中医药辨证施治对传染性非典型肺炎患者整体功能康复的调解

目的：探讨辨证施治的中医药疗法对传染性非典型肺炎患整体功能的改善作用，寻求合理有效的中医药干预措施。方法：对中医药在治疗传染性非典型肺炎领域的应用进行探讨。同一症候可能存在多种辨证描述；而同一治则也可能存在多种表达方式。针对中医药的“理、法、方、药”进行总结。结果：辨证施治的中医药疗法对传染性非典型肺炎具有良好的干预效果。根据传染性非典型肺炎不同阶段的临床特点，按其自然过程，总结出不同的辨证方法。辨证施治的原则基本上都是根据不同的病情而定的，病理特点相同，自然治疗法则也大致相同。理性抽提的原则是在原有治则基础上，进行综合分析，根据病理特点进行取舍，最后达到既符合病理要求，又“不离原则，不泥原则”的目的。方剂和药物都是根据病情某期所用处方及药品的频次来取台，抽提原则是选择出现频率高的药物组成推荐方剂。结论：中医药疗法能根据传染性非典型肺炎不同证候进行施治，有效改善传染性非典型肺炎患的整体功能，特别是对康复期患的整体功能调整和恢复作用尤为显。     

非典型肺炎病区内胸部摄片体会

非典型肺炎(atypicalpneumonia)，又称严重急性呼吸综合症(severeacuterespiralorysyndrome，SARS)。2003年春节前后广东省部分地区流行的非典型肺炎是传染性很强的疾病，由于初期对该病的传染性认识不足，短期内出现了大批的感染者，包括众多的医务人员。我院自该病发病高峰期便设立了医治非典型肺炎的特别病区，共收治患者80例，除3例外院转入病情较重出现并发症抢救无效死亡外，其余患者均治愈出院。由于我院在各方面都做好了充足的预防隔离措施，全体医务人员无一人感染发病，现将该病区内非典型肺炎病人的胸部摄片体会总结如下：     

78例SARS患者外周血白细胞升高与抗菌治疗的临床研究

目的研究传染性非典型肺炎患者在病情发展过程中白细胞升高的特点、影响因素及其治疗方案.方法以78例传染性非典型肺炎患者为研究对象,采用相对一致的治疗方案,定期化验外周血WBC、CD4+淋巴细胞、血培养、痰培养等,对其特点、病情和治疗做统计学分析.结果61.5%病人在病程的第15.67±5.39天出现了WBC增高,平均为15.71±5.92(109/L),中性粒细胞比例84.2±10.9%.其升高与临床分型、CD4+细胞降低、激素的使用、呼吸机的使用相关.86.7%患者抗生素治疗有效.结论传染性非典型肺炎患者在病情发展过程中出现的WBC升高可能为继发细菌感染所致,可按降阶梯原则进行抗菌治疗.     

严重急性呼吸综合征患者血清病毒抗体消长规律的研究

2003年传染性非典型肺炎在全世界几十个国家和地区暴发流行，世界卫生组织根据其发病特征于2003年4月16日正式命名为严重急性呼吸综合征(Severe Acute Respiratory Syndrome，简称SARS)。由SARS冠状病毒(SARS-associated coronavirus，简称SARS-CoV)引起的此次传染性非典型肺炎发病后，病情发展较急，部分病人病情较重，临床上大致符合病毒感染的病情变化。我们检测了95例SARS患者体内不同时期SARS病毒抗体，探讨病毒抗体在患者体内出现的规律，现报道如下。     

非典部分严重症状的治疗探讨

传染性非典型肺炎又称严重急性呼吸道综合症(简称SARS)，或简称“非典”，其发病原因复杂，目前仍处于研究中。这是一种传染性极强，患者病情凶险的疾病，严重病例可以出现高热，痰拥塞、致敏，或后期并发金黄色葡球菌感染，最终可致衰竭死亡。SARS这些症状较难处理，治疗效果目前尚不理想。笔者认为，在现在治疗方法的基础上，可试用下面方法辅助治疗：服石膏煎、身柱穴注射药液，应用中药鱼腥草、仙鹤草、北芪等办法进行中西医结合治疗，以提高临床效果。     

