我院1997-2008年肺血栓栓塞症诊治状况分析

目的 分析我院1997-2008 年间肺血栓栓塞症（PTE）患者发病和诊治状况,以期增加临床医师对PTE相关知识的认识。方法 回顾分析12年间PTE患者逐年诊断例数及其年龄、性别及首诊科室分布等,总结其特征。结果　12年来PTE发病率明显上升,尤其以呼吸病区的变化最显著。男女比例为1. 79∶1,男性患者分布在各年龄段,而女性患者50岁以下发病明显少于男性,50岁以后女性发病逐渐升高。结论　我院PTE发病率逐年升高,这与临床医生对PTE的认识及诊治意识、与放射科影像诊断技术水平的提高密切相关。年轻男性患者PTE并不少见,临床上更要提高警惕。PTE并非仅见于呼吸专科,提高对PTE的认识、加强各科室PTE的培训非常重要。     

支架相关性呼吸道感染的研究进展

气道支架置入是治疗中央气道狭窄的有效手段, 可快速缓解患者气促症状, 改善患者生活质量, 但是其远期并发症常见, 如支架相关性呼吸道感染、支架移位、肉芽生长等, 目前临床医师对支架相关性呼吸道感染关注不足, 本文就支架相关性呼吸道感染的诊断、类型及防治等方面进行综述, 以期提高临床医师对本病的重视。     

不同年龄段肺血栓栓塞症患者的临床特征及预后影响因素分析

Objective To explore the clinical characteristics of pulmonary embolism(PE)in different age-groups and to analyze prognostic factors of PE. Methods Data of 209 PE patients diagnosed in our hospihal from 2004 to 2009 were reviewed retrospectively. Results Of the 209 patients with PE,95 subjects (45.5%) were over the age of 65,and 114 were≤65 years.The third leading comorbidity were activity limitation that were banding in bed.chronic obstructive pulmonary disease,neoplasm and hypertension,accounting for 42.1%,24.4% and 21.5%,respectively.The typical clinical presentations included dyspnea(83.7%),cough(74.2%),chest pain(29.2%),haemoptysis(15.3%)and syncope (3.8%).In 186(92.1%)patients,D-dimer wag above the normal level,37.8%(79)and 54.0%(81/150) subjects were found having got a venous thrombosis in lower extremity and pulmonary hypertension,respectively by using ultrasonic visualization.16.7%(35)and 80.9%(169)had received thrombolytic and anticoagulant therapy.respectively.The death rate of PE was 6.7%.A difierence in clinical characteristics wag obserred between younger and older patients.The later had more comorbidity such as COPD.neoplasm and hypertension,the older patients had fewer complaints of chest pain,haemoptysis,fever,hypotension and typical electrocardiogram(ECG),but had more cough with sputum,pulmonary rales and lower extremity edema.in comparison to the younger patients.The older PE patients were less likely to suffer from be thrombosis and pulmonary infarction,and to received thrombolytie therapy. Multivariate logistic regression showed that PaO_2 < 60 mm Hg(1 mm Hg = 0. 133 kPa), having pulmonary rales, having abnormal neutrophilic granulocyte counts, not receiving thrombolysis and anticoagulant therapy, suffering from emergency rescue, having comobidities with tumor and pneumonia were important prognostic factors. Conclusion The clinical features of PE were various and non-specific. More attention should be paid to PE patients, in particular to older patients who usually had more comorbidities and non-specific clinical manifestations.     

