经纤支镜气道内膜下注射药物治疗对支气管内膜结核患者并发症的影响

目的探讨纤支镜气道注射药物治疗对支气管内膜结核患者并发症的影响。方法选择2018年1月—2019年1月在湖北省潜江市中心医院治疗的支气管内膜结核患者66例,分为对照组和研究组各33例。对照组给予药物雾化吸入疗法,研究组经过纤支镜气道内膜下注射药物治疗。比较两组治疗效果和症状缓解的影响。结果研究组总有效率为90.91%,对照组总有效率为84.85%,研究组的治疗效果均高于对照组(P<0.05);对照组并发症发生率为39.39%,研究组并发症发生率18.18%,研究组并发症发生率明显低于对照组(P<0.05)。结论经纤支镜气道内膜下注射药物治疗支气管内膜结核患者并发症的发生率较小。     

心理干预联合认知干预在惠州市学校 肺结核病密切接触者中的应用观察

目的研究心理干预联合认知干预在惠州市学校肺结核病密切接触者中的应用效果。方法随机数表法将学校2018年1月—2019年1月肺结核患者密切接触者200名分为观察组和对照组,各100例,对照组给予认知干预,观察组给予心理干预联合认知干预。观察并比较两组研究对象干预前后的焦虑自评量表(SAS)评分、调查主动检查人数、发病情况、对肺结核的了解情况以及两组研究对象的满意度。结果与干预前比较,两组干预后SAS评分下降,肺结核知识评分上升,且观察组干预后下降或上升幅度大于对照组(P<0.05);观察组主动筛查率高于对照,感染发病率明显低于对照组(P<0.05);观察组满意率为95.00%,高于对照组的86.00%(P<0.05)。结论心理干预联合认知干预在学校肺结核密切接触者中应用可有效缓解不良情绪,提高主动筛查率和疾病的认知了解。     

The technological imperative in tuberculosis care and prevention in Vietnam

ABSTRACT

A monocausal bacteriological understanding of infectious disease orients tuberculosis control efforts towards antimicrobial interventions. A bias towards technological solutions can leave multistranded public health and social interventions largely neglected. In the context of globalising biomedical approaches to infectious disease control, this ethnography-inspired review article reflects upon the implementation of rapid diagnostic technology in low- and middle-income countries. Fieldwork observations in Vietnam provided a stimulus for a critical review of the global rollout of tuberculosis diagnostic technology. To address local needs in tuberculosis control, health managers in resource-poor settings are readily cooperating with international donors to deploy novel diagnostic technologies throughout national tuberculosis programme facilities. Increasing investment in new diagnostic technologies is predicated on the supposition that these interventions will ameliorate disease outcomes. However, suboptimal treatment control persists even when accurate diagnostic technologies are available, suggesting that promotion of singular technological solutions can distract from addressing systemic change, without which disease susceptibility, propagation of infection, detection gaps, diagnostic delays, and treatment shortfalls persist.     

A hypothesis for reactivation of pulmonary tuberculosis: How thoracic wall shape affects the epidemiology of tuberculosis

This study was aimed at determining the cause for the high incidence of tuberculosis (TB) reactivation occurring in males with a low body mass index (BMI). Current thinking about pulmonary TB describes infection in the lung apex resulting in cavitation after reactivation. A different hypothesis is put forward for TB infection, suggesting that this occurs in subclinical apical cavities caused by increased pleural stress due to a low BMI body habitus. A finite element analysis (FEA) model of a lung was constructed including indentations for the first rib guided by paramedian sagittal CT reconstructions, and simulations were conducted with varying antero‐posterior (AP) diameters to mimic chests with a different thoracic index (ratio of AP to the transverse chest diameters). A Pubmed search was conducted about gender and thoracic index, and the effects of BMI on TB. FEA modeling revealed a tenfold increase in stress levels at the lung apex in low BMI chests, and a four‐fold increase with a low thoracic index, r² = 0.9748 P < 0.001. Low thoracic index was related to BMI, P = 0.001. The mean thoracic index was statistically significantly lower in males, P = 0.001, and increased with age in both genders. This article is the first to suggest a possible mechanism linking pulmonary TB reactivation to low BMI due to the flattened thoracic wall shape of young male adults. The low thoracic index in young males may promote TB reactivation due to tissue destruction in the lung apex from high pleural stress levels. Clin. Anat. 28:614–620, 2015. © 2015 Wiley Periodicals, Inc.     

精神分裂症合并肺结核患者咯血诱因及护理

目的:探讨精神分裂症合并肺结核患者咯血的诱因和护理对策。方法:回顾性总结近5年我科精神分裂症合并肺结核患者9人临床咯血的主要诱因及采取的有效护理措施。结果:咯血的主要诱因有:不服从卧床休息、吸烟后呛咳、排便用力,饮食控制不当、情绪激动等,经过护理干预,消除患者咯血的诱因,积极配合治疗和抢救,1人行肺叶切除术已治愈,4人因呼吸衰竭抢救无效死亡,其余4人咯血已控制,病情稳定。结论:精神分裂症合并肺结核出现咯血的诱因多样,需实行有针对性的护理措施。     

N-乙酰半胱氨酸治疗COPD合并肺结核临床观察

目的：评价N-乙酰半胱氨酸（NAC）对慢性阻塞性肺疾病（COPD）合并肺结核患者肺功能、细胞免疫功能和生活质量的影响。方法：93例患者随机分为对照组47例和观察组46例，对照组予常规治疗，观察组加服NAC，6个月为一个疗程。比较抗结核作用、肺功能、细胞免疫功能和生活质量，记录不良反应。结果：治疗后，与对照组相比，观察组肺功能指标FEV₁/FVC和PEF，CD4+T、CD4+Foxp3+调节性T细胞亚群比例明显升高，CD4+/CD8+和SGRQ问卷中症状、活动、影响维度评分明显降低，组间均有显著性差异（P<0.05）。其余指标组间无差异。结论：NAC可明显改善COPD合并肺结核患者的肺功能、细胞免疫功能和生活质量，值得临床推广。