SARS患者白细胞计数的临床价值探讨

我院2003年1-6月共收治SARS(sever aeute respiratory syndrome，SARS)疑似病例134例，参照卫生部疾病控制司传染性非典型肺炎病例的临床诊断标准，确诊41例。SARS患者外周血白细胞计数一般不升高或降低，常有淋巴细胞计数减少，是目前作为临床诊断传染性非典型肺炎或疑似传染性非典型肺炎的重要依据。为进一步探讨外周     

传染性非典型肺炎诊断治疗体会

目的 总结114例传染性非典型肺炎的诊治经验和体会。方法 根据卫生部推荐的传染性非典型肺炎的诊断标准，对内蒙古114例传染性非典肺炎进行诊断，并给予甲基强的松龙、机械通气、免疫增强剂、抗生素，支持及对症处理等综合治疗。结果 所有病人（重症26.4％）经l～2个月综合治疗（其中39例使用无创正压通气CPAP或BiPAP，2例行气管插管机械通气治疗1全部治愈出院。结论 流行病学史、临床表现及影像学动态改变为主要诊断依据。目前传染性非典型肺炎无特异性治疗手段，但经合理有效的综合治疗绝大部分病人可以治愈。     

16例重症传染性非典型肺炎的CT表现分析

目的 评价重症传染性非典型肺炎的CT表现。方法 回顾性总结分析了16例经临床确诊的重症非典型肺炎病例的临床及CT资料。结果 ①初期：单发病灶仅5例(31．2％)，多段多叶病灶11例(68％)，表现多种多样，78．4％病灶小于5cm；②进展期：病变迅速发展，范围扩大，病灶数目明显增多，CT表现多样化，新、老病灶并存。少数伴胸膜改变；③吸收期：病灶明显缩小，变淡，胸膜改变也随之消失。结论 传染性非典型肺炎患者临床及CT表现重，病灶进展快，肺部病变范围大，数量多，是其特征。CT初查及定期复查，对于临床诊治及判断预后有重要意义。     

非典型肺炎与传染性非典型肺炎的区别

“非典型肺炎”是由支原体、衣原体、军团菌等病原体引起的肺部炎症。用“非典型”是因为这些病原体有许多与“典型”细菌不同的特征。如：它们仅在细胞内寄生；不能用常规微生物学方法分离。临床上常用血清学方法来诊断这些非典型病原体的感染。而传染性非典型肺炎为一种传染性强的呼吸系统疾病，世界卫生组织认为它是一种新型冠状病毒，简称为(SARS)。两者区分如下：     

医院内SARS暴发流行的临床分析

目的：总结严重急性呼吸综合征(SARS，或称传染性非典型肺炎，IAP)的临床表现、诊断和治疗，以及外界输入性病例引起暴发流行的传染链特点。方法：对2例外院输入病例的临床资料和传染链进行分析，并总结41例SARS患者的临床资料。结果：①SARS患者的传染性极强，防范不当可使大量人群感染；②SARS的临床特征主要是发热(100．0％)，有相当部分患者在发病初期(1—3d)呼吸道症状并不明显(占53．7％)，并伴有外周血白细胞(52．6％)和淋巴细胞(68．4％)比例减少；②早期给予利巴韦林、甲基氢化泼尼松和免疫增强治疗对控制病情的进一步发展有一定效果。结论：重视防范、早发现、早隔离和早治疗，对改善SARS的预后和控制其蔓延有着十分重要的意义。     

