纤维支气管镜清除治疗肺曲菌球的护理

目的　探讨经纤维支气管镜清除治疗肺曲菌球的护理措施。方法　对 17例经纤维支气管镜清除治疗肺曲菌球的全程护理并追踪治疗效果。结果　 17例患者能配合治疗护理 ,完成疗程 ,肺曲菌球完全清除干净 ,复查示肺部病灶稳定 ,肺内原有曲菌球的部位及其他部位未见曲菌生长。结论　全方位的术前准备、术中术后并发症的观察和护理 ,是治疗获得成功的保证。     

纤维支气管镜清除治疗肺曲菌球的护理

目的探讨经纤维支气管镜清除治疗肺曲菌球的护理措施.方法对17例经纤维支气管镜清除治疗肺曲菌球的全程护理并追踪治疗效果.结果17例患者能配合治疗护理,完成疗程,肺曲菌球完全清除干净,复查示肺部病灶稳定,肺内原有曲菌球的部位及其他部位未见曲菌生长.结论全方位的术前准备、术中术后并发症的观察和护理,是治疗获得成功的保证.     

经纤维支气管镜诊断治疗肺曲菌球及疗效观察

目的探讨经纤维支气管镜(纤支镜)诊断治疗肺曲菌球的方法及治疗效果。方法对38例肺曲菌球采用经纤支镜钳夹活检确定诊断，经镜下清除曲菌球、全身及局部使用抗真菌药物等治疗方法进行治疗，部分大咯血病例在纤支镜治疗前先予支气管动脉双重栓塞治疗咯血，对上述病例的治疗效果进行追踪观察。结果38例肺曲菌球病例均得到病理诊断，30例肺曲菌球全部清除干净的病例，咯血症状完全消失，X线及胸部CT示肺部病灶明显减少或消失，追踪观察2—45个月，肺曲菌球病情无复发，肺内无曲菌球再生长，X线及胸部CT复查肺部病灶无变化；8例因各种原因未能彻底清除肺曲菌球的病例则出现咳嗽、咯血症状再发。结论经纤支镜可早期确诊肺曲菌球，并能对多数病例进行彻底清除，该治疗方法可行，损伤小，疗效确切，可作为除手术之外肺曲菌球的另一有效治疗方法。     

经纤维支气管镜诊断继发性肺曲菌病患者的护理

目的：总结经纤维支气管镜诊断继发性肺曲菌病患者的护理体会。方法：对2009年1月～2010年12月我院12例经纤维支气管镜确诊的继发性肺曲菌病患者的临床资料和护理措施进行回顾性分析。结果：通过在支气管肺活检术术前、术中、术后积极的护理干预,12例继发性肺曲菌病患者能尽早确诊,便于下一步诊疗。结论：积极有效的护理干预,在经纤维支气管镜诊断继发性肺曲菌病中具有重要意义。     

纤维支气管镜肺灌洗联合导管介入治疗难治性肺感染的护理

1998年1月至2001年4月我们为25例行支气管镜肺灌洗联合导管介入治疗难治性肺感染的患进行了护理，取得了满意的效果，现将护理体会报告如下。     

经纤维支气管镜诊断肺曲菌病（附4例报告）

近４年来，我们应用纤支镜诊断肺曲菌病４例，现报告如下。１临床资料例１女，４２岁。咳嗽，咯痰半个月，胸片示右上肺肺不张而行纤支镜检查。镜下见右上叶管口有一息肉状新生物，几乎完全阻塞管口，表面附有胶冻状分泌物，活检时感组织韧，无出血。刷检找到曲菌菌丝，病...     

