Unilateral pupillary mydriasis from nebulized ipratropium bromide: A false sign of brain herniation in the intensive care unit

Although there are many causes of anisocoria in the intensive care setting, the development of unilateral mydriasis in patients with intracranial hemorrhage or tumor is a neurological emergency, as it may herald the onset of uncal herniation. We describe two patients with a hemiparesis from neurosurgical disorder who subsequently developed a fixed and dilated pupil. The pupillary abnormality was caused by nebulized ipratropium bromide in both cases, and resolved when the medication was discontinued. Nebulized ipratropium may leak from the mask into ipsilateral eye and cause mydriasis in patients with facial weakness. This benign cause of anisocoria in the intensive care setting is distinguished from uncal herniation by the laterality of neurologic findings, and lack of mental status change, ptosis, and extraocular movement impairment.     

单磷酸阿糖腺苷联合复方异丙托溴铵、布地奈德治疗毛细支气管炎患儿的疗效及对血清样淀粉蛋白A的影响

目的 评价单磷酸阿糖腺苷联合复方异丙托溴铵、布地奈德治疗小儿毛细支气管炎疗效及对血清样淀粉蛋白A （SAA）水平的影响。方法 选取2016年2月-2017年12月收治的毛细支气管炎患儿110例,随机分为观察组和对照组,每组55例。对照组给予布地奈德混悬液0.5 mg联合复方异丙托溴铵1.25 mL溶入3 mL生理盐水中雾化吸入。观察组在对照组的基础上加用单磷酸阿糖腺苷10 mg溶于5%葡萄糖溶液100 mL中iv。两组均治疗7 d,比较两组临床疗效（包括发热、咳喘、啰音等）以及治疗前后血清SAA、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）以及IL-8水平。结果 观察组和对照组的总有效率分别为96.4%和83.6%,差异有统计学意义（P<0.05）;治疗后观察组症状体征消失时间和住院时间与对照组相比明显缩短,差异有统计学意义（P<0.05）;治疗后两组患儿血清SAA表达水平及血清TNF-α、IL-6及IL-8水平均较治疗前明显下降,且观察组显著低于对照组,差异有统计学意义（P<0.05）。结论 单磷酸阿糖腺苷联合复方异丙托溴铵、布地奈德治疗小儿毛细支气管炎疗效确切,可改善机体免疫功能及降低炎症指标,值得临床推广应用。     

双水平气道正压通气联合雾化吸入治疗AECOPD临床研究

目的探讨双水平气道正压通气(BiPAP)呼吸机加雾化吸入复方异丙托溴铵溶液治疗慢性阻塞性肺疾病急性加重(AECOPD)的临床疗效。方法 96例AECOPD患者随机分为治疗组和对照组。两组患者均根据痰培养及药敏结果选用敏感抗生素,纠正酸碱失衡及水、电解质紊乱,给予解痉平喘、止咳祛痰及营养支持等常规治疗,并使用BiPAP呼吸机治疗。治疗组在此基础上加用复方异丙托溴铵溶液2 ml(含异丙托溴铵4 mg,沙丁胺醇2 mg)加生理盐水3 ml雾化吸入15~20 min,2次/d。结果 1治疗组总有效率为91.7%(44/48),对照组总有效率为81.3%(39/48),两组比较差异有统计学意义(P0.05);2治疗组死亡1例,对照组死亡3例,两组对比差异无统计学意义(P0.05)。3治疗后两组动脉血二氧化碳分压逐渐下降,治疗组下降更明显,两组比较差异均有统计学意义(P0.01)。治疗后两组动脉血氧分压、pH、动脉血氧饱和度逐渐升高,治疗组升高更明显,两组比较差异均有统计学意义(P0.05或P0.01)。4治疗后两组心率、呼吸频率逐渐下降,治疗组下降更明显,两组比较差异均有统计学意义(P0.05或P0.01)。5治疗组与对照组通气时间、住院天数比较差异有统计学意义(P0.01),治疗组通气时间、住院天数均比对照组缩短。结论 BiPAP联合雾化吸入复方异丙托溴铵溶液治疗AECOPD具有疗效显著、操作简单、安全方便等优点,值得在临床推广应用。     

氨溴特罗口服液治疗小儿支气管肺炎的疗效观察简

目的 探讨氨溴特罗口服液治疗小儿支气管肺炎的疗效.方法 78例患儿随机分为两组,观察组采用氨溴特罗口服液治疗,对照组采用盐酸氨溴索颗粒治疗,比较两组疗效、咳嗽咳痰评分和免疫指标变化.结果 观察组有效率89.74%,对照组71.79%,观察组疗效优于对照（Ridit z=48.478,P=0.000）;治疗3 d后观察组咳嗽、咳痰情况优于对照（P〈0.05）;两组IgG差异有统计学意义（P〈0.05）.结论 氨溴特罗口服液治疗小儿支气管肺炎起效快,且能调理患儿免疫功能,值得临床推广和应用.     

