静注丙种球蛋白辅治21例婴幼儿重症肺炎临床分析

重症肺炎是儿科常见的危重症之一，严重威胁着患儿的生命，我科于1994年-1995年间应用静注丙种球蛋白（IVIG）辅治婴幼儿重症肺炎21例，结果提示IVIG在缩短病程、减轻症状促进肺部炎症吸收等方面明显优于对照组（P＜0．01）未见不良反应，提示IVIG有很高的抗感染效应，安全有效，现报告如下：资料与结果一般资料：本组共41例，分IVIG治疗组ZI例，对照组2o例，全部病例均按全国统一标准诊断，两组病情相似均属重症肺炎。IVIG治疗组男14例，女7例，年龄一6月19例（占治疗组9o％），－u月1例（占5％）；－2岁】例（占5％）；其中合并…     

传染性非典型肺炎临床及影像学研究

目的探讨传染性非典型肺炎的临床影像学特点及治疗方法.方法分析了我院2003年2月～4月SARS 37例的临床和影像学资料. 结果均有发热,62.2%为高热,可伴咳嗽(40.6%)、畏寒(32.5%) 、乏力(24.4%)、肌痛(13.6%)等;可存在白细胞下降(48.7%)、淋巴细胞减少(27.1%)、血小板减少(19.0%)、乳酸脱氢酶(LDH)增高(21.7%).肺部 X线改变主要为斑片状阴影,或间质性炎症改变,短时间内病灶可明显进展.治疗以抗病毒抗炎支持治疗为基础,合理应用皮质激素.死亡率为2.7%.结论传染性非典型肺炎具有发热、白细胞下降、酶学改变、X线肺部炎症改变等临床特征.目前隔离、抗病毒、皮质激素是有效的治疗措施.     

传染性非典型肺炎临床及影像学研究

目的　探讨传染性非典型肺炎的临床影像学特点及治疗方法 .方法　分析了我院 2 0 0 3年 2月～ 4月SARS 37例的临床和影像学资料 .结果　均有发热 ,6 2 .2 %为高热 ,可伴咳嗽 ( 4 0 .6 % )、畏寒 ( 32 .5 % )、乏力 ( 2 4 .4 % )、肌痛 ( 13.6 % )等 ;可存在白细胞下降 ( 4 8.7% )、淋巴细胞减少 ( 2 7 1% )、血小板减少 ( 19 0 % )、乳酸脱氢酶 (LDH)增高( 2 1.7% ) .肺部X线改变主要为斑片状阴影 ,或间质性炎症改变 ,短时间内病灶可明显进展 .治疗以抗病毒抗炎支持治疗为基础 ,合理应用皮质激素 .死亡率为 2 .7% .结论　传染性非典型肺炎具有发热、白细胞下降、酶学改变、X线肺部炎症改变等临床特征 .目前隔离、抗病毒、皮质激素是有效的治疗措施     

布地奈德吸入治疗小儿急性感染性喉炎的疗效观察

目的探讨不同治疗方法在小儿急性感染性中的疗效.方法将临床确诊的急性感染性喉炎患儿70例, 随机分为布地奈德吸入组(观察组)35例;静脉皮质激素组(对照组)35例.结果观察组患儿的呼吸困难、喉喘鸣、声嘶、犬吠样咳可迅速缓解,明显优于对照组.观察组住院时间缩短(p<0.05)和治愈率提高(p<0.05).结论在常规抗感染治疗基础上予布地奈德吸入治疗是快速缓解急性喉炎患儿喉梗阻的有效、安全的方法,并可避免静脉使用皮质激素的副作用,明显缩短住院时间和提高临床治愈率,减少了气管切开的机率.     

布地奈德吸入治疗小儿急性感染性喉炎的疗效观察

目的探讨不同治疗方法在小儿急性感染性中的疗效.方法将临床确诊的急性感染性喉炎患儿70例,随机分为布地奈德吸入组(观察组)35例;静脉皮质激素组(对照组)35例.结果观察组患儿的呼吸困难、喉喘鸣、声嘶、犬吠样咳可迅速缓解,明显优于对照组.观察组住院时间缩短(p<0.05)和治愈率提高(p<0.05).结论在常规抗感染治疗基础上予布地奈德吸入治疗是快速缓解急性喉炎患儿喉梗阻的有效、安全的方法,并可避免静脉使用皮质激素的副作用,明显缩短住院时间和提高临床治愈率,减少了气管切开的机率.     

