救治重型颅脑损伤早期纤维支气管镜吸痰加肺泡灌洗的临床意义

目的 探讨早期纤维支气管镜吸痰加肺泡灌洗对纠正重型颅脑损伤患者缺氧及防治肺部感染的临床意义.方法 分析比较重型颅脑损伤患者早期纤维支气管镜吸痰加肺泡灌洗50例和常规吸痰50例动脉血氧纠正情况,肺部感染发生率,肺部感染控制时间.结果 早期纤维支气管镜吸痰加肺泡灌洗能明显迅速改善缺氧,纤维支气管镜吸痰组肺部感染发生率及肺部感染治愈时间显著低于非纤维支气管镜吸痰组(P<0.01).结论 对重型颅脑损伤患者可先考虑早期纤维支气管镜吸痰加肺泡灌洗取代常规吸痰以通畅呼吸道,尤其是合并明显缺氧、肺部感染患者.     

经纤维支气管镜支气管肺泡灌洗治疗重症肺部感染临床分析

目的:观察经纤维支气管镜支气管肺泡灌洗治疗重症肺部感染的临床疗效。方法:将94例重症肺部感染患者随机分为观察组和对照组,每组47例,两组均全身应用抗生素及祛痰药,观察组在其基础上采用经纤维支气管镜吸痰及支气管肺泡灌洗术治疗,对照组用普通吸痰机常规吸痰。结果:观察组治疗前后各主要指标差异均有显著差异(P均<0.05),对照组除呼吸频率及动脉血氧分压外,其他指标治疗前后结果无显著差异(P>0.05)。两组治疗有效率对比结果有显著差异(P<0.05)。结论:经纤维支气管镜支气管肺泡灌洗能改善呼吸道症状和通气功能,提高肺部感染治愈率,是治疗重症肺部感染的有效手段。     

纤维支气管镜吸痰及支气管肺泡灌洗在高原地区呼吸衰竭患者中的应用及护理

目的研究纤维支气管镜吸痰及支气管肺泡灌洗在高原地区呼吸衰竭患者中的应用及护理。方法本次取材时间段为2016年1月至2018年1月,总计选取呼吸衰竭患者46例,使用纤维支气管镜吸痰以及支气管肺泡灌洗治疗其中23例患者,将其划分为观察组,剩余的23例患者则接受常规吸痰治疗,将其划分为对照组。结果观察组中患者的缺氧改善情况明显优于对照组,整个治疗过程中出现肺部感染的患者数量以及患者恢复健康所需时间也明显少于对照组。结论高原地区呼吸衰竭患者的治疗中联合使用纤维支气管镜吸痰以及支气管肺泡灌洗治疗作用效果显著,患者的缺氧状况得到有效改善,整个治疗过程中出现肺部感染的患者数量也得到有效控制,应用价值显著。     

探讨纤维支气管镜肺泡灌洗吸痰术治疗ICU患者重症肺部感染的安全性及临床疗效

目的观察探讨纤维支气管镜肺泡灌洗吸痰术治疗ICU患者重症肺部感染的安全性以及临床效果。方法将我院收治的280例重症肺部感染患者选取为此次研究对象,按照随机分配原则将其分成对照组与观察组,对照组患者应用常规治疗,观察组患者在此基础上应用纤维支气管镜肺泡灌洗吸痰术治疗,对比两种治疗方法的治疗效果以及安全性。结果观察组患者的症状消失时间、住院时间以及通气时间均明显低于对照组患者,且观察组患者未见不良反应以及严重创伤,组间数据比较差异有统计学意义(P0.05)。结论 ICU患者重症肺部感染可在常规治疗的基础上应用纤维支气管镜肺泡灌洗吸痰术,大大缩短了患者的症状维持时间,治疗方法安全有效。     

机械通气下纤维支气管镜介入诊治重症肺部感染的临床观察

目的 探讨纤维支气管镜(纤支镜)防污染毛刷(PSB)取痰液标本培养在机械通气重症肺部感染患者病原学诊断中的价值,探讨机械通气联合纤支镜吸痰及支气管肺泡灌洗术治疗重症肺部感染的安全性及临床效果.方法 选取74例重症肺部感染应用有创机械通气患者,将其分为治疗组和对照组.对照组机械通气37例使用无菌吸痰管吸取下呼吸道分泌物,...     

