1-6月婴儿重症肺炎35例临床分析

目的:总结1-6月婴儿重症肺炎的临床表现和治疗方法.方法:回顾性分析2008年1月-2010年12月收治的1-6月婴儿重症肺炎35例的临床资料.结果:1-6月婴儿重症肺炎临床表现严重,并发心力衰竭14例(40%)、呼吸衰竭5例(14%)、心肺衰竭3例(9%).结论:1-6月婴儿重症肺炎容易出现心力衰竭、呼吸衰竭并发症,临床上经验性抗生素治疗是考验临床医生的难题.     

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.     

An evidence-based oral hygiene education program for nursing staff

Increasing evidence shows strong statistical correlations between improved oral hygiene and reduction in the incidence, and mortality, from health care-associated pneumonia among elderly. Therefore, it is important that nursing staff are well educated in oral hygiene. The objective was to describe the design of a new oral hygiene educational program for nursing staff, where the theoretical parts of the education were integrated with evidence about the preventive effect of improved oral care on respiratory tract infections and health care-associated pneumonia among hospitalized or nursing home resident older people. An educational model was translated into three educational steps: hands-on training, group discussions, and a theoretical lecture including scientific evidence about the preventive effect of oral hygiene on respiratory tract infections, and health care-associated pneumonia, among older people. Evidence-based oral hygiene education seems to be a feasible way to increase the motivation for daily oral care tasks among nursing staff, and thus to improve the oral hygiene status among the nursing home resident elderly. Further studies are, however, needed to further evaluate the effect of evidence-based oral hygiene educations in different health care settings and over longer time periods.     

急性间质性肺炎(附三例报告及文献复习)

目的 :探讨急性间质性肺炎的诊断与鉴别诊断。方法 :本文报告了三例经临床与病理确诊为急性间质性肺炎 (AIP)病例。并结合相关文献的复习 ,总结出该病的临床特征是一不明原因的急性呼吸窘迫综合征 (ARDS)的发展过程。病情凶险、迅速发展为呼吸衰竭。病理表现为弥漫性肺泡损伤 (     

小儿不同CRP水平呼吸道疾病肺炎支原体感染情况分析

目的 研究小儿不同C反应蛋白(CRP)水平呼吸道疾病肺炎支原体感染的情况,为临床诊断肺炎支原体感染提供参考依据.方法 对2011年3月至2012年2月湛江市妇幼保健院收治的呼吸道感染疾病住院患儿,每月随机抽取50例,合计600例,记录下患儿的年龄、发病季节、入院时诊断,并在入院时检测患儿CRP与肺炎支原体抗体(MP-IgM)水平,分析比较不同CRP水平下不同呼吸道疾病组、不同年龄组、不同季节组肺炎支原体感染率(MP-IgM阳性率)情况.结果 CRP正常组MP-IgM阳性率显著高于CRP异常组(P＜0.05).CRP正常水平时MP-IgM阳性率:婴幼儿组较年长儿组高,秋季组与冬季组较春季组高,支气管肺炎组(肺炎组)与毛细支气管炎组(毛支组)较急性上呼吸道感染组(上感组)高,毛支组较急性支气管炎组(支炎组)高,差异均有统计学意义(P＜0.05).CRP异常水平时MP-IgM阳性率:婴幼儿组与年长儿组及不同季节组之间差异均无统计学意义(P＞0.05);肺炎组较上感组与支炎组高,差异有统计学意义(P＜0.05).结论 CRP正常水平下,婴幼儿、秋冬季、肺炎、毛细支气管炎肺炎支原体感染率高;CRP异常水平下,肺炎、毛细支气管炎肺炎支原体感染率高,临床上均要加强检测,及早诊断与治疗,以减少肺炎支原体所引起的并发症.     

A case of death from AIDS in the USSR

The authors describe the first case of death from AIDS in the USSR of our countrywoman. The clinical manifestations of AIDS in the young woman were determined by opportunistic infections: disseminated candidiasis of the gastrointestinal tract, respiratory organs as well as Pneumocystis pneumonia which ran an extremely grave course with a progressive increase of acute respiratory and cardiopulmonary failure and sepsis.     

Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic

Coronavirus disease 2019 (COVID-19) is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular manifestations. The cardiovascular manifestations reported comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications. In this review, we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation     

小儿肺炎支原体感染肺外并发症临床分析

目的 探讨肺炎支原体(MP)肺炎肺外并发症的临床特点及诊断要点.方法 对2003年8月至2009年12月我院确诊的MP感染患儿116例的临床资料进行回顾性分析,其中肺外并发症42例,发生率36.2%,根据发病年龄分为≤2岁组(Ⅰ组)7例,＞2～6岁组(Ⅱ组)19例,＞6～14岁组(Ⅲ组)16例,对3组患儿肺部啰音发生情况、热程及肺外并发症等情况进行比较.结果 MP除呼吸道损伤外,可引起不同程度、不同系统的肺外表现,Ⅲ组患儿啰音发生率低于Ⅰ组和Ⅱ组(18.8%vs 63.1%vs 71.4%),差异均有统计学意义(P＜0.05),而Ⅰ组和Ⅱ组间差异无统计学意义,Ⅲ组热程小于7天百分率高于Ⅱ组(68.8%vs 26.3%,P＜0.05),3组患儿肺外并发症的发生率差异无统计学意义.结论 患儿年龄大,啰音发生率低,热程短,而肺外并发症的发生率和年龄没有明显关系.     

