二合一吸痰盒的设计与应用

正吸痰是一种高度危险的操作,在临床上因其操作流程不当或物品管理不规范而引起的呼吸道相关性感染多有报道[1-2]。按照吸痰操作的标准要求:吸痰管在吸痰开始和结束时,分别要用灭菌注射用水冲洗[3]。而现在常规使用的吸痰包内仅有吸痰管和手套,所以操作前常需另外准备一次性换药碗来盛装冲洗用水,以保证吸痰各个步骤的顺利完成。但这种方式会增加病人呼吸道感染的危险,甚至造成严重的后果。为此,笔者将吸痰包与换药碗相结合,设计了二     

3-chlorotyrosine in Sputum of COPD Patients: Relationship with Airway Inflammation

ABSTRACT

The airways of patients with chronic obstructive pulmonary disease (COPD) are associated with increased numbers of inflammatory cells, in particular neutrophils and macrophages. Contained within the primary granules of neutrophils is the heme enzyme called myeloperoxidase (MPO) that has been used as a biomarker of neutrophilic inflammation in COPD and other inflammatory diseases. MPO is the only enzyme in the body that produces hypochlorous acid (HOCl), which effectively chlorinates tyrosine residues in proteins. The presence of 3-chlorotyrosine (3Cl-Tyr) in sputum of COPD patients has yet to be established. Spontaneously produced sputum was collected from 14 stable COPD patients, and ultra-centrifuged to prepare sol phase samples for analysis. Sputum 3Cl-Tyr levels were measured using Mass Spectrometry (LC-MSMS). Sputum MPO activity was measured using a standard chromogenic substrate assay. The Spearman rank correlation was used to analyse the data. We report for the first time the measurement of 3Cl-Tyr in sputum from stable COPD patients. The sputum levels of 3Cl-Tyr correlated well with sputum MPO activity (r = 0.88; p < 0.0001). The presence of 3Cl-Tyr in the sputum of stable COPD patients suggests an active process related to MPO that may play a role in the pathophysiology of this disease.     

Changes in sputum cytology,airway inflammation and oxidative stress due to chronic inhalation of biomass smoke during cooking in premenopausal rural Indian women

To perform sputum analysis for verification of pulmonary changes in premenopausal rural Indian women chronically exposed to biomass smoke during cooking.Three consecutive morning sputum samples were collected from 196 women (median age 34 years) cooking with biomass and 149 age-matched control women cooking with cleaner fuel liquefied petroleum gas. Smears made on slides were stained with Papanicolaou and Perl's Prussian blue. Airway oxidative stress was estimated as reactive oxygen species (ROS) generation (by flow cytometry) and superoxide dismutase (SOD) level (by spectrophotometry) in sputum cells. Airway inflammation was measured as sputum levels of interleukin (IL)-6, -8 and tumor necrosis factor- alpha (TNF-α). Particulate matter of diameter less than 10 (PM₁₀) was measured using laser photometer while benzene exposure was monitored by measuring trans, trans-muconic acid (t,t-MA) in urine by HPLC-UV. Compared with control, sputum of biomass users contained more neutrophils, lymphocytes, eosinophils, alveolar macrophages, and showed presence of ciliocytophthoria, Charcot-Leyden crystals, Curschmann's spiral. ROS generation was increased by 2-fold while SOD was depleted by 31% in biomass users. They also had higher sputum levels of IL-6, -8 and TNF-α. Levels of PM₁₀ and t,t-MA were 2.9- and 5.8-times higher in biomass-using women. PM₁₀ and t,t-MA levels were positively associated with cellular changes in the sputum, markers of airway inflammation, and oxidative stress. Cooking with biomass alters sputum cytology, and increases airway inflammation and oxidative stress that might result in further amplification of the tissue damaging cascade in women chronically exposed to biomass smoke.     

早期纤维支气管镜灌洗吸痰在微创食管癌术后肺部并发症中的临床研究

目的探讨纤维支气管镜(纤支镜)灌洗吸痰在预防及治疗食管癌术后肺部并发症中的作用。方法回顾性分析纳入我院胸心外科2016年1月至2019年1月收治的98例微创食管癌手术患者的临床资料,其中50例术后予以纤支镜灌洗吸痰作为试验组,48例行常规物理治疗作为对照组,对比分析两组患者术后发生肺部感染、呼吸衰竭、吻合口瘘的情况,以及引流管留置时间、抗生素使用时间、平均住院日等。结果试验组在术后肺部感染(20.0%和45.8%,χ^2=7.43、P=0.006)、呼吸衰竭(2.0%和12.5%,χ^2=4.07、P=0.000)、术后引流管留置[(7.7±1.9)d和(9.9±2.3)d,t=-5.28、P=0.000]、抗生素使用[(8.2±1.5)d和(11.6±2.5)d,t=-5.90、P=0.000]低于对照组;两组在吻合口瘘的发生率、平均住院时间上差异无统计学意义(均P>0.05)。结论微创食管癌术后早期经纤支镜灌洗吸痰,可以减少围术期风险及术后并发症,提高治疗效果,临床中值得推广。     

应用品管圈提高呼吸内科住院病人痰标本送检率

目的 探讨品管圈活动在提高呼吸内科住院病人痰标本送检率中的应用效果。方法 皖南医学院弋矶山医院呼吸内科于2016年4月成立品管圈小组,确定活动主题,通过现状把握、目标设定、要因分析、对策拟定并实施,对活动前后呼吸内科住院病人痰标本送检率进行统计分析。结果 实施品管圈后,住院病人痰标本送检率达到91.98%(χ²=42.358,P<0.001),较活动前的62.07%有明显提高。结论 品管圈能提高住院病人的痰标本送检率。     

