烧伤早期并发肺水肿23例临床分析

大面积烧伤并发肺水肿是一种较常见的烧伤并发症,我院从1990年以来共收治大面积烧伤446例,其中烧伤早期并发肺水肿23例,现报告如下。1临床资料1.1一般资料本组23例,男16例,女7例;年龄3~65岁,其中<12岁的15例,>12岁8例;烧伤面积20%~93%;烧伤原因:热汤烧伤12例,火焰烧伤6例,酸烧伤2例,碱烧伤3例;合并有吸入性损伤4例;并发肺水肿在伤后48 h内发生的20例,48小时后发生的3例;气管切开6例;均有不同程度的呼吸困难、咳嗽、咯血或粉红色泡沫样痰,双肺有弥漫性湿啰音。符合肺水肿的表现。1.2治疗方法确诊并发肺水肿后,即严格控制输液速度,在补足血容…     

小儿高原肺水肿临床特点及治疗

目的 :探讨小儿高原肺水肿的临床特点及治疗方法。方法 :对 86例高原肺水肿患儿在患病年龄、发病时间、诱因、临床表现及治疗后患儿肺部音消失时间、胸片阴影消失时间、临床治愈时间进行观察分析。结果 :在本组 86例患儿中 ,上呼吸道感染、过度活动是小儿高原肺水肿的主要诱因 ,小儿高原肺水肿多发生在进入高原前 3天 ,年长儿的肺部音消失时间、胸片阴影消失时间及临床治愈时间明显短于婴幼儿 (P <0 0 5 ,或 0 0 1)。结论 :对小儿高原肺水肿及时诊断 ,针对小儿的病理生理特点 ,进行积极的治疗 ,是提高小儿高原肺水肿的救治水平的有效方法     

小儿有机磷农药中毒的临床特点

40例小儿有机磷农药中毒16例追问不出毒物接触史,多数经皮肤吸收中毒,病情发展快,可迅速出现肺水肿,易发生惊厥抽风,水、电解质紊乱,酸碱失衡,这与小儿中枢神经系统发     

小儿吸入性烧伤42例治疗分析

小儿吸入性损伤虽发生率较低,但往往病情重、并发症多、进展快、病死率高,尽早有效的治疗是救治的关键。2004年至今我院共收治小儿吸入性烧伤42例。现将治疗情况分析如下。临床资料:本组42例患儿,男24例,女18例;其中年龄6个月～2岁10例,2～6岁18例,6～12岁14例。烧伤原因:火焰烧伤24例,火药爆炸伤     

小儿神经源性肺水肿32例临床分析

神经源性肺水肿(NPE)是继发于各种中枢神经系统损伤所致的突发性颅内压增高引起的急性肺水肿,而无原发性心、肺、肾等疾病。我们于1990年1月至1997年12月共收治小儿NPE32例,现分析如下。 1 临床资料 1.1 一般资料 男13例,女19例。年龄8月～1岁2例,～3岁8例,～6岁9例,～14岁13例。 1.2 临床表现 全部病例均有不同程度的意识障碍     

早期气管切开救治大面积烧伤合并吸入性损伤16例体会

大面积烧伤常伴有不同程度的吸入性损伤,而吸入性损伤是烧伤患者死亡的主要原因之一,我院自2000年以来共收治此类患者16例,均在早期行气管切开,取得良好效果,现报告如下。1临床资料16例中男性12例,女性4例,年龄14~82岁,烧伤原因:火焰12例,火药爆炸2例,钢水1例,碱蒸汽1例;烧伤面积48%~95%TBSA,气管切开时间为伤后3~12 h,平均7·31h,手术时颈部水肿不明显,患者基本能安静配合,手术过程均顺利;治愈4例,治愈率为87·5%,死亡2例,死亡原因:1例为老年患者重度吸入性损伤并发肺水肿及呼吸功能衰竭,1例为烧伤感染及多器官功能衰竭。发生呼吸道感染4…     