布地奈德福莫特罗联合噻托溴铵对重度慢性阻塞性肺疾病稳定期患者的疗效分析

目的 探讨布地奈德福莫特罗（信必可都保）联合噻托溴铵（思力华）对重度慢性阻塞性肺疾病（COPD）稳定期患者的临床治疗效果.方法 选取重度COPD患者90例,随机分为试验组（45例）和对照组（45例）,两组均在常规治疗（常规吸氧、抗炎、解痉、平喘）的基础上,试验组使用布地奈德福莫特罗联合噻托溴铵吸入,对照组则以布地奈德福莫斯特罗单药治疗,治疗周期6个月;对两组患者的疗效进行对比分析.结果 经过6个月的治疗,两组患者的6 min步行距离、呼吸困难的症状均有改善,但试验组的效果更加明显（P＜0.05）;试验组患者的血气、肺功能指标均明显升高（P＜0.05）.结论 相比于使用布地奈德福莫特罗单药治疗,患者在血气分析、肺功能以及呼吸困难的改善上,噻托溴铵与布地奈德福莫特罗联合治疗重度COPD稳定期患者的疗效更好,具有在临床治疗中推广应用的价值.     

噻托溴铵联合沙美特罗替卡松治疗慢性阻塞性肺疾病稳定期患者的疗效观察

目的 观察噻托溴铵联合沙美特罗替卡松对慢性阻塞性肺疾病(COPD)稳定期的治疗效果.方法 采用随机、双盲的方法将62例COPD患者分为观察组和对照组,观察组给予噻托溴铵和沙美特罗替卡松治疗,对照组给予沙美特罗替卡松治疗,分别对两组患者治疗前后呼吸困难评分和肺功能检测进行比较.结果 治疗两个月后,与对照组比较观察组肺功能FEV1、FVC、FEV1/FVC%,呼吸困难评分改善差异有统计学意义(P＜0.05).结论 噻托溴铵与沙美特罗替卡松联合吸入治疗COPD,疗效优于沙美特罗替卡松单药治疗.     

复方异丙托溴胺治疗支气管哮喘发作的应用

目的 讨论复方异丙托溴胺在支气管哮喘治疗中的作用.方法 回顾性分析我院2009年10月至2010年10月在我科住院治疗的支气管哮喘发作期60例病人的临床表现,治疗方法及治疗效果.结果 两组病人经治疗后,治疗组喘息、胸闷、呼吸困难等症状有效率及显效率明显高于对照组.差异有显著性(P<0.05).结论 复方异丙托溴胺在治疗支气管哮喘发作期起效快,效果明显,能明显改善患者的肺功能.     

Iron-Oxide Nanocluster Labeling of Clostridium novyi-NT Spores for MR Imaging–Monitored Locoregional Delivery to Liver Tumors in Rat and Rabbit Models

PurposeTo label Clostridium novyi-NT spores (C. novyi-NT) with iron oxide nanoclusters and track distribution of bacteria during magnetic resonance (MR) imaging-monitored locoregional delivery to liver tumors using intratumoral injection or intra-arterial transcatheter infusion.Materials and MethodsVegetative state C. novyi-NT were labeled with iron oxide particles followed by induction of sporulation. Labeling was confirmed with fluorescence microscopy and transmission electron microscopy (TEM). T2 and T2* relaxation times for magnetic clusters and magnetic microspheres were determined using 7T and 1.5T MR imaging scanners. In vitro assays compared labeled bacteria viability and oncolytic potential to unlabeled controls. Labeled spores were either directly injected into N1-S1 rodent liver tumors (n = 24) or selectively infused via the hepatic artery in rabbits with VX2 liver tumors (n = 3). Hematoxylin-eosin, Prussian blue, and gram staining were performed. Statistical comparison methods included paired t-test and ANOVA.ResultsBoth fluorescence microscopy and TEM studies confirmed presence of iron oxide labels within the bacterial spores. Phantom studies demonstrated that the synthesized nanoclusters produce R2 relaxivities comparable to clinical agents. Labeling had no significant impact on overall growth or oncolytic properties (P >.05). Tumor signal-to-noise ratio (SNR) decreased significantly following intratumoral injection and intra-arterial infusion of labeled spores (P <.05). Prussian blue and gram staining confirmed spore delivery.ConclusionsC. novyi-NT spores can be internally labeled with iron oxide nanoparticles to visualize distribution with MR imaging during locoregional bacteriolytic therapy involving direct injection or intra-arterial transcatheter infusion.