老年性肺曲菌球8例治疗分析

8例肺曲菌球老年患者。男7例，女1例；年龄56～69岁，平均年龄62．8岁。8例患者均有咳嗽、咯血史，病史3个月～4年，咯血量10～80mml／次。既往有肺结核病史6例，支气管扩张病史2例。胸部CT示病灶内有透亮区，透亮区内可见球状病灶3例，结节状病灶5例。病灶位于双肺多叶3例，右肺3     

气管支气管曲菌病的支气管镜表现

目的 探讨气管支气管曲菌病的支气管镜表现.方法 通过分析并发侵袭性肺曲菌病(invasive pul-monary asperginosis,IPA)的26例免疫损害宿主、3例免疫功能正常宿主支气管镜检查结果 ,结合文献复习,分析气管支气管曲菌病的支气管镜表现.结果 3例免疫功能正常宿主中2例表现为严重的伪膜性气管支气管炎,1例表现为气管内息肉样肿块阻塞支气管腔;并发IPA的26例免疫损害宿主中7例支气管镜检查有异常表现.表现为气管黏膜结节,支气管腔内灰绿色赘生物,周围黏膜肉芽增生,赘生物和增生的肉芽组织半阻塞管腔,或局限的黏膜黄白苔附着,受累支气管黏膜充血、糜烂.10例表现为非特异性的黏膜充血,水肿.9例未见明显异常.结论 气管支气管曲茵病支气管镜表现为受累支气管黏膜结节,局灶的黄白苔附着,腔内灰绿色赘生物和肉芽增生为主.也可以特征性地表现为严重的伪膜性气管支气管炎.     

纤支镜对以支气管肉芽肿为表现的肺曲菌病的诊断价值

目的：探讨纤支镜对以支气管肉芽肿为表现的肺曲菌病的诊断价值。方法：对12例以支气管腔内肉芽肿为主要表现的肺曲菌感染的纤支镜检查结果作一分析。结果：12例患者，以咳嗽和咯血为主，X线表现以肺不张多见，有基础疾病5例。纤支镜所见大部分位于两上叶，呈息肉肿块状7例，气管狭窄阻塞4例，3例呈粘膜改变为主。8例有略样坏死动物及黄色分泌物。结论：以支气管肉芽肿为主要表现的肺曲菌病纤支镜下所见的肿块、质硬、干酪样分泌物及黄色分泌物具有诊断特异性。     

肺移植术后纤维支气管镜介入治疗3例的护理

纤维支气管镜介入治疗是处理肺移植后气道并发症的有效手段,做好患者的心理护理和充分的术前准备、术中密切配合医生、术后做好并发症处理,是保证介入治疗成功的要素。     

X线非典型肺曲菌病纤支镜下所见与病理观察

目的：探讨纤支镜检查对以X线非典型肺曲菌病的诊断价值。方法：对29例X线非典型肺曲菌病的纤支镜下所见及病理结果作对照观察与分析。结果：29例患者以咳嗽、发热、反复咳血痰及不等量咯血临床症状为主。X线表现以支气管及支气管肺炎、肺脓肿、肺不张多见，无明显曲菌球X线影象特征。纤支镜所见，病变气管内壁呈炎性息肉样突起，官腔呈裂隙状狭窄及阻塞，所有病例纤支镜活检及刷检物进行病理及细胞学检查，均为侵性炎性肉芽组织及大量曲菌丝体、抱子和坏死组织。结论：X线非典型肺曲菌病，起病隐匿，X线表现复杂多样互无特异性，极易误诊。此病经胸部X线及CT扫描结合纤支镜与病理细胞学的联合检查对继发此病的诊断具有重要的实用价值。     

Therapy of Murine Pulmonary Aspergillosis with Antibody-Alliinase Conjugates and Alliin