补中生血汤治疗缺铁性贫血96例分析

目的：观察补中生血汤治疗缺铁性贫血的疗效。方法：治疗组96例口服补中生血汤毒1月为1疗程，2个疗程后统计结果。对照组82例口服硫酸亚铁片疗程同治疗组。结果：治疗组治愈60人占62．50％，有显效19人占19．79％，有效12人占12．50％，无效5人占5．20％；对照组治愈31人占37．80％，有显效16人占19．51％，有效18人占18．22％，无效17人占20．73％；经Ridit检验，P〈0．05。结论：补中生血汤治疗缺铁性贫血具有起效快，服药后3～7天开始见效，症状改善明显，副作用少等特点。     

纤支镜对术后肺部感染的治疗价值

目的：探讨纤支镜对胸腹术后肺部感染的治疗价值。方法：分析了52例经积极常规治疗无效、肺部感染加重的术后病人使用纤支镜的治疗效果。结果：显效42例，有效4例，无效6例，总有效率88．4％，同时吸取的分泌物培养显著显示可获是较高的病菌分离率（69．2％，无1例发生严重并发症，结论：胸腹术后肺部感染病人使用纤维支镜治疗有助于确定致病菌、较长方氏清除大气道分泌物、改善肺通气，局部给药提高病灶内药物浓度，增强抗菌效果。     

142例小儿肺炎支原体感染临床分析

目的探讨小儿肺炎支原体感染病例临床特点。方法回顾性总结142例肺炎支原体感染住院患儿的临床资料并进行统计学处理。结果婴幼儿50例，肺部出现哕音者28例，占56％，3岁以上患儿92例，肺部出现哕音者14例，占14．2％，二者之间有显著性差异（P〈0．01）；合并肺外并发症者婴幼儿14例，占28％，3岁以上患儿43例，占46．3％，二者之间差异有统计学意义（P〈0．05）。结论肺炎支原体感染患儿中婴幼儿病例以肺部表现明显且较重，而3岁以上患儿肺部体征不明显，更易发生肺外并发症，所有病例应用阿奇霉素治疗效果好，疗程短，依从性好。     

脑CT及脑电地形图在急性进展性脑梗死中的应用研究

目的：观察脑CT及脑电地形图（BEAM）在急性进展性脑梗死（APCI）变化特点，为临床早期诊断和治疗提供客观依据。方法：对103例发病2．5～24小时、急性脑梗死患者进行前瞻性研究，其中APCI患者32例，分析脑CT和BEAM早期变化特点，并与71例非进展性脑梗死进行对比。结果：脑CT：103例患者，70例脑CT出现异常（68．0％）。进展组32例患者，27例（84．4％）出现脑梗死早期表现，明显高于非进展组（43例，60．6％），病情进展至高峰时，脑CT显示，16例（50％）出现梗死体积增大，5例（15．6％）有出血性梗死，3例（9．4％）有新部位的梗死，8例（25％）梗死体积无明显变化。BEAM检查：两组患者异常率为91．4％。进展组患者病变区8频带平均功率值高于非进展组，并且异常部位波及范围较大。结论：脑CT和BEAM可作为早期诊断APCI的预测指标。导致病情进展的直接原因可能与梗死体积增大、出血性脑梗死和再梗死有关。     

梧州地区原发闭经52例临床分析

目的通过观察原发闭经患者临床特点、诊治目的，探讨其诊断与治疗方法。方法对52例原发闭经患者的临床表现、染色体核型、性激素测定及治疗结果进行回顾性分析。结果52例原发闭经患者中，先天性无阴道28例，占53．85％；性发育异常22例，占42．31％；低促性腺性闭经2例，占3．85％。其中染色体核型为46，XX32例，45，XO及嵌合体18例；45，X0／46，XY及46，XY各1例。性激素测定正常28例，异常24例。手术治疗17例；性激素替代治疗18例，皮质激素治疗2例。结论对原发闭经患者应尽早行性激素测定及染色体检查，了解遗传学基础。生殖器发育异常者予手术纠正，性激素异常者，予激素替代治疗。     

Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA)

Obstructive sleep apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality of life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from the Apnea Positive Pressure Long‐term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) versus sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. Overall we found no significant improvement in quality of life among sleep apnea patients after CPAP treatment. However, after stratifying by OSA severity, it was found that long‐term improvement in quality of life might occur with the use of CPAP in people with severe and possibly moderate sleep apnea, and no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea.     

Effects of 2-week nocturnal oxygen supplementation and continuous positive airway pressure treatment on psychological symptoms in patients with obstructive sleep apnea: a randomized placebo-controlled study

Psychological symptom improvement has been observed after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation, the mechanism of psychological symptom improvement is unclear. Using a 3-arm placebo-controlled design, we parsed out the separate effects of treatment on psychological symptoms. OSA patients (N = 38) were monitored 2 nights with polysomnography and then randomized to 2-weeks therapeutic CPAP, placebo CPAP, or O(2) supplementation. Pre and post-treatment, patients completed the Brief Symptom Inventory (BSI): Higher scores indicate greater severity. Repeated measures analysis of covariance reveals a Time x Treatment interaction for BSI Global Severity Index (GSI): significant pre- to post-treatment reductions in GSI with O(2) supplementation and therapeutic CPAP, but not placebo CPAP. A Time x Treatment interaction was also found for depression: Depression decreased with O(2) supplementation but not with therapeutic CPAP or placebo CPAP. Both therapeutic CPAP and O(2) supplementation resulted in decreased psychological symptoms. Results suggest hypoxemia may play a stronger role than sleep disruption vis-à-vis OSA related psychological distress.     

Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders

Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBD) including obstructive sleep apnea (OSA). Currently, PAP devices come in three forms: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) automatic self-adjusting positive airway pressure (APAP). After a patient is diagnosed with OSA, the current standard of practice involves performing full, attended polysomnography during which positive pressure is adjusted to determine optimal pressure for maintaining airway patency. This titration is used to find a fixed single pressure for subsequent nightly usage. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guideline for using CPAP and BPAP appropriately (an earlier review and practice parameters for APAP was published in 2002). Major conclusions and current recommendations are as follows: 1) A diagnosis of OSA must be established by an acceptable method. 2) CPAP is effective for treating OSA. 3) Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate. 4) CPAP usage should be monitored objectively to help assure utilization. 5) Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation if needed. 6) Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems. 7) Heated humidification and a systematic educational program are recommended to improve CPAP utilization. 8) Some functional outcomes such as subjective sleepiness improve with positive pressure treatment in patients with OSA. 9) CPAP and BPAP therapy are safe; side effects and adverse events are mainly minor and reversible. 10) BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.     

Constant mean airway pressure with different patterns of positive pressure breathing during the adult respiratory distress syndrome

Twenty-one ARDS patients were divided into two groups of severity according to FIO2 and PEEP required to maintain an adequate gas exchange. The 10 most severe patients (group A) underwent continuous positive pressure ventilation (CPPV) (I/E 3:1) with the mean airway pressure maintained at 21 +/- 6.2 cmH2O. The PEEP values were 12.6 +/- 4.3 cmH2O during CPPV and 6.5 +/- 3.7 cmH2O during IRV (p less than 0.01). Eleven less severe ARDS patients (group B) underwent CPPV and positive pressure spontaneous breathing (CPAP) at constant mean airway pressure of 14.3 +/- 3.8 cmH2O. The PEEP was 7 +/- 2.5 cmH2O during CPPV and 14.9 +/- 4.3 cmH2O during CPAP (p less than 0.001). In five patients of each group, the SF6 shunt was measured as representative of true shunt. The results showed that gas exchange, including true shunt, and haemodynamics did not change between CPPV and IRV and between CPPV and CPAP tests. Taken with previous work on mean airway pressure, our results further support the concept that the main determinant of oxygenation and haemodynamics is the mean airway pressure, irrespective of the PEEP level and of the mode of ventilation.     