不同年龄段肺血栓栓塞症患者的临床特征及预后影响因素分析

Objective To explore the clinical characteristics of pulmonary embolism(PE)in different age-groups and to analyze prognostic factors of PE. Methods Data of 209 PE patients diagnosed in our hospihal from 2004 to 2009 were reviewed retrospectively. Results Of the 209 patients with PE,95 subjects (45.5%) were over the age of 65,and 114 were≤65 years.The third leading comorbidity were activity limitation that were banding in bed.chronic obstructive pulmonary disease,neoplasm and hypertension,accounting for 42.1%,24.4% and 21.5%,respectively.The typical clinical presentations included dyspnea(83.7%),cough(74.2%),chest pain(29.2%),haemoptysis(15.3%)and syncope (3.8%).In 186(92.1%)patients,D-dimer wag above the normal level,37.8%(79)and 54.0%(81/150) subjects were found having got a venous thrombosis in lower extremity and pulmonary hypertension,respectively by using ultrasonic visualization.16.7%(35)and 80.9%(169)had received thrombolytic and anticoagulant therapy.respectively.The death rate of PE was 6.7%.A difierence in clinical characteristics wag obserred between younger and older patients.The later had more comorbidity such as COPD.neoplasm and hypertension,the older patients had fewer complaints of chest pain,haemoptysis,fever,hypotension and typical electrocardiogram(ECG),but had more cough with sputum,pulmonary rales and lower extremity edema.in comparison to the younger patients.The older PE patients were less likely to suffer from be thrombosis and pulmonary infarction,and to received thrombolytie therapy. Multivariate logistic regression showed that PaO_2 < 60 mm Hg(1 mm Hg = 0. 133 kPa), having pulmonary rales, having abnormal neutrophilic granulocyte counts, not receiving thrombolysis and anticoagulant therapy, suffering from emergency rescue, having comobidities with tumor and pneumonia were important prognostic factors. Conclusion The clinical features of PE were various and non-specific. More attention should be paid to PE patients, in particular to older patients who usually had more comorbidities and non-specific clinical manifestations.     

291例肺血栓栓塞症住院病例回顾分析

目的：对PTE临床病例进行回顾分析,以提高早期正确的诊断率。方法：收集本院2004年1月-2009年6月291例临床诊断PTE住院病例（其中确诊209例）,综合分析一般资料、临床表现、实验室检查、首诊科室分布、相关危险因素等。结果：PTE首诊科室以呼吸内科为首,散在分布于多个科室,其中呼吸内科222例（76．29％）,心血管内科20例（6．87％）,胸外科16例（5．5％）,骨科6例（2．06％）,消化内科6例（2．06％）,妇产科5例（1．72％）,整形科4例（1．37％）,普外科3例（1．03％）,中医科3例（1．03％）,颅外科2例（0．68％）,神内科2例（0．68％）,内分泌科1例（0．34％）,风湿科1例（0．34％）;PTE临床症状复杂多样,无特异性,确诊病例中出现呼吸困难84．21％,咳嗽74．64％,咳痰62．68％,胸闷胸痛46．41％,发热24．40％,咯血15．79％,晕厥3．83％,合并呼吸困难、胸痛、咯血三联征只有4．78％。确诊病例中19．62％无明显阿E相关危险因素,实验室检查明显异常心电图（3．35％）、彩色超声心动图肺动脉高压（38．76％）、D-二聚体增高（〉500ng／L）（88．52％）。结论：PTE临床表现复杂,涉及多学科领域,需保持对其高度警惕性,综合分析临床表现、实验室检查等,才能提高其诊断水平。     

增强现实导航气管镜技术在呼吸内镜医师培训的初步应用

目的探讨增强现实导航支气管镜技术(Lung Point)在呼吸内镜医生培训中的可行性。方法随机抽取10名我院2017年1—6月呼吸内镜中心招录的呼吸内镜培训医师为研究对象。随机分成两组,A组按常规方式教学,B组根据胸部CT应用Lung Point系统在支气管镜术前重建支气管三维模型教学,每人操作20例次检查。将操作次数分为1~5例次、6~10例次、11~15例次、16~20例次。评价操作是否到达目标所在亚段支气管、到达目标所在亚段支气管所用时间,少于5分钟为及格,多于5分钟为不及格。比较两种教学方法在支气管镜检查操作时间、定位精准率。结果比较两种支气管镜检查操作所需时间,A组为(398.16±91.51)s,B组为(275.01±62.64)s,两组对比,差异具有统计学意义(P=0.00);操作时间的达标率,A组低于B组(24%vs.72%);两种培训法随着培训例次的增多,操作所花费时间逐渐减少。在常规培训法上,16~20例次比其余各例次组所花的时间明显减少,且随着操作例次增多,在规定时间内操作成功次数逐渐增多;在常规培训法上,各组次在规定时间内操作成功率对比,差异无统计学意义(P=0.95),但操作时间上,与1~5例次比较,另外三组明显减少。但6~10例次与11~15例次对比,差异无统计学意义(P0.05)。两种操作方法的定位精准率,常规培训法组低于Lung Point培训法(60%vs.84%),且不同例次的比较,差异具有统计学意义(P0.05);两种评价指标均达标,则A组低于B组(14%vs.53%)。结论增强现实导航支气管镜技术(Lung Point系统)可缩短呼吸内镜医师培训时间,提高培训成效。     