腹部带蒂真皮下血管网皮瓣转移术治疗小儿手部瘢痕30例

目的观察腹部带蒂真皮下血管网皮瓣转移术治疗小儿手部瘢痕的疗效。方法 30例（36只手）手部深度烧伤后严重瘢痕挛缩畸形小儿患者,均采用瘢痕切除、腹部带蒂真皮下血管网皮瓣转移术治疗。结果术后皮瓣均顺利成活,创面一期愈合。术后随访6～14个月,根据手部关节活动度评定疗效,本组优25只手,良11只手。结论腹部带蒂真皮下血管网皮瓣转移术治疗小儿手部烧伤后严重瘢痕挛缩畸形疗效满意。     

胸腔血容量指数与外肺水指数对烧伤患者肺水肿的早期预测价值

目的研究胸腔血容量指数与外肺水指数对烧伤患者肺水肿的早期预测价值。方法选取2013年1月到2014年12月在我院烧伤科接受治疗及Pi CCO检测且伤后10天内发生肺水肿的严重烧伤患者42例,根据患者肺水肿类型分为肺损伤型组与静水压型组,对比两组Pi CCO监测指标及肺损伤评分,探索EVLWI与ITBVI、氧合指数的相关性。结果两组患者EVLWI水平相差不大,但静水压型组ITBVI及氧合指数均明显大于非损伤组,Murray评分明显低于肺损伤组;EVLWI与ITBVI呈显著正相关性,r=0.921,P0.05;EVLWI与氧合指数呈明显的负相关性,r=-0.718,P0.05。结论烧伤早期实行监测胸腔血容量指数与外肺水指数对患者发生肺水肿预测和鉴别具有重要参考意义。     

肝移植术后早期急性肺水肿14例临床相关因素分析

目的 探讨肝移植术后早期急性肺水肿的临床相关因素,为临床合理处理提供线索。方法观察我院行肝移植术后急性肺水肿14例患者的术前终末期肝病模型（MELD）评分、手术前后肾功能（尿量、血肌酐）的变化情况;记录移植术中及术后前3d总入量、总出量和液体平衡量。结果肝移植术后急性肺水肿患者（14例）术前MELD评分较非肺水肿组（127例）显著增高（P〈0．01）,且术后死亡率明显上升（P〈0．01）;急性肺水肿患者术前存在肾功能不全,术后血肌酐、尿量延迟恢复;术中、术后液体正平衡显著增加,与非肺水肿组差异均有统计学意义（P〈0．01）。结论肝移植术后早期急性肺水肿与术前高MELD分值、术前肾功能障碍、术后肾功能延迟恢复及术中大量输液、术后限液不足密切相关,术中、术后严格控制出入量平衡,尽快恢复患者肾功能及相关重要脏器支持是防止肝移植早期急性肺水肿的有效措施。     

儿童烧伤后用血情况调查

目的:分析烧伤的儿童患者的血液成分使用情况,为临床合理用血提供参考依据。方法:收集2017-01—2018-08收治的烧伤儿童(0～14岁)患者病历资料2 113份,对性别、年龄、烧伤原因、烧伤部位、烧伤面积、烧伤程度、是否手术、是否休克、是否输血、输血量等信息进行分析。结果:此次调查的2 113例患儿中有89例患儿进行过输血,共输入悬浮红细胞116 U,血浆322 U。患儿是否输血与性别、年龄、烧伤原因等比较,差异无统计学意义(P0.05),是否输血与烧伤严重程度、烧伤部位、是否手术比较,差异有统计学意义(P0.05),红细胞输注量与烧伤严重程度比较,差异无统计学意义(P0.05),血浆输注量与烧伤严重程度比较,差异有统计学意义(P0.05)。结论:重度及特重度烧伤、多个部位烧伤、手术患者输血率明显高于轻中度、单个部位、非手术患者。随着烧伤程度增加血浆输注量也明显增加。针对14岁以下的烧伤患儿用血,应严格掌握输血适应证,合理输注成分血,杜绝血液滥用,保障临床用血安全。     

Pulmonary echinococcosis (hydatidosis) in children: results of surgical treatment.