支气管扩张症-慢性阻塞性肺疾病重叠综合征临床特点分析

目的分析总结支气管扩张症-慢性阻塞性肺疾病重叠综合征(ECOS)患者的临床特点,提高对该病的认识,指导临床工作。方法回顾性分析2018年1〜12月在成都市双流区第一人民医院呼吸与危重医学科住院的490例确诊为慢性阻塞性肺疾病急性加重期患者的临床资料,将通过高分辨CT诊断为BCOS的患者45例为ECOS组,同时在剩余的患者中随机选择(采用随机数表法)同期入住呼吸与危重医学科的单纯慢性阻塞性肺疾病(COPD)患者45例作为对照组,分别比较2组患者在一般资料、临床表现、肺功能、实验室检査、住院时间及费用、出院后6个月内急性加重次数及再入院率等方面的差异。结果2组患者在年龄、性别、吸烟指数、体质量指数、住院前基础用药方面差异无统计学意义。BCOS组与COPD组比较,其临床症状更重,实验室检查提示白细胞计数、降钙素原阳性率更高,动脉血氧分压值及氧合指数下降更明显,痰培养阳性率更高,肺功能受损更显著,住院时间更长,住院费用更高,出院6个月内急性加重次数更多。结论BCOS患者发病率较高,临床症状更重,肺功能受损更明显,住院时间及费用明显升高,临床应更加重视此类患者,早诊断,早治疗,以更好的改善患者预后。     

诱导痰炎性标志物对老年人晚发哮喘严重程度判断和鉴别诊断的价值

目的探讨老年人晚发哮喘(LOA)患者诱导痰中嗜酸细胞和嗜酸细胞阳离子蛋白(ECP)水平与其严重程度的关系及与慢性阻塞性肺疾病(COPD)的鉴别诊断价值。方法随机选择54名LOA患者,检测肺功能并分别采用瑞氏染色及荧光免疫法检测高渗盐水诱导痰中嗜酸细胞数量和ECP水平。选择25例老年COPD患者和10例老年健康人作为对照。结果LOA患者诱导痰中嗜酸细胞数量和ECP水平与患者第一秒用力呼气容积占用力肺活量百分比呈显著负相关(r值为-0.68、-0.61,均为P<0.01)。患者诱导痰中嗜酸细胞数量〔(19.4±8.1)%〕和ECP水平〔(391±186)μg/L〕显著高于老年COPD组〔(3.1±1.4)%和(51±26)μg/L,P<0.01〕和老年健康组〔(1.2±0.7)%和(44±22)μg/L,P<0.01〕。以诱导痰中嗜酸细胞≥7%和ECP≥100μg/L为判别标准与COPD鉴别,诊断哮喘的敏感性分别为85.2%和87.0%;特异性分别为84.0%和88.0%。联合检测两者的敏感性和特异性分别为92.6%和92.0%。结论诱导痰中嗜酸细胞和ECP水平可了解LOA的严重程度,并有助于与老年COPD的鉴别。     

Health-related quality of life trajectories among adults with tuberculosis: differences between latent and active infection

BACKGROUND: Tuberculosis (TB) remains a public health threat with significant annual impacts on morbidity and mortality. However, few studies have examined the impact of active and latent TB infection (LTBI) on health-related quality of life (HRQL). METHODS: Patients with recently diagnosed active TB or LTBI patients were administered the Short Form-36 (SF-36) and the Beck depression inventory (DI) at baseline, 3 months, and 6 months. Mixed-effect linear regression was used to compare the trajectory of HRQL over time in the two patient groups after adjusting for potential confounders. Ordinal logistic regression was used to determine the relationship between changes in HRQL of at least the minimal important difference. RESULTS: One hundred four active TB and 102 LTBI patients participated. At baseline, participants with active TB had significantly lower SF-36 mean domain and component scores (4 to 12 points lower, p < 0.03) and higher mean Beck DI scores (4 points higher, p < 0.0001) when compared to LBTI participants. In the responder analysis, those with active TB were associated with reporting improved scores at 6 months of at least the minimal important difference in vitality (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.3 to 5.6), role physical (OR, 3.1; 95% CI, 1.4 to 6.5), mental component score (OR, 3.2; 95% CI, 1.5 to 6.9), social functioning (OR, 11.1; 95% CI, 3.8 to 33), and role emotional (OR, 2.7; 95% CI, 1.2 to 6.0). CONCLUSIONS: Active TB patients had large improvements in most HRQL domains by 6 months. However, when compared to LTBI participants and US norms, HRQL was still low at completion of therapy.     

莫西沙星与肺结核痰转化率相关性的Meta分析

目的系统评价抗结核药莫西沙星与肺结核痰转化率（SCR）的相关性。方法检索中国知网（CNKI）、维普中文科技期刊全文数据库和万方数据库等中文数据库以及美国国立图书馆（PubMed）、荷兰医学文摘（EMBASE）和Cochrane图书馆等英文数据库,运用Meta分析方法综合评价莫西沙星与肺结核SCR的相关性。文献资料使用RevMan4．2软件进行Meta分析。结果共纳入7篇研究,包含治疗组503例和对照组527例。7项研究的合并分析结果显示,莫西沙星与肺结核SCR存在相关性（OR=1．37,95％CI：1．04-1．81）。结论莫西沙星提高了肺结核患者的SCR,可能是当前短疗程治疗药物敏感性肺结核的一种选择。