Preventive strategies for aspiration pneumonia in elderly disabled persons

Pneumonia is the fourth leading cause of death despite the availability of potent new antimicrobials in Japan. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia. Impairments in swallowing and cough reflexes among disabled older persons, e.g., related to cerebrovascular disease, increase the risk of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. Since both swallowing and cough reflexes are mediated by endogenous substance P contained in the vagal and glossopharyngeal nerves, pharmacologic therapy using angiotensin-converting enzyme inhibitors, which decrease substance P catabolism, can improve both reflexes and result in the lowering of the risk of pneumonia. Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine can reduce the incidence of pneumonia. Furthermore, since mortality from infections correlates with cutaneous anergy, interventions that reverse these age-associated changes in the immune system are also effective. The main theme of this review is to discuss how pneumonia develops in disabled older people and to suggest preventive strategies that may reduce the incidence of pneumonia among these subjects.     

Prevention of Descending Pneumonia in Rats with Perflubron-delivered Tobramycin

OBJECTIVES: Patients undergoing emergent endotracheal intubation are at increased risk for developing pneumonia. Although numerous strategies have been investigated to reduce ventilator-associated pneumonia (VAP), the incidence of VAP and its associated mortality remains high. This investigation tested the hypothesis that LiquiVent (Alliance Pharmaceutical, San Diego, CA-LV) delivered antibiotics (via spray-dried microspheres-SDM) would improve survival in a rat model of descending gram-negative pneumonia. METHODS: Wistar rats (n = 49) were randomized to receive prophylaxis with 1). nothing (controls); 2). intramuscular (IM) tobramycin, 3). intratracheal LV plus SDM shells (vehicle), 4). intratracheal LV plus SDM shells plus IM tobramycin, or 5). intratracheal LV plus SDM containing 1 mg/kg of tobramycin. All interventions were given 24 hours before a bacterial challenge with 10(8) colony-forming units of intratracheal Klebsiella pneumoniae. Mortality at ten days was the sole outcome measure. Survival in individual groups was compared with controls by Fisher's exact test with Bonferroni correction for multiple comparisons. RESULTS: All animals in the control group died of pneumonia within ten days of bacterial inoculation (0% survival). Prophylaxis with either IM tobramycin or SDM vehicle plus IM tobramycin provided no protection (0% survival). This is in sharp contrast to the cohort receiving pretreatment with tobramycin-containing SDM delivered via LV, in which 60% of the animals survived to study completion (p < 0.05). CONCLUSIONS: Prophylaxis with SDM containing antibiotics delivered in low-dose LV provided significant protection in a rat model of descending gram-negative pneumonia. These data support the hypothesis that perfluorocarbon-delivered intratracheal antimicrobials may be useful in the prevention of VAP.     

Mycoplasma pneumoniae and central nervous system complications: a review

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. Little is known about the extrapulmonary manifestations of this organism. Numerous central nervous system (CNS) manifestations have been described with M. pneumoniae. CNS involvement is probably the most common site of involvement in addition to the respiratory system. Up to 7% of patients hospitalized with M. pneumoniae may have CNS symptoms. Common CNS presentations include encephalitis, aseptic meningitis, polyradiculitis, cerebellar ataxia, and myelitis. The mechanism behind these CNS manifestations remains unclear. Direct invasion, neurotoxin production, or an immune-mediated mechanism has been proposed. Newer diagnostic techniques for the direct detection of the antigen and the microorganism are proving useful for the detection of extrapulmonary disease. This review comprehensively reviews the CNS complications that have been reported with M. pneumoniae.     

The acquired immune deficiency syndrome (AIDS): current status and implications for respiratory care practitioners.

The acquired immune deficiency syndrome (AIDS) has affected more than 2,600 persons since 1981, with the number of reported cases rising exponentially. The disease is characterized by a deficiency in the cell-mediated immune system, which allows entrance to a host of opportunistic infections as well as tumors. The most common infection associated with AIDS is Pneumocystis carinii pneumonia, a previously uncommon infection of immunocompromised hosts. The most common neoplasm associated with AIDS is an otherwise rare skin tumor, Kaposi's sarcoma. AIDS is most often seen in homosexuals and intravenous-drug abusers, but the spectrum of the disease is widening and now includes other high-risk groups. The pulmonary manifestations of AIDS range from a nonproductive cough to acute respiratory failure. Once hospitalized, the AIDS patient may require several diagnostic and therapeutic services from respiratory care personnel. We review the epidemiology of this new syndrome, provide the basic framework for an understanding of the immunologic dysfunction in AIDS victims, review the clinical manifestations, and discuss the implications of the communicability of AIDS for the respiratory care practitioner.     