From 1986-1996, 33 children with 49 pulmonary hydatid cysts underwent surgical treatment in Vienna and Istanbul. Cysts were unilateral in 28 and bilateral in 5 cases; unruptured cysts (URC) were diagnosed in 19 patients, and 14 children presented with ruptured cysts (RC). Ten patients had cysts in other organs (liver, spleen, central nervous system) in addition to pulmonary cysts. Diagnosis was primarily based on chest X-ray and computed tomography scan. In Austrian children, a new combination of serological tests was used successfully (71% positive). The standard surgical procedure was cystotomy followed by capitonnage. The main postoperative complications were fever and wound infection. There were two recurrences after a mean follow-up of 4.8 years, and one patient died because of multiple organ involvement. We conclude that the therapy of choice in pediatric pulmonary hydatidosis is complete surgical elimination of the cyst by cystotomy and capitonnage, whereas more extended resections should be avoided. Ideally, benzimidazole treatment should be combined with surgery. New serological tests can improve diagnostic accuracy.     

重度烧伤并发重症肺炎患者的特殊病原学分析

目的 探讨分析重度烧伤合并气道损伤患者,发生重症肺炎时耶氏肺孢子虫感染的临床特点,总结诊断经验,减少误诊和漏诊.方法 回顾分析近2年因合并重症肺炎收入我院ICU的12例重度烧伤患者的诊治及转归情况,入住ICU的第1天和第7天分别送检BALF的细菌及真菌培养.结果 转入ICU的12例患者中有4例患者BALF涂片中耶氏肺孢子虫阳性,经BALF发现还合并有鲍曼不动杆菌的有3例,肺孢子菌4例,白色念珠菌4例,铜绿假单胞菌3例,病原学检出率高.结论 重度烧伤合并气道损伤患者在治疗过程中极易出现各种院内二重机会性感染,例如肺孢子虫肺炎;经BALF检查可以提高病原菌检出率,应注重对此类重症患者肺部感染病原学的早期筛查及治疗.     

肺动脉悬吊的诊断与治疗

目的:探讨肺动脉悬吊的临床特征、诊断与治疗。方法:回顾性分析2008年7月至2011年12月在首都医科大学附属北京安贞医院诊断为肺动脉悬吊患者的临床特征、影像学检查、诊断和治疗。结果:7例肺动脉悬吊患者,男性1例,女性6例,年龄1个月～21岁,<1岁4例,伴有咳喘、肺炎或呼吸困难病史,6例因心脏杂音就诊,经超声心动图、多排螺旋CT明确诊断,2例行纤维支气管镜检查。伴发中位心1例,心内畸形6例,气管、支气管狭窄6例。4例患者手术治疗,3例疗效满意,1例术后早期死亡。结论:儿童中反复出现原因不明的咳喘等呼吸道症状者,应重视肺动脉悬吊的可能,超声心动图联合多排CT可明确诊断,早期行左肺动脉移植术以解除气管狭窄是生存的关键。     

Inhalation injuries

Inhalation injuries occur in approximately one-third of all major burns and account for a significant number of deaths in those burn patients each year. Victims die as a result of carbon monoxide poisoning, hypoxia, and smoke inhalation. These deaths can occur without thermal wounds as well as with burn injuries. There are three distinct problems with inhalation injuries: thermal burns of the upper airway, carbon monoxide poisoning, and smoke inhalation. Each has different symptoms and signs, different treatment, and different prognosis. Thermal burns occurring in the upper airway are usually manifested within 48 hours of injury. Diagnosis is made by direct visualization of the upper airway, looking for signs of thermal injury. Admission for observation with humidified oxygen, attentive pulmonary toilet, bronchodilators as needed, and prophylactic endotracheal intubation as indicated are the mainstays of treatment. Resolution of the injury usually occurs within days. Carbon monoxide poisoning, the most common cause of death in inhalation injury, is a result of combustion. Symptoms and signs correlate with blood levels, but arterial blood gases are used to determine the degree of carbon monoxide intoxication. Treatment is based on the principle that carbon monoxide dissociation occurs much faster if the patient is placed on 100% oxygen. Occasionally the patient's symptoms may persist or get worse despite adequate treatment. Smoke inhalation significantly damages normal respiratory physiology, resulting in injury progressing from acute pulmonary insufficiency to pulmonary edema to bronchopneumonia, depending on the severity of exposure. Diagnosis is based on history, but clinical findings, arterial blood gases, and fiberoptic bronchoscopy are helpful. Treatment is supportive with careful attention paid to fluid resuscitation in the patient with burns.(ABSTRACT TRUNCATED AT 250 WORDS)     