传染性非典型肺炎后股骨头坏死的病因及治疗

背景：大部分非典型肺炎患者在康复早期出现了不同程度的髋关节滑囊炎并逐步发展为股骨头坏死。目的：分析非典型肺炎后遗症股骨头坏死各种病因,并介绍股骨头坏死治疗方法。方法：由第一作者应用计算机检索 PubMed、中国期刊全文数据库（CNKI）、维普数据库和万方数据库1997年1月至2012年8月相关文献。在标题、摘要、关键词中以“传染性非典型肺炎,后遗症,股骨头坏死,骨缺血,病因,传染性非典型肺炎病毒,保守治疗,手术治疗,全髋置换”或“infectious atypical pneumonia sequela, femoral head necrosis, bone ischemia, etiology, infectious atypical pneumonia virus, conservative treatment, operation treatment, total hip replacement”为检索词进行检索,初检得到872篇,最终选择56篇文献进行综述。结果与结论：传染性非典型肺炎后遗症股骨头坏死与患者在治疗过程中使用激素剂量大小、使用时间长短、患者对激素敏感程度及使用的方法及患者本身分泌的瘦素及骨降钙素量的多少有密切关系,还与传染性非典型病毒本身的作用有密切关系。由于这些病因导致股骨头坏死,先采用保守治疗减慢股骨头坏死的进程,延迟假体的置换,最终大部分患者还是采用手术治疗,传染性非典型肺炎后遗症股骨头坏死晚期置入假体置换是治疗股骨头坏死最好的结果。     

COVID-19 in a young man with hypertension: A case study of missed opportunities in intensive progression

We report the case of a young patient diagnosed with coronavirus disease 2019 with a history of hypertension. The patient improved after antiviral treatment but eventually developed severe respiratory distress syndrome and cardiac insufficiency. His respiratory secretions were tested for nucleic acids and returned negative twice. Computed tomography imaging of the patient showed evidence of viral pneumonia on the 11th day of onset and continued to worsen. The patient was finally intubated and transferred to a higher-level care centre for further treatment. We were very focused on infectious disease protection throughout the treatment, however, suboptimal treatment was provided due to the switch in antihypertensive medication, lack of early nutritional support and fluid restriction management.     

Infectious mononucleosis, diffuse pneumonia and acute respiratory failure in an elderly woman

Infectious mononucleosis (IM) is a benign disease and is frequently associated with mild respiratory symptoms. The pulmonary manifestations rarely dominate the clinical picture. We report a case of an older adult patient with IM who developed diffuse pneumonia and acute respiratory failure. The diagnosis of IM was confirmed serologically, whereas other possible causes of pneumonia were excluded in this study. Pulmonary manifestations of IM are discussed, and the atypical features that may be seen in older adults are simultaneously reviewed.     

Acute respiratory failure with a single dose of quetiapine fumarate

OBJECTIVE: To report a case of acute respiratory failure after a single dose of quetiapine fumarate in an elderly patient with a history of chronic obstructive pulmonary disease (COPD). CASE SUMMARY: A 92-year-old woman with a history of COPD was admitted to the hospital with pneumonia. Her symptoms improved with antibiotics. Because of acute agitation and delirium, quetiapine 50 mg twice daily was started. After receiving the first dose, the woman developed acute respiratory failure and severe central nervous system depression. She required mechanical ventilation and supportive care in the intensive care unit (ICU). She had a full recovery within 24 hours. DISCUSSION: Quetiapine is an atypical antipsychotic that has been used successfully for the treatment of schizophrenia and bipolar disorder for many years. Recently, it has also been used to treat delirium and agitation. It has proven to be very safe, even in the elderly. In previously reported cases, serious adverse effects were seen in patients who ingested very high doses of quetiapine. Those patients required intubation and supportive care in the ICU. To our knowledge, as of January 19, 2006, this is the first case report of acute respiratory failure of such severity with one dose of quetiapine. Using the Naranjo probability scale, we conclude that the acute respiratory failure observed in this patient was probably related to quetiapine. CONCLUSIONS: This case suggests that quetiapine can have significant adverse effects even with a single 50 mg dose. Elderly patients, especially those with significant underlying pulmonary pathology, should be monitored closely when started on this medication.     