纤维支气管镜支气管肺泡灌洗治疗重症肺部感染疗效观察

目的:探究重症肺部感染使用纤维支气管镜支气管肺泡灌洗治疗的疗效。方法:选取80例重症肺部感染患者为研究对象,其中40例重症肺部感染患者实施常规治疗,作为对照组,另40例患者在对照组基础上使用纤维支气管镜支气管肺泡灌洗治疗,作为观察组,比较两组效果。结果:比较两组患者的治疗有效率,观察组明显高于对照组;比较两组患者的恢复时间,观察组患者明显短于对照组,差异有统计学意义(P<0.05)。结论:纤维支气管镜支气管肺泡灌洗治疗重症肺部感染能够提高患者治疗效果,帮助患者症状及时缓解,促进其恢复,值得临床推广。     

床边纤维支气管镜灌注吸痰在胸部外伤中的应用

目的探讨床边纤维支气管镜吸痰和灌洗对胸部外伤患者的恢复和肺部感染的预防作用。方法各种胸部外伤术后患者49例,外科处理后出现肺不张,对其中27例患者给予床边纤支镜吸痰和支气管肺泡灌洗治疗,观察患者肺不张的改善、肺部感染发生的情况,以及床边纤支镜治疗前后血气分析指标变化。结果行床边纤支镜治疗患者肺部感染发生率显著低于常规治疗组(P<0.05);治疗后患者缺氧状况迅速改善(P<0.05),肺不张在短期内解除。结论床边纤支镜吸痰及支气管肺泡灌洗治疗是胸部外伤患者症状改善和预防肺部并发症行之有效方法。     

纤维支气管镜肺泡灌洗治疗重症肺部感染临床观察

目的:观察纤维支气管肺泡灌洗术在重症肺部感染中的治疗效果.方法:总结近3年来收治的重症肺炎患者72例,分为支气管肺泡灌洗组及常规治疗临床症状,痰培养阳性率住院天数对比进行临床疗效评估.结果:支气管肺泡灌洗组有效率96.5%,常规治疗组有效率80.2%(P＜0.05),痰培养阳性率,支气管肺泡灌洗组71.43%,常规治疗组47.51%(P＜0.05).住院平均天数支气管肺泡灌洗组14.2天,常规治疗组23.8天.结论:经纤维支气管镜肺泡灌洗对重症肺部感染性疾病疗效优于常规治疗组.     

术中纤维支气管镜肺泡灌洗对预防微创食管癌术后肺部并发症的临床研究

【摘要】 目的 探讨术中纤维支气管镜肺泡灌洗（BAL）对微创食管癌术后肺部并发症的预防效果。方法 纳入2020年1月至2021年7月自贡市第四人民医院胸心外科连续收治的69例微创食管癌手术的临床资料,根据术中吸痰方式分为纤维支气管镜肺泡灌洗组（试验组32例）和常规吸痰组（对照组37例）。分析两组病人术后肺部并发症的情况,以及抗生素使用时间,术后住院时间等预后指标。结果 纤维支气管镜肺泡灌洗组在术后肺部感染发生率、肺不张发生率、抗生素使用强度、术后住院时间上低于常规吸痰组,且差异有统计学意义。结论 微创食管癌手术中使用支气管镜肺泡灌洗对预防肺部感染,肺不张的发生有一定作用。     

纤维支气管镜吸痰联合肺泡灌洗治疗重症肺部感染50例

目的:研究纤维支气管镜吸痰联合肺泡灌洗治疗重症肺部感染的效果。方法:选取自2013年12月至2015年11月间在我院治疗的50例重症肺部感染患者为研究对象,将患者分组并采用不同的方式进行吸痰处理,并对患者治疗前后的评价指标值进行统计对比。结果:采用纤维支气管镜吸痰联合肺泡灌洗治疗的观察组的动脉血气指标值(SpO2、PaO2、PaCO2、pH)明显优于采用常规方法治疗的对照组,比差异值P0.05,有统计学意义。结论:对重症肺部感染的治疗采用纤维支气管镜吸痰联合肺泡灌洗可获得较好的治疗效果,值得临床推广应用。     

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China

Background Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai,China.Methods A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments,and clinical outcomes were collected for analysis.Results Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3-14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation.Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis,pyopneumothorax and stroke.Conclusions Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.     