Aspergillus fumigatus is an opportunistic fungal pathogen responsible for invasive aspergillosis in immunocompromised individuals. The high morbidity and mortality rates as well as the poor efficacy of antifungal agents remain major clinical concerns. Allicin (diallyl-dithiosulfinate), which is produced by the garlic enzyme alliinase from the harmless substrate alliin, has been shown to have wide-range antifungal specificity. A monoclonal antibody (MAb) against A. fumigatus was produced and chemically ligated to the enzyme alliinase. The purified antibody-alliinase conjugate bound to conidia and hyphae of A. fumigatus at nanomolar concentrations. In the presence of alliin, the conjugate produced cytotoxic allicin molecules, which killed the fungus. In vivo testing of the therapeutical potential of the conjugate was carried out in immunosuppressed mice infected intranasally with conidia of A. fumigatus. Intratracheal (i.t.) instillation of the conjugate and alliin (four treatments) resulted in 80 to 85% animal survival (36 days), with almost complete fungal clearance. Repetitive intratracheal administration of the conjugate and alliin was also effective when treatments were initiated at a more advanced stage of infection (50 h). The fungi were killed specifically without causing damage to the lung tissue or overt discomfort to the animals. Intratracheal instillation of the conjugate without alliin or of the unconjugated monoclonal antibody significantly delayed the death of the infected mice, but only 20% of the animals survived. A limitation of this study is that the demonstration was achieved in a constrained setting. Other routes of drug delivery will be investigated for the treatment of pulmonary and extrapulmonary aspergillosis.Aspergillus fumigatus is an opportunistic fungal pathogen that is responsible for invasive aspergillosis (IA) in immunocompromised individuals (19, 22, 25). Patients with hematological or solid malignancies, as well as organ transplant recipients, are particularly vulnerable to infection. Pulmonary infection by A. fumigatus airborne conidia is the predominant cause of IA (22). Despite advances in early diagnosis and new antifungal agents, IA currently remains a leading cause of death in the immunocompromised patient population, with an attributable mortality rate ranging from 30% to 80% (13, 50).Allicin (diallyl-dithiosulfinate), the biologically active molecule of garlic, has been shown to have a very wide range of antimicrobial activities and contributes to the defense of the garlic plant against soil microorganisms (1, 11, 15, 20, 29, 36, 44). Allicin is produced by the catalytic reaction of the enzyme alliinase (EC 4.4.1.4) with the inert, nonprotein amino acid substrate alliin [(+)-S-allyl-cysteine sulfoxide]. Crushing the garlic clove breaks down the compartmentalization and brings the enzyme and its substrate into contact, leading to allicin production (20, 30). The potential use of pure allicin as an anti-Aspergillus agent in vivo was shown in our previous work (44). Despite its short half-life, five repetitive doses of pure allicin administered intravenously (i.v.) to mice infected with A. fumigatus significantly prolonged their survival. The delivery of allicin, however, remains a major concern, due to its instability in blood circulation. Allicin rapidly transforms into secondary products that lack antimicrobial activity following intravenous injection (14, 20, 37).Our novel approach for antifungal therapy overcomes this problem by generating the production of allicin on the targeted pathogen. In a previous investigation, we developed a system of targeted production of allicin to kill specifically cancer cells (3, 27). In the present study, the potential efficacy of this novel in vivo treatment was investigated with a murine model of invasive pulmonary aspergillosis (IPA) (54). We prepared a conjugate consisting of the alliinase enzyme ligated to a monoclonal anti-A. fumigatus antibody to target the production of allicin molecules to the surface of the fungus. After infection, the conjugate and then the substrate alliin were repeatedly administered by intratracheal (i.t.) instillation as described previously (17). The main advantages of this approach over other antibody-directed enzyme prodrug therapy (ADEPT) systems (4) are (i) the harmless nature of the prodrug alliin, a natural food component that has been declared by the FDA as a substance that is generally recognized as safe (GRAS) and that can be administered in unlimited amounts and (ii) the fact that the hydrophobic allicin molecules produced on the target cell have a limited area of effect; due to their high reactivity and short lifetime, they kill the fungi without causing visible damage to the adjacent lung epithelial cells. To the best of our knowledge, this work constitutes the first example of a targeted allicin generation system for antimicrobial treatment.(This work was presented in part at the Annual Meeting of the Israel Society of Microbiology, Bar Ilan University, Ramat Gan, Israel, 5 March 2009.)     