硫酸卷曲霉素超声雾化吸入联合抗结核药物治疗复治菌阳肺结核的近期疗效观察

目的评价硫酸卷曲霉素(CPM)超声雾化吸入联合抗结核药物治疗复治菌阳肺结核的疗效。方法126例复治菌阳肺结核患者随机分为治疗组和对照组,2组均予以合理抗结核化疗方案,治疗组加用卷曲霉素超声雾化吸入治疗。结果经过3个月的治疗,治疗组的痰菌阴转率为82.5%,肺部病变吸收总有效率为93.7%,空洞闭合或缩小的总有效率为93.7%;对照组的痰菌阴转率为61.9%,肺部病变吸收总有效率为73.0%,空洞变化总有效率为80.9%;治疗组明显优于对照组,差异有统计学意义（P＜0.01）。结论并用卷曲霉素超声雾化吸入治疗复治菌阳肺结核疗效优于对照组,值得进一步研究。     

Clinical review 138: Anabolic-androgenic steroid therapy in the treatment of chronic diseases.

The purpose of this study was to review the preclinical and clinical literature relevant to the efficacy and safety of anabolic androgen steroid therapy for palliative treatment of severe weight loss associated with chronic diseases. Data sources were published literature identified from the Medline database from January 1966 to December 2000, bibliographic references, and textbooks. Reports from preclinical and clinical trials were selected. Study designs and results were extracted from trial reports. Statistical evaluation or meta-analysis of combined results was not attempted. Androgenic anabolic steroids (AAS) are widely prescribed for the treatment of male hypogonadism; however, they may play a significant role in the treatment of other conditions as well, such as cachexia associated with human immunodeficiency virus, cancer, burns, renal and hepatic failure, and anemia associated with leukemia or kidney failure. A review of the anabolic effects of androgens and their efficacy in the treatment of these conditions is provided. In addition, the numerous and sometimes serious side effects that have been known to occur with androgen use are reviewed. Although the threat of various side effects is present, AAS therapy appears to have a favorable anabolic effect on patients with chronic diseases and muscle catabolism. We recommend that AAS can be used for the treatment of patients with acquired immunodeficiency syndrome wasting and in severely catabolic patients with severe burns. Preliminary data in renal failure-associated wasting are also positive. Advantages and disadvantages should be weighed carefully when comparing AAS therapy to other weight-gaining measures. Although a conservative approach to the use of AAS in patients with chronic diseases is still recommended, the utility of AAS therapy in the attenuation of severe weight loss associated with disease states such as cancer, postoperative recovery, and wasting due to pulmonary and hepatic disease should be more thoroughly investigated.     

Surgical treatment of pulmonary atresia with intact ventricular septum.

Fifty-nine children with pulmonary atresia and intact ventricular septum underwent various forms of surgical treatment at the Hospital for Sick Children, Toronto, during 1950 to mid 1975. Twenty-three patients had pulmonary valvotomy, 15 direct, 2 indirect, and 6 both direct valvotomy and infundibulectomy. All died, 19 early and 4 late. Of 13 patients who received a systemic-pulmonary artery shunt, 4 combined with surgical atrial septectomy, there are only 2 long-term survivors both of whom were children who had had a Waterston anastomosis. Recently we have been treating infants with small right ventricles with balloon atrial septostomy at cardiac catherterization followed by a Potts anastomosis and pulmonary valvotomy. If the Potts anastomosis appears satisfactory the persistent ductus arteriosus is ligated. This scheme was used in 23 infants, with 4 early deaths and 2 late deaths. Of 17 survivors, further shunts were required in 4 children. One child has had a formal repair, with insertion of valves in both tricuspid and pulmonary areas. We believe that this operative combination of Potts anastomosis and pulmonary valvotomy offers the infant with pulmonary atresia and a small right ventricle a relatively low initial mortality and the possibility of right ventricular enlargement and subsequent repair.     