152例老年人肺炎的临床和影像学特点

目的：通过分析老年人肺炎患者的临床和影像学特点,进一步加深对本病的认识以减少漏诊和误诊。方法：回顾分析152例75岁以上老年肺炎患者的临床表现、实验室检查、胸部影像学特点。结果：老年人肺炎多合并其他基础疾病,起病隐匿,临床表现不典型,除呼吸系统症状和体征外,常有其他非特异性表现,痰培养阳性率低,在痰细菌培养阳性者中革兰阴性菌检出率高,影像学上以支气管肺炎为主,并发症发生率高。结论：老年人肺炎患者临床表现不典型,容易漏诊、误诊。胸部CT检查能提高老年肺炎的早期诊断率和抢救成功率。     

Scrub typhus pneumonitis: an entity which is frequently missed

Four cases of scrub typhus pneumonitis are reported. Diagnosis was confirmed by positive Weil-Felix OX-K reaction and immunofluorescent antibody test for Rickettsia tsutsugamushi. Two patients presented with atypical pneumonia and two had overwhelming pneumonia resembling adult respiratory distress syndrome. All patients made a full recovery after appropriate treatment.     

A fatal case of alemtuzumab-associated interstitial pneumonitis

Alemtuzumab is a humanized monoclonal antibody primarily used in refractory chronic lymphocytic leukemia. Although bronchospasm and infectious pneumonia are not uncommon adverse effects of therapy, alemtuzumab-associated interstitial pneumonitis causing acute respiratory failure has not yet been described. Here the authors describe a patient with chronic lymphocytic leukemia who developed acute respiratory failure following 3 weeks of alemtuzumab salvage therapy. A microbial or neoplastic cause of the lung disease could not be found. Findings of computed tomography of the chest and wedge biopsy were consistent with interstitial pneumonitis. The patient subsequently died of progressive respiratory failure after 2 months of hospitalization.     

Ventilatory care in myasthenia gravis crisis: assessing the baseline adverse event rate

OBJECTIVE: Myasthenic patients who require mechanical ventilation often develop pneumonia or atelectasis. Although there are differences in the prevalence of these complications among various institutions, there is no evidence that aggressive treatment shortens the course of the myasthenic crisis. We have quantified the severity of lung injury and aggressiveness of respiratory intervention in myasthenic patients admitted to the neuro-critical care unit. DESIGN: We retrospectively identified all mechanically ventilated myasthenic patients admitted in our unit between 1990 and 1998. SETTING: Neuro-critical care unit of a tertiary care center in an urban area with a large, established, regional neuromuscular disease program. PATIENTS: Eighteen myasthenia gravis patients with 24 episodes of respiratory failure requiring mechanical ventilation. INTERVENTIONS: A novel respiratory intervention index, comprising the use of suction, intermittent positive-pressure breathing or bronchodilator treatments, sighs, and chest physiotherapy represented the aggressiveness of the respiratory treatment. The respiratory intervention index was correlated with the lung injury score, used as a measure of lung involvement and other respiratory variables.MEASUREMENTS AND MAIN RESULTS Our patients had less atelectasis and pneumonia than previously published series (46% vs. 91%), leading to shorter mechanical support and neuro-critical care unit stay. The mean respiratory intervention index correlated with lung injury score and inversely with forced vital capacity. CONCLUSIONS: This study presents an estimate for both severity of pulmonary complications and intensity of respiratory therapy in the severe myasthenic patient with mechanical ventilatory compromise. Our results suggest that aggressive respiratory treatment should be used in myasthenic patients in crisis to diminish the risk for prolonged respiratory complications. These observations should be validated in a prospective study.     

Fire-eater's pneumonia: two case reports of accidentally aspirated paraffin oil

Background

Fire-eater’s pneumonia is a chemical pneumonitis that can develop after accidental aspiration of liquid hydrocarbon-based fuel during a flame-blowing or a fire-eating performance. Typical findings of the patient are similar with any infectious pneumonia: chest pain, shortness of breath, cough, fever, and hemoptysis can be seen.

Case reports

We report two cases of acute paraffin oil-induced pneumonia due to accidental aspiration during fire-eating performance.

Conclusion

The symptoms and course of respiratory manifestations and the treatment strategies of fire-eater’s pneumonia are reviewed.