苏州市初治菌阴肺结核患者就诊延迟现况及临床特征

目的 分析初治菌阴肺结核患者就诊延迟现况及临床特征,为制定有效措施提供科学依据。方法 应用横断面研究,收集苏州市5家结核病定点医院初治菌阴肺结核患者人口学、经济来源、生活方式、结核病知识、主要病史及进入结核病定点医院前发病和就诊等临床资料,采用Logistic回归方法进行统计分析。结果 379例初治菌阴肺结核患者就诊延迟186例,就诊延迟率为49.08%。老年人(OR=1.898,95% CI=1.157~3.112,P=0.011)、日工作时间大于8 h(OR=1.774,95% CI=1.014~3.102, P=0.044)、流动人口(OR=3.252; 95% CI=1.807~5.855, P<0.001)和发热(OR= 2.061,95% CI=1.021~4.160,P=0.043)是初治菌阴肺结核患者发生就诊延迟的危险特征,而咯血(OR= 0.356, 95% CI= 0.164~0.773,P=0.009)是就诊延迟的保护特征。结论 初治菌阴肺结核患者就诊延迟现象较严重,需对不同临床特征的患者采取综合干预措施,减少就诊延迟发生。     

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。     

The Feasibility of Extracorporeal Membrane Oxygenation in the Variant Airway Problems

Introduction: Extracorporeal membrane oxygenation (ECMO) is widely used to treat respiratory distress during cardiac or respiratory arrest; moreover, its use is being extended to a wide variety of clinical fields. In this study we assess the utility of ECMO in the management of airway obstruction.Patients and Methods: 15 patients underwent ECMO for airway obstruction. We retrospectively analyzed and evaluated the feasibility of ECMO in the treatment of airway problems.Results: Seven patients received ECMO to facilitate respiration and promote stability during trachea surgery. In six cases ECMO ceased immediately following the operation; in the remaining case ECMO cessation was delayed due to post-operative ARDS. In three cases emergency ECMO was used in response to respiratory arrest; two patients died. In five cases ECMO was emergently inserted to prevent death, following airway blockade by massive hemoptysis. One patient was not discharged from the intensive care unit. Another patient was transferred to a general ward but died from other causes.Conclusion: ECMO is useful during anesthesia in patients at high risk of airway blockade, for example due to endobronchial bleeding, and during complex thoracic surgery. ECMO confers a safer environment during airway surgery, and its complication rate is acceptable.     

Onyx胶血管内栓塞治疗急性大咯血的临床效果

目的 探讨Onyx胶血管内栓塞治疗急性大咯血的安全性及有效性.方法 选取2015年3月至2017年8月因急性大咯血于我院接受Onyx胶血管内栓塞治疗的患者20例,男14例、女6例,中位年龄45.5(17～73)岁,支气管扩张10例、肺结核3例、肺癌2例、血管畸形1例、不明原因4例.其中10例为外院采用常规材料栓塞术后短期内(≤7 d)再次咯血.统计Onyx胶血管内栓塞治疗急性大咯血的技术成功率和临床成功率,分析相关并发症,并计算近期(<3个月)、中期(3～<12个月)及远期(≥12个月)复发率.结果 20例患者均成功进行栓塞,术后出血均得到有效控制,技术成功率与临床成功率均达100.0％(20/20).所有患者均未出现脊髓损伤、呼吸衰竭等严重并发症.术后中位随访时间22.5(3～42)个月,18例(90.0％)患者随访12个月以上.3例患者分别于术后1、7、15个月复发,均经内科治疗有效,未再接受血管内栓塞止血治疗.2例肺癌患者分别于术后4、10个月死于原发性肿瘤.近期复发率为5.0％(1/20),中期复发率为5.0％(1/20),远期复发率为5.6％(1/18).结论 采用Onyx胶血管内栓塞治疗急性大咯血安全、有效.     

纤维支气管镜对中老年咯血93例病因诊断

目的 探讨纤维支气管镜检对45岁以上中老年咯血患病因诊断的价值。方法 分析1991年－2001年本院93例45岁以上咯血患的纤维支气管镜检查结果。结果 93例中纤支镜检查示肺癌38.7%（31例肺癌和5例肺癌合并结核病）；结核病37.6%(35例）；慢性炎症21.5%（20例）；急性炎症5.4%（5例）；支气管扩张2.2%（2例）。结论 45岁以上中老年咯血患的主要病因为肺癌与结核病。两有伴发现象；纤支镜下常规刷检或组织活检找癌细胞和结核肝菌是简便快捷的鉴别方法。     

DSA支气管肺动脉栓塞术治疗大咯血31例临床疗效观察

目的评价支气管动脉栓塞术在治疗大咯血患者中的作用。方法通过对31例大咯血患者行数字减影血管造影术(DSA)支气管动脉栓塞术观察临床疗效。结果术后6个月进行随访,结果显示31例病例中有2例肺癌患者再发咯血,3例因肺癌晚期死亡,2例支气管扩张症再次发生大咯血,其余均无咯血症状复发。结论应用DSA支气管动脉栓塞术对大咯血患者进行治疗,能够在术中对出血点进行有效治疗,效果较好。而且其适应证广泛,对患者痛苦小,微创、安全。     

Propylthiouracil-induced autoimmune disease

Hyperthyroidism is a condition characterized by excessive production of thyroid hormones. Propylthiouracil (PTU) is commonly used as first line drug in the management of hyperthyroidism. This is a case report of 24-year-old female, a known case of hyperthyroidism since 4 years, who came with a history of fever and myalgia since 3 days and dyspnea with coughing out of blood since 1 day. Patient was taking PTU (100 mg per day) since 4 years for hyperthyroidism. Patient was immediately intubated for type-II respiratory failure. Diagnosed to be having PTU-induced autoimmune disease. PTU was stopped and treated with methylprednisolone and cyclophosphamide. Clinical features improved over a period of 8 days and discharged home successfully. Having a high suspicion for the onset of autoimmune disease in hyperthyroidism patients who are on PTU therapy and timely treatment with immunosuppressants and supportive care along with the withdrawal of the drug can make a difference in morbidity and mortality.     

Pulmonary Resection in the Treatment of Life-Threatening Hemoptysis

Purpose: Massive hemoptysis is a life threatening situation with high mortality rates. Surgery is effective, however generally an avoided treatment. We report our experience with patients undergoing lung resection for life-threatening hemoptysis.Methods: Records of all surgically treated patients for hemoptysis between June 2009 and June 2012 were reviewed and analyzed retrospectively.Results: Anatomical resection was performed on 31 (15.3%) patients out of 203 patients referred to our intensive care unit for life-threatening hemoptysis. 25 (80.6%) were male and six (19.4%) were female; with mean age of 46.4 ± 13.7 (21–77). Pneumonectomy was performed in four (12.9%), lobectomy in 24 (77.4%), segmentectomy in two (6.5%) and bilobectomy in one case. Postoperative complications developed in eight (25.8%), and mortality was observed in two (6.5%) patients. Etiology was bronchiectasis in 13 (42.0%), tuberculosis in eight (25.8%), carcinoma in four (12.9%), aspergilloma in four (12.9%), hydatid cyst in one (3.2%) and lung abscess in one (3.2%) of the cases.Conclusions: Although lung resection in the treatment of massive hemoptysis is accompanied with high morbidity and mortality rates, surgery is the only permanent curative modality. Acceptable results can be achived in the company of a multidisciplinary approach, through avoidance of pneumonectomy and urgent surgery.