复合脉冲磁性治疗仪辅助治疗小儿支气管肺炎109例疗效观察

目的探讨复合脉冲磁性治疗仪在小儿支气管肺炎中的临床疗效。方法选择218例患儿随机分为观察组（复合脉冲磁性治疗仪加常规治疗）和对照组（常规治疗）各109例,进行治疗效果观察。结果观察组治愈率、退热时间、喘息消失时间、肺部哕音消失时间、平均住院天数等指标均明显优于对照组（P〈0．01）。结论复合脉冲磁性治疗仪辅助治疗支气管肺炎,疗效显著。     

小儿AIDS合并肺部感染的临床和影像学分析

目的 探讨小儿艾滋病(AIDS)合并肺部感染的临床特点和影像表现。方法 收集援博茨瓦纳医疗队临床确证的小儿常见肺部感染67例，对其临床资料和影像表现进行综合分析。结果 小儿AIDS合并肺部感染最常见的类型为淋巴细胞间质性肺炎(LIP，34例)、卡氏肺囊虫肺炎(PCP，15例)、重症肺炎(13例)和肺结核(PTB，5例)，临床表现以咳嗽、发热和气促最为多见。(1)LIP最为常见，病变以慢性间质性变化为主；(2)PCP发病急，进展快，典型影像表现为双肺门周围弥漫磨玻璃样浸润或网织结节状影；(3)重症肺炎常表现为双侧散在斑片状实变，一般经过2周积极治疗可明显吸收好转，但易复发；(4)反复发作的呼吸道感染难以治愈，应考虑小儿AIDS合并PTB的可能，胸片可表现为肺内实变、粟粒结节、空洞、气胸和肺门淋巴结肿大等。结论 小儿AIDS易反复合并肺部机会性感染，临床症状和影像学表现具有一定的特点。提高对小儿AIDS的认识是早期诊断、及时治疗和提高患儿生存率及生活质量的关键。     

哮喘儿童肺通气功能检测的临床分析

目的：通过监测哮喘儿童急性发作期与缓解期肺通气功能各指标变化情况,了解其在儿童哮喘病情评估及指导治疗中的作用。方法应用德国Jaeger Master Screen肺功能仪对43例5～12岁哮喘急性发作期和经治疗后进入缓解期的哮喘儿童进行肺通气功能检测,包括大气道指标（ FVC、FEVl、FEV1/FVC、PEF）及小气道指标（ FEF25、FEF50、FEF75、MMEF75/25）,同时收集哮喘患儿病史资料和治疗情况。结果哮喘急性发作期患儿肺功能指标FVC、FEV1、FEV1/FVC、PEF与缓解期及健康对照组儿童比较,差异有统计学意义（ P＜0.01）;哮喘缓解期患儿的FVC、FEV1、PEF与健康对照组比较,差异无统计学意义（ P＞0.05）。小气道功能指标FEF25、FEF50、FEF75、MMEF75/25在哮喘急性发作期患儿中均明显降低,与缓解期组及健康对照组儿童相比差异有统计学意义（ P＜0.01）;哮喘治疗缓解期组中FEF25、FEF50、FEF75、MMEF75/25仍低于健康对照组,差异有统计学意义（ P＜0.05）。哮喘急性发作期不同严重程度患儿的肺通气功能指标（ FVC％pred、FEV1％pred、PEF％pred、FEF25％pred、FEF50％pred、FEF75％pred、MMEF75/25％pred ）随哮喘严重程度增加各指标越低,差异有统计学意义（ P＜0.05）。结论哮喘急性发作期肺通气功能受损,治疗缓解后小气道肺功能指标仍低于正常。肺通气功能的小气道功能指标在儿童哮喘的病情评估及治疗监测指导中意义更大。