肺曲霉菌病的影像学表现

目的：探讨肺曲霉菌病（PA）的影像学表现,提高影像诊断水平。材料与方法：回顾性分析13例经病理及实验室证实的肺曲霉菌病CT表现及病理资料。其中,男8例,女5例,平均年龄40．83岁（26～78岁）。结果：13例中,影像学表现为炎性实变的4例,单发或多发结节2例,肿块样浸润2例,支气管扩张2例,曲菌球2例,肺不张1例。结论：曲菌球为其特征性改变。如果在影像上发现结节或／和肿块及其周围晕征、胸膜下楔形肺实变等征象时,首先要考虑到肺曲菌病的可能。     

肺曲霉病误诊原因分析

目的 探讨并分析导致肺曲霉病患者误诊的原因,为早期诊断并及时正确治疗提供科学的依据.方法 回顾性分析2010年1-4月问确诊为肺曲霉病的3例患者在诊治过程中被误诊的原冈.结果 3例患者均缺乏明显的特异性临床表现和影像学表现.最后确诊均依据病理学活检证实.结论 肺部的曲霉菌感染缺乏特异性的f临床和影像学表现,及早行纤维支...     

纤维支气管镜床边支气管肺泡冲洗治疗肺部感染

我院自 2 0 0 1年 1月～ 2 0 0 2年 1 1月对各种不同疾病并肺部感染的危重病人 ,除常规全身用药外 ,行床边纤维支气管镜 (便携式 )支气管肺泡冲洗(BL)组和对照组进行随机抽样分组 ,探讨BL对各种不同疾病并肺部感染的疗效。1　对象与方法1 .1　对象全部病例均为住院患者 ,筛选符合条件者 ,采用掷币法随机分为治疗组和对照组。治疗组 41例 :男2 7例 ,女 1 4例 ,年龄 2 1～ 76岁。其原发病分别为 :慢性支气管炎并呼吸衰竭 2 1例 ,脑部手术后 3例 ,脑血管意外昏迷 1 1例 ,全身烧伤 2例 ,胸部手术后3例 ,多发性骨折 1例 ;对照组 3 9例 :其中男 …     