高血压脑出血术后院内肺部感染的特征及防治

目的　探讨急性高血压脑出血患者血肿清除术后院内肺部感染特征及其防治方法。方法　回顾性分析 2 0 0 0— 2 0 0 3年神经外科收治的 112例急性高血压脑出血血肿清除术患者 ,对其中 2 9例院内肺部感染者与同期未发生院内肺部感染者进行对照 ,采集痰液标本进行细菌培养和药物敏感性试验。结果　本组院内肺部感染率为 2 5 .89% ,病原体以革兰阴性菌为主 ,常见细菌为铜绿假单胞菌和金黄色葡萄球菌 ,病死率为34.4 8% ( 10 / 2 9例 ) ,预后较未发生肺部感染对照组差 ( 7.2 3% ,6 / 83例 ,P<0 .0 1)。结论　对急性高血压脑出血血肿清除术患者 ,减少医源性感染危险因素、监测病原体、合理选用抗生素、加强呼吸和营养支持等 ,均有利于院内肺部感染的预防和控制     

Acute Myocardial Infarction From Embolized Left Ventricular Thrombus in Coronavirus Disease 2019

A 44-year-old man with a late presentation of coronavirus disease 2019 (COVID-19) pneumonia developed a left ventricular apical thrombus resulting in an asymptomatic anterior myocardial infarction due to extensive thrombosis of the left anterior descending artery. There are increasing reports of thrombotic complications in patients infected with COVID-19. This case highlights the risk of thrombotic events caused by severe acute respiratory syndrome-related corona virus-2 and the associated challenges in management. The objective of this case report is to generate primary literature and raise awareness and appreciation for cardiac manifestations of COVID-19.     

Clinicomorphyological peculiarities of pneumonias complicating the course of oncohematological diseases

The modern concept of pneumonia should not be considered to be a logically accomplished theory. The diagnostic aspects remain complicated; the reasons for an increasing frequency of complication and lethality are not quite clear. Hospital pneumonia is under careful study, which is connected with its severity, complications, high lethargy, and a significantly higher cost of treatment. The morphological peculiarities of pneumonia in myelodepressed oncohematological patients deserve to be studied. In this study, 73 postmortem records of patients who had died of hemoblastoses and had had pneumonia were analyzed. The study showed that the first place in the clinical manifestations of pneumonia in myelo-depressed patients with hematoblastomas belongs to respiratory failure and toxic infective syndrome, which makes difficulties for diagnostic search of the infective process localization. Chest radiograms do not always make it possible to verify an inflammatory process in the lung tissue. Lung tissue infiltration in patients with myelodepression is within the limits of anatomic structures, which is also explained by the absence of cell elements forming the inflammatory bank. This morphological study demonstrates the absence of classic histological picture of pneumonia in the form of neutrophilic infiltration in patients with myelodepression, which often leads to the diagnosis of pulmonary edema or hemorrhage. Matching of clinicoradiological picture to the data of histological studies of the autopsy samples suggests that pneumonia in patients with myelodepression is atypical and implies forming serohemorrhagic and/or fibrinogenous exudate in the alveols.     

Exercise intervention in patients with chronic obstructive pulmonary disease (CE)

Chronic obstructive pulmonary disease (COPD) is characterized by worsening airflow obstruction. In its late stages, patients experience decreased physical function and increased incidents of pneumonia, pulmonary hypertension, cor pulmonale, and chronic respiratory failure. Patients who regularly participate in moderate exercise experience greater control of symptoms and increased functional capacity compared with those being treated by pharmacologic measures alone. Guidelines for a comprehensive exercise program are provided. The Seven Step Approach is discussed as a means of motivating older adults with COPD to incorporate physical exercise into their daily activity. Encouraging exercise in older adults with COPD will help these individuals reach and maintain their highest level of function and quality of life.     

脑梗死致急性假性球麻痹的临床护理

报告５０ 例脑梗死致急性假性球麻痹的临床护理。２４ 例为完全性假性球麻痹,２６ 例为不全性假性球麻痹。其主要表现为：吞咽困难、饮水呛咳、构音障碍。可致营养不良,吸入性肺炎,甚至窒息死亡。做好心理护理,有重点地针对吞咽困难所采取的鼻饲、喂食的护理和吞咽肌训练,加强呼吸道管理和其它基础护理对疾病的转归起重要作用。     

Red blood cell exchange to avoid intubating a COVID-19 positive patient with sickle cell disease?

As the COVID-19 pandemic continues to claim lives across the globe, insufficient data exists regarding the optimal treatment. It is well known that patients 55 years of age or older and patients with certain chronic diseases are at higher risk of severe illness, including acute respiratory distress syndrome and death. A potentially fatal pulmonary complication of sickle cell disease, acute chest syndrome, can be precipitated by acute infections, including respiratory viruses. We report the case of a patient with sickle cell disease (HbSC) who developed COVID-19 pneumonia and acute chest syndrome who was treated with emergent red blood cell exchange in order to avoid endotracheal intubation.     

合并肺炎支原体感染的儿童EB病毒传染性单核细胞增多症的临床特点及高危因素分析

目的分析EB病毒传染性单核细胞增多症(EBV-IM)合并肺炎支原体(MP)感染患儿的临床