Nasal CPAP in obstructive sleep apnea: mechanisms of action

Sixteen patients with the obstructive sleep apnea syndrome (OSAS) were studied for 1-2 h while receiving continuous positive airway pressure (CPAP) delivered via a nasal mask. Obstructive apneas were obliterated in all. Eight patients had studies of genioglossal muscle activity (GG EMG) and one patient had computed tomograms (CT) of the upper airway while on nasal CPAP. The GG EMG studies showed two patterns: suppression and augmentation of GG EMG while on CPAP. The CT scan showed the airway to be narrowed while the patient was awake off CPAP. It returned to a normal caliber when CPAP was applied, despite sleep. These results are interpreted to suggest three potential mechanisms of action for nasal CPAP in OSAS: 1) reduced upper airway resistance due to prevention of sleep-induced collapse of the airway; 2) reduced upper airway resistance due to dilatation of the airway by nasal CPAP beyond its dimension in the awake state; and 3) possible stimulation of mechanoreceptors leading to an increase in airway tone while CPAP is applied.     

Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis

STUDY OBJECTIVE: To compare the effectiveness of auto-titrating continuous positive airway pressure (APAP) versus conventional continuous positive airway pressure (CPAP) in reducing the apnea-hypopnea index (AHI), reducing the mean airway pressure, improving subjective sleepiness, and improving treatment adherence in patients with obstructive sleep apnea (OSA). DESIGN: Meta-analysis and metaregression of published randomized trials comparing APAP to CPAP. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. RESULTS: We identified 9 randomized trials studying a total of 282 patients. Compared to CPAP, there was no significant advantage of APAP in reducing AHI or sleepiness (pooled APAP-CPAP posttreatment AHI and Epworth Sleepiness Scale score = -0.20 events per hour, 95% confidence interval:[-0.74,0.35], and -0.56 [-1.4,0.3] respectively). The use of APAP reduced the mean applied pressure across the night by 2.2 cm water [1.9,2.5] compared to CPAP. Adherence with therapy was not substantially improved with APAP; pooled estimate of improvement was 0.20 hours per night ([-0.16,0.57], P = .28) using a random-effects model. CONCLUSIONS: Compared to standard CPAP, APAP is associated with a reduction in mean pressure. However, APAP and standard CPAP were similar in adherence and their ability to eliminate respiratory events and to improve subjective sleepiness. Given that APAP is more costly than standard CPAP, APAP should not be considered first-line chronic therapy in all patients with OSA. However, APAP may be useful in other situations (eg, home titrations, detection of mouth leak) or in certain subgroups of patients with OSA. Identifying circumstances in which APAP is a definite improvement over CPAP in terms of costs or effects should be the focus of future studies.     

The effect of one versus two nights of in-laboratory continuous positive airway pressure titration on continuous positive airway pressure compliance

Objective: To investigate continuous positive airway pressure (CPAP) compliance after one versus two nights of CPAP titration. Method: A chart review and a telephone questionnaire interview were conducted in 110 sleep apnea patients who received one or two nights of CPAP titration. Of these patients, 78 followed through with phone interview. Results: There was no difference in CPAP compliance between those who had one or two nights of CPAP titration. The titration pressures on the first and second nights were not significantly different. But there was significant improvement in sleep efficiency from the first to the second diagnostic night. Conclusion: One versus two nights of CPAP titration did not affect CPAP compliance, but sleep efficiency improved on the second diagnostic night and an extra titration study may be necessary for some patients, especially those with only one diagnostic night.     