Inhaled Voriconazole for Prevention of Invasive Pulmonary Aspergillosis

Targeted airway delivery of antifungals as prophylaxis against invasive aspergillosis may lead to high lung drug concentrations while avoiding toxicities associated with systemically administered agents. We evaluated the effectiveness of aerosolizing the intravenous formulation of voriconazole as prophylaxis against invasive pulmonary aspergillosis caused by Aspergillus fumigatus in an established murine model. Inhaled voriconazole significantly improved survival and limited the extent of invasive disease, as assessed by histopathology, compared to control and amphotericin B treatments.Invasive aspergillosis is a significant cause of morbidity and mortality in heavily immunocompromised patients and is associated with significant hospital costs and therapy complications in those with multiple comorbidities (3, 5, 9). Targeted pulmonary delivery by aerosolization of antifungals has recently gained attention, as this strategy may lead to high local concentrations at the primary site of infection (1, 4, 6). Our objective was to assess an inhaled aqueous solution of voriconazole as prophylaxis against invasive pulmonary aspergillosis. We hypothesized that this strategy would prevent invasive disease and improve survival in an established murine model.This study was approved by the Institutional Animal Care and Use Committee at the University of Texas Health Science Center at San Antonio, and all animals were handled in accordance with the American Association for Accreditation of Laboratory Animal Care. Outbred ICR mice (Harlan) were immunosuppressed by cyclophosphamide and cortisone acetate and inoculated via an aerosol chamber with Aspergillus fumigatus clinical isolate Af293 as previously described (7, 8). Mice were assigned to the following groups: (i) inhaled voriconazole (5 ml of a 6.25-mg/ml formulation of commercially available voriconazole IV containing 100 mg/ml sulfobutyl ether-β-cyclodextrin sodium via 20 min of aerosolization twice daily; Pfizer, Inc.) or aerosolized sulfobutyl ether-β-cyclodextrin sodium as a control (5 ml of a 100-mg/ml solution via 20 min of aerosolization twice daily; Captisol, CyDex Pharmaceuticals, Inc.) as prophylaxis begun 2 days prior to pulmonary inoculation or (ii) amphotericin B deoxycholate treatment (1 mg/kg intraperitoneally daily) begun 1 day after inoculation. Voriconazole and control mice received aerosolized solutions in a nose-only dosing chamber by an Aeroneb Pro micropump nebulizer system. All agents were continued until day 7 postinoculation. Mice were then monitored off therapy until day 12. Animals that appeared moribund were euthanized, and death was recorded as occurring the next day.For fungal burden analysis, 12 mice from each group were euthanized on day 8 and the lung tissue was harvested. Lungs were homogenized in sterile saline, and serial dilutions were plated onto potato dextrose agar. Following 24 h of incubation at 37°C, colonies were enumerated and numbers of CFU per gram of lung tissue were calculated. Pulmonary fungal burdens were also quantified by real-time quantitative PCR (qPCR) as previously described (2). DNA was extracted from 90 μl of lung homogenate with a commercially available kit (DNeasy Tissue Kit; Qiagen), and fungal DNA was measured by qPCR with a probe and primers specific for the A. fumigatus FKS gene (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"U79728","term_id":"2149092","term_text":"U79728"}}U79728) and reported as the number of conidial equivalents (CE) per gram of tissue (11). Two additional mice per group were selected and euthanized on days 8 and 12 for histopathology. Lungs were placed into 10% (vol/vol) formaldehyde, processed, and embedded in paraffin wax, and coronal sections were obtained. Sections were stained with hematoxylin and eosin and viewed by light microscopy. Survival was plotted by Kaplan-Meier analysis, with differences in median and percent survival analyzed by the log rank and chi-square tests, respectively. Differences in fungal burden (numbers of CFU and CE per gram) were assessed by analysis of variance with Tukey''s posttest for multiple comparisons. A P value of ≤0.05 was considered statistically significant.Mice that received aerosolized voriconazole had a survival advantage over controls and those treated with amphotericin B, with survival on therapy significantly improved in the aerosolized voriconazole prophylaxis group (92%) compared to that of controls (25%; P < 0.05) and those treated with amphotericin B (31%; P < 0.05) (Fig. ​(Fig.1).1). This survival benefit was maintained once therapy was discontinued, with 67% of the animals that received voriconazole surviving until day 12, compared to 17% of the controls (P < 0.05) and 23% of those treated with amphotericin B (P < 0.05). No survival difference was observed between the control and amphotericin B groups. The median survival time of mice that received aerosolized voriconazole (>12 days) was also significantly longer than that of mice that received the control or amphotericin B, 7.5 and 7 days, respectively (P < 0.01). Although survival in the amphotericin B treatment group was poor, the survival at day 4 is consistent with previously reported data after 4 days of treatment with the same dose (12). Furthermore, survival rates have only reached 50% when the dose of amphotericin B deoxycholate has been increased to 3 mg/kg/day or when high-dose liposomal amphotericin B (10 mg/kg/day) has been used in this animal model (11). These results demonstrate the difficulty in achieving favorable treatment outcomes in heavily immunocompromised hosts once disease is established.Open in a separate windowFIG. 1.Survival curves of immunosuppressed mice that received aerosolized voriconazole (VRC; 6.25 mg/ml twice daily), amphotericin B deoxycholate (AMB), or a control (aerosolized sulfobutyl ether-β-cyclodextrin sodium, 100 mg/ml twice daily) and were challenged by pulmonary inoculation with A. fumigatus. (A) Survival on therapy (day 7; n = 24 per study group). (B) Survival after therapy was discontinued (n = 12 per study group).Although survival was improved in animals that received aerosolized voriconazole, this benefit was not explained by reductions in tissue burden. As shown in Table ​Table1,1, no significant differences in median tissue burden, as measured by CFU count or qPCR, were observed between any of the groups (Table ​(Table1).1). However, marked differences in lung histopathology were found (Fig. ​(Fig.2).2). Animals that received the control or amphotericin B had more severe invasive disease and marked abnormalities within the lungs compared to those administered aerosolized voriconazole. Specifically, lungs from control and amphotericin B-treated animals had increased epithelial disruption, congestion, necrosis, angioinvasion, and vascular lesions within the small airways on day 8. The extent of pulmonary lesions was variable in mice that received amphotericin B, indicating inconsistent in vivo activity (Fig. ​(Fig.3).3). In contrast, mice that received aerosolized voriconazole had fewer signs of invasive disease and markedly improved histological findings. Similar findings were also noted on day 12 postinoculation, supporting the finding that the protective effects of aerosolized voriconazole are maintained once prophylaxis is stopped. Thus, the improved survival may be attributed to reductions in the extent of invasive disease following aerosolized voriconazole. Furthermore, both aerosolized voriconazole and sulfobutyl ether-β-cyclodextrin sodium are well tolerated, with no lung injury or inflammatory changes on histology in uninfected mice (data not shown).Open in a separate windowFIG. 2.Representative histopathology, on days 8 and 12 postinoculation, of lungs from mice that received a control (aerosolized sulfobutyl ether-β-cyclodextrin sodium), intraperitoneal amphotericin B deoxycholate, or aerosolized voriconazole. Lung sections were stained with hematoxylin and eosin and viewed by light microscopy at ×20 magnification.Open in a separate windowFIG. 3.Box plots of the numbers of necrotic foci observed by histopathology in lungs per animal (A) and per lung field (B) in mice that received a control (aerosolized sulfobutyl ether-β-cyclodextrin sodium), prophylaxis with aerosolized voriconazole (VRC), or treatment with intraperitoneal amphotericin B deoxycholate (AMB). Boxes represent the 25th and 75th percentiles, and horizontal lines within the boxes represent the median values.

