创序贯机械通气)52例与常规组(传统有创机械通气)46例，比较两组治疗前后血气分析指标、呼吸频率(RR)、心率(HR)变化情况，统计两组机械通气总时间、有创通气时间、入住重症监护病房时间、总住院时间、呼吸机相关肺炎(VAP)发生率、撤机成功率及院内死亡率。另外测定比较两组患者血清相关炎症因子及心损伤相关指标。结果 两组治疗后RR、HR、二氧化碳分压(PaCO2)比治疗前均明显下降，氧分压(PaO2)、pH值明显上升，差异有统计学意义(P＜005)，但组间比较无明显差异(P＞005)；序贯组机械通气总时间、有创通气时间、入住ICU时间、总住院时间均明显短于常规组，VAP发生率、院内死亡率均显著低于常规组，撤机成功率明显高于常规组(P＜005)；序贯组治疗后3d血清白介素 4(IL 4)、白介素 6(IL 6)、白介素 10(IL 10)、肿瘤坏死因子 α(TNF α)水平、血浆心钠肽(ANP)、B型氨基端利钠肽原(NT proBNP)、肌钙蛋白I(cTnI)水平均明显低于常规组(P＜005)。结论 有创 无创序贯机械通气治疗重症肺炎合并呼吸衰竭疗效较好，能明显缩短有创通气时间，显著降低血浆ANP、NT proBNP水平，减轻心功能损伤，同时能明显减轻机体炎症反应，减少VAP发生率及死亡率。     

B型脑钠肽对多发伤所致急性肺损伤评估及撤机预测中的应用

目的观察多发伤所致ALI患者BNP水平的变化,评价BNP对ALI、严重程度及预后评估的价值,同时评估BNP对急性肺损伤中机械通气患者撤机结果的预测价值。方法通过测定诊断为ALI的患者60例(ALI组)及健康体检者58例(对照组)的血浆BNP浓度,比较两组BNP的水平;根据肺损伤评分,研究ALI组患者肺损伤的严重程度与血浆BNP浓度变化的关系;因病情严重需要机械通气患者,依撤机结果分为撤机成功组和失败组,比较两组间撤机前BNP的差异。结果 ALI组血浆BNP水平较对照组显著升高(P0.01),且与ALI严重程度密切相关(P0.01);撤机失败组BNP水平明显高于成功组(P0.01)。结论BNP水平可成为ALI,评价ALI严重程度及机械通气撤机的重要标志物。     

Durable graft‐versus‐leukaemia effects without donor lymphocyte infusions – results of a phase II study of sequential T‐replete allogeneic transplantation for high‐risk acute myeloid leukaemia and myelodysplasia

Allogeneic haematopoietic stem‐cell transplantation remains the only curative treatment for relapsed/refractory acute myeloid leukaemia (AML) and high‐risk myelodysplasia but has previously been limited to patients who achieve remission before transplant. New sequential approaches employing T‐cell depleted transplantation directly after chemotherapy show promise but are burdened by viral infection and require donor lymphocyte infusions (DLI) to augment donor chimerism and graft‐versus‐leukaemia effects. T‐replete transplantation in sequential approaches could reduce both viral infection and DLI usage. We therefore performed a single‐arm prospective Phase II clinical trial of sequential chemotherapy and T‐replete transplantation using reduced‐intensity conditioning without planned DLI. The primary endpoint was overall survival. Forty‐seven patients with relapsed/refractory AML or high‐risk myelodysplasia were enrolled; 43 proceeded to transplantation. High levels of donor chimerism were achieved spontaneously with no DLI. Overall survival of transplanted patients was 45% and 33% at 1 and 3 years. Only one patient developed cytomegalovirus disease. Cumulative incidences of treatment‐related mortality and relapse were 35% and 20% at 1 year. Patients with relapsed AML and myelodysplasia had the most favourable outcomes. Late‐onset graft‐versus‐host disease protected against relapse. In conclusion, a T‐replete sequential transplantation using reduced‐intensity conditioning is feasible for relapsed/refractory AML and myelodysplasia and can deliver graft‐versus‐leukaemia effects without DLI.     

无创呼吸机在 COPD 急性加重期患者中的应用效果及护理研究

目的：探讨无创呼吸机在慢性阻塞性肺疾病急性加重期（ AECOPD）患者中的应用效果，并总结护理措施。方法选择2012年12月至2014年1月接诊的60例AECOPD患者的临床病例资料，其中，观察组30例患者采用无创呼吸机进行通气治疗，而对照组30例患者采用常规治疗措施，比较两组患者的疗效。结果治疗后，观察组患者的血气分析、心率等指标均明显优于对照组，其治疗相关情况也明显优于对照组，组间差异具有明显统计学意义（ P＜0.05）。结论无创呼吸机在AECOPD患者中具有较佳的治疗效果，而辅以相应的护理措施则更有利于患者病情的改善，从而促进患者的预后，值得临床应用。     

Invasive pulmonary aspergillosis caused by Aspergillus versicolor in a patient on mechanical ventilation

Aspergillus spp. often colonise the respiratory tract of critically ill patients in intensive care units and subsequently cause invasive disease. The risk of developing invasive disease is more in immunocompromised patients. Here we report a case of fatal invasive pulmonary aspergillosis caused by Aspergillus versicolor in a post-operative patient on mechanical ventilation, who did not respond to intravenous itraconazole. We then discuss the challenges involved in the accurate diagnosis of this condition and appropriate management.