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China

Background  Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai, China.

Methods  A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.

Results  Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3–14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation. Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis, pyopneumothorax and stroke.

Conclusions  Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.

     

支气管肺泡灌洗治疗重症肺部感染37例临床观察

目的探讨经纤维支气管镜行支气管肺泡灌洗在重症肺部感染治疗中的临床价值。方法将74例患者随机分为灌洗组和非灌洗组,每组37例。灌洗组在常规治疗基础上加支气管肺泡灌洗,非灌洗组采用常规治疗,观察两组病例的治疗效果。结果灌洗组患者经纤维支气管镜肺泡灌洗治疗后临床症状有明显改善,总有效率为94.59％,非灌洗组为62.16％;灌洗前后血气分析指标有统计学意义。结论支气管肺泡灌洗治疗重症肺部感染疗效可靠,提高治愈率,有较高的临床应用价值。     

重症高血压脑出血术后气管切开手术时机及预后探讨

目的:探讨重症高血压脑出血术后患者气管切开手术时机对预后的影响。方法:对重症高血压脑出血术后患者行气管切开术47例,按切开时机分为早切组25例(≤24 h)和非早切组22例(>24 h)。比较2组患者1周后的格拉斯哥昏迷评分、肺部感染、低氧血症发生率及病死率。结果:早切组1周后的格拉斯哥昏迷评分高于非早切组(P<0.05),而肺部感染、低氧血症发生率及病死率均低于非早切组(P<0.05~P<0.01)。结论:重症高血压脑出血术后患者早期行气管切开能明显改善患者预后,降低患者病死率和肺部感染的发生率。     

Comparison of sputum induction with broncho-alveolar lavage in the diagnosis of smear-negative pulmonary tuberculosis

Sputum microscopy and AFB-culture being gold standard and a fundamental tool for diagnosis of pulmonary tuberculosis (PTB) has got its limitation of low sensitivity. Fibreoptic bronchoscopy (FOB) has been widely recommended as the diagnostic procedure of choice in smear negative patients. But bronchoscopy is an invasive procedure, costly, not readily available in our country and needs expertise. Several studies abroad have directly compared the yield of sputum induction (SI) with 3% saline (NaCl solution) with Bronchoalveolar lavage (BAL) through FOB in smear-negative suspected PTB patients and showed that SI was a low cost, safe and well tolerated procedure with equal efficacy to BAL through FOB for the diagnosis of PTB in such patients. For the first time a prospective comparison was conducted in Bangladesh to see the yield of sputum induction (SI) and BAL in 52 selected smear- negative patients of suspected PTB. Each of the samples of induced sputum and BAL fluid were examined for AFB by Ziehl-Neelsen's method. Samples of both SI and BAL from 20 patients were cultured for AFB in Lowenstein-Jensen medium for 6 weeks irrespective of their induced sputum smear being positive or negative for AFB. Data were managed and analyzed using computer program SPSS version 10.0. Agreement of SI and BAL was tested using Pearson Chi-square and Kappa test. The results showed that the yield of SI were significantly more than that of BAL (p<0.05).The AFB smear results from specimens obtained by SI and BAL were in agreement in 75% cases (p=0.02).Statistical analysis of the yield of culture results from SI and BAL group with Fishers Exact test showed they were in agreement in 90% cases (p=0.0001) and was measured by Kappa test as significant (p=0.0004). The sensitivity of AFB-smears in samples from SI and BAL were 74% and 58% respectively. The specificity of smear positivity and of culture was assumed to be 100%. SI is a safe procedure with considerable diagnostic yield and a high agreement with the results of BAL through FOB for the diagnosis of PTB. SI offers an alternative or additional approach to the diagnosis of smear-negative suspected PTB patients and would enhance sensitivity for the diagnosis of tuberculosis.     