Sleep during titration predicts continuous positive airway pressure compliance

STUDY OBJECTIVES: Poor compliance with continuous positive airway pressure (CPAP) has been identified as a significant obstacle in the treatment of obstructive sleep apnea. While previous studies have focused on diagnostic screening variables, side effects, health beliefs, and measures of disease severity, investigators have generally ignored sleep parameters assessed during CPAP titration as predictors of compliance. As the titration night represents patients' initial exposure to nocturnal CPAP treatment, we hypothesized that nocturnal polysomnographic (PSG) variables, representing improved sleep at this time, would predict higher subsequent compliance. DESIGN: Prospective analyses of a sequential case series were undertaken using nocturnal PSG variables during titration as early predictors of CPAP compliance. SETTING: Accredited sleep center. PATIENTS: Seventy-one patients with sleep apnea, aged 31-78 years, with a mean respiratory disturbance index of 62.0 +/- 32.2. Interventions: N/A MEASUREMENTS AND RESULTS: Compliance was calculated as mean hours per night of CPAP use over the initial follow-up period (mean 46.9 days). Standard PSG variables and subjective reports of sleep were used as predictive variables in multivariate analyses. Mean objective compliance was 5.04 hours per night +/- 2.59. Consistent with our hypothesis, the best predictor of compliance was change in sleep efficiency (SE) from diagnostic to titration night [F (1,66) = 17.31, p < .000 (r = .48)], indicating that patients whose sleep improved most on the titration night had the highest levels of compliance. This relationship was also significant after controlling for measures of disease severity obtained during the diagnostic testing night. Importantly, individuals whose sleep improved on the CPAP titration night had nightly compliance rates of approximately 2 hours greater than patients whose sleep did not improve during titration. CONCLUSIONS: The findings suggest that patients' initial experience with CPAP treatment and, in particular, the degree of improvement in sleep during CPAP titration may be crucial factors in determining their subsequent use of this treatment modality.     

Obstruktive Schlafapnoe bei Herzinsuffizienz

Obstructive sleep apnea (OSA) is a common comorbidity in heart failure (HF) patients and likely contributes to HF severity, symptoms, and prognosis. The main objective is to maintain upper airway patency and prevent OSA-related consequences to the heart, such as increases in cardiac pre- and afterload as well as hypoxia. Continuous positive airway pressure (CPAP) best accomplishes this and causes improvements in cardiovascular function. CPAP treatment of OSA should be considered in HF patients. Whether CPAP improves symptoms or quality of life and also fully suppresses central respiratory events has to be evaluated in the individual patient. Moreover, CPAP’s effects on morbidity and mortality have not been tested in controlled trials, and it is, therefore, not clear whether short-term improvements in cardiovascular function induced by treatment with positive airway pressure support translate into reduced morbidity or mortality. This question is targeted in ongoing long-term randomized trials.     

Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial

STUDY OBJECTIVES: To compare compliance and treatment response between continuous positive airway pressure (CPAP) and auto-titrating positive airway pressure (APAP) and to develop selection criteria for the use of APAP. DESIGN: Randomized, single-blinded, parallel crossover study. SETTING: Tertiary referral sleep disorders center. PATIENTS: Consecutive patients with obstructive sleep apnea syndrome requiring treatment with CPAP. INTERVENTIONS: 2-month treatment each of conventional CPAP and APAP in random order comparing objective compliance, Epworth Sleepiness Score, SF-36 Health Survey, visual-analog measures of ease of and attitude to treatment, side effects, and treatment pressures or system leaks obtained from the Autoset T device. MEASUREMENTS AND RESULTS: There were no differences between treatment modes in overall compliance (CPAP 4.86 +/- 2.65, APAP 5.05 +/- 2.38 hours per night, P = .14), Epworth Sleepiness Scale scores (baseline 12.4 +/- 5.1, CPAP 8.4 +/- 5.2, APAP 7.9 +/- 4.8, P < .001 relative to baseline, NS between modes), SF-36 scores (significant improvements in Role Physical and Vitality domains relative to baseline, P < .001 but NS between modes). There were fewer reported side effects in APAP mode (CPAP 28, APAP 15 reports, P = .02) and compliance was greater with APAP in those reporting any side effect (95% confidence interval CPAP 0-6.8, APAP 2.9-7.8 hours per night, P < .001). APAP delivered significantly lower median and 95th centile airway pressures and fewer system leaks. CONCLUSIONS: Compliance, subjective sleepiness, and quality of life are similar between patients who used CPAP and APAP. APAP delivers lower pressures and results in lower-pressure leaks and fewer reported side effects. Compliance is higher with APAP in subjects reporting any side effect. APAP may be indicated in patients reporting side effects with conventional CPAP.