TABLE 1.

Pulmonary fungal burdens of the mice used in this study

经纤支镜灌洗治疗肺心病141例报告

目的：研究通过纤支镜对肺源性心脏病肺段灌洗治疗清除积痰后的疗效。方法：按常规纤支镜操作方法，采用配有抗菌素、化痰、止喘等药物的生理盐水进行灌洗治疗。结果：通过分次灌洗治疗，患者血氧饱和度明显上升，可达85％－93％，平均提高8％－25％，肺部感染能有效控制，通气功能明显改善。结论：经纤支镜灌洗治疗肺心病是目前的一种行之有效、病人生命得以延长的一种好的治疗方法。     

20例肺曲霉菌感染病人的护理

总结20例肺曲霉菌感染病人的护理经验.指导护士对霉菌感染病人的护理.本文统计了20例肺曲霉菌感染病人在综合治疗的前提下,对病人实施心理护理、呼吸道症状护理、抗霉菌药物治疗护理以及密切的病情观察等措施,正确的护理可减少药物的不良反应,使病人积极配合治疗.     

纤维支气管镜诊治长期误诊的成人支气管异物

目的：探讨纤维支气管镜（纤支镜）对成人支气管异物的诊治价值。方法：回顾性分析了10例长期误诊的成人支气管异物的临床特点,纤支镜下特征及钳取异物技巧。结果：主要临床表现为咳嗽,咳脓痰,发热,呼吸音减弱,吸气时干罗音,胸片及胸CT均未见异物的直接表现,误诊为肺癌4例,肺炎2例,支气管炎2例,支气管扩张1例,支气管哮喘1例,误诊时间1个半月－21年,纤支镜下直接见到异物5例,经冲洗吸引后见异物2,异物被肉芽组织或坏死物覆盖,镜下见新生物3例,均用普通活检钳成功取出异物,异物性质为猪排骨4例,鱼骨4例,虾1例,瓜籽1例。结论：成人支气管异物的误诊应予重视,纤支镜检查是诊治成人支气管异物的最主要手段。