Diabetes insipidus following cardiorespiratory arrest

Diabetes insipidus following cardiac arrest and hypoxemic encephalopathy occurred in two patients. In both, severe hypoxemic brain damage was followed within three days by clinical and laboratory features of diabetes insipidus, which were corrected by administration of exogenous vasopressin. Hypothalamic injury resulting in diabetes insipidus should be considered in the differential diagnosis of polyuria and dehydration occurring in critically ill patients who have suffered cardiorespiratory arrest.     

ICU危重患者镇静治疗中的护理

目的探讨重症监护病房（ICU）患者镇静治疗的病情观察和护理措施。方法对湘南学院附属医院ICU收治128例ICU患者进行镇静治疗。结果102例均取得良好的治疗效果，25例发生肺部感染，经治疗好转，1例死亡。结论对ICU患者镇静水平检测，妥善处理复发性躁动不安，避免由于镇静时患者的各种反应减弱而发生各种并发症是护理关键。     

不同分型手足口病内皮素-1水平和临床资料分析

目的研究内皮素-1（ET-1）在手足口病病情变化中的作用及常规临床检验在不同分型手足口病的意义。方法选取2010年4月至2010年11月住院的手足口病患儿40例,分为普通组,重症组和危重症组。记录患儿的临床资料,并通过酶联免疫定量检测血清ET-1水平。结果重症组和危重症组均较普通组血白细胞计数明显升高;危重症组较普通组血血糖水平明显升高;与重症组相比较,危重症组年龄偏小,血糖水平偏高。普通组、重症组和危重症组ET-1水平无统计学差异,但均高于正常水平。结论血白细胞和血糖是手足口病的病情的早期判断的重要辅助指标,年龄亦为危重症的危险因素之一,内皮素-1水平在手足口病患儿中会有所升高。     

利奈唑胺和万古霉素对重症医学科患者耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染相关指标的影响

目的奈唑胺和万古霉素治疗重症医学科患者耐甲氧西林金黄色葡萄球菌肺部感染的效果分析。方法选取2017年2月至2019年2月本院收治的100例耐甲氧西林金黄色葡萄球菌肺部感染的重症医学科患者,随机分为对照组与研究组,每组50例。对照组实施万古霉素治疗,研究组予以利奈唑胺治疗。观察比较两组细菌清除有效率、治愈率、不良反应(消化道反应、血小板减少)发生率。结果两组治愈率、不良反应(消化道反应、血小板减少)发生率比较差异无统计学意义;研究组细菌清除有效率为70.00%,高于对照组的56.00%,差异具有统计学意义(P<0.05)。结论利奈唑胺和万古霉素治疗耐甲氧西林金黄色葡萄球菌肺部感染的重症医学科患者效果显著,且安全性均较高,利奈唑胺具有更高的细菌清除效果。     

床旁纤维支气管镜检查在重症免疫抑制相关性肺病中的应用

目的探讨纤维支气管镜检查在重症免疫抑制相关性肺病中的应用价值。方法80例免疫抑制相关性肺病患者中有25例(31·2%)重症患者进行了经纤维支气管镜支气管肺灌洗,对其中10例(40%)进行透壁肺活检。分别对肺灌洗液和肺组织进行病原学和病理学检查。结果25例重症免疫抑制相关性肺病中,18例(72%)培养出病原微生物,7例(28%)培养阴性。其中细菌12例(66·7%),真菌6例(33·3%),细菌与真菌混合感染者3例。10例肺活检患者中有5例患者得到明确的病理诊断,5例为非特异性病理学改变。检查过程中25例患者中有6例(14%)血氧饱和度显著下降,4例(16%)术后少量咯血,2例(8%)在随后机械通气过程中发生气胸。结论对重症免疫抑制相关性肺病患者早期进行气管镜检查能提高病原微生物的检出率,及时指导调整治疗方案,进行针对性治疗。恰当的运用经气管镜肺活检,能进一步明确肺部并发症的性质,提高诊断正确率。对重症免疫抑制相关性肺病患者进行纤维支气管镜检查是安全可行的。