中国县级医院支气管镜技术应用现状调查

目的了解我国县级医院支气管镜资源配置及技术应用现状。方法一项横断面调查。2021年3—8月, 根据地区生产总值、县域数量分层抽样, 从中国各省中抽样12个省级行政区, 共抽查291家县级医院, 调查支气管镜技术在县级医院的开展情况。在每个省级行政区常规开展支气管镜技术的县级医院中用计算机随机抽样2家, 调查这24家医院的支气管镜资源配备、技术应用、洗消及麻醉等现状。组间比较采用独立样本t检验或两相关样本非参数检验。采用Spearman相关分析探索相关性。双侧P<0.05为差异有统计学意义。结果根据抽样结果估算, 每个省级行政区常规开展支气管镜技术的县级医院数量占县级医院总数的比例是11.4%(9.9%, 13.8%), 与省级行政区内人口数(r=0.64, P=0.025)、地区生产总值(r=0.65, P=0.025)显著相关。接受问卷调查的24家县级医院每家配备(1.6±1.0)条支气管镜, 配备电子支气管镜、纤维支气管镜的医院数量分别为22家(91.7%)、6家(25.0%)。6家(25.0%)医院每个工作日进行支气管镜操作, 12家(50.2%)医院有相对固定的医生及护士...     

间质性肺疾病合并肺栓塞12例的临床特征分析

目的：探讨分析间质性肺疾病(ILD)合并肺栓塞(PE)患者的临床特征。方法收集2011年1月至2011 年 12月期间在广州呼吸疾病研究所住院治疗的12例 ILD 并发 PE 的患者为 ILD 合并PE 组,并募集同期24例性别、年龄相匹配的 PE 患者作为对照,即单纯 PE 组,比较两组病例的身高、体质量、既往病史、近期制动或手术、吸烟、糖皮质激素使用等特征,咯血、胸痛、呼吸困难、心悸、下肢浮肿等症状,以及 D-二聚体、动脉血气分析、肺动脉收缩压、PE 类型(大面积和非大面积)等实验室检查。结果与单纯 PE 组相比,ILD 合并 PE 组糖皮质激素应用史(50.0% vs 12.5%)、咳嗽(100.0% vs 70.8%)、心悸(41.7% vs 8.3%)比例更高,动 脉血气分析 提 示 PaO 2下降更明显[(63.14±12.94)mmHg vs (73.05±14.67)mmHg]。两组在基础疾病、咯血、胸痛、呼吸困难、下肢浮肿、血常规、D-二聚体、肺动脉收缩压及 PE 的类型差异无统计学意义,12例 ILD 合并 PE 的患者都为非大面积 PE。结论 ILD 合并 PE 组患者糖皮质激素应用及咳嗽、心悸等症状发生率高,动脉血气 PaO 2下降更明显,对 ILD 合并 PE 可能有提示作用。     

支气管镜超声弹性成像在肺门纵隔淋巴结良恶性的诊断价值

目的 探讨经支气管镜实时超声弹性成像鉴别肺门纵隔淋巴结性质的诊断价值.方法 经支气管镜超声弹性成像评价肺门纵隔淋巴结性质,并对该淋巴结行针吸活检术.弹性成像评分为1～4分.l、2分为阴性淋巴结,3、4分为阳性淋巴结.结果 纳入29例患者共43枚淋巴结.不同弹性分级组间良恶性构成比差异有统计学意义(X2＝16.92,P=0.001).弹性成像对恶性淋巴结的敏感度、特异度、准确度分别为70.83％、84.21％、76.74％.结论 经支气管镜实时超声弹性成像的敏感度、特异度、准确度高,有助于肺门纵隔淋巴结良恶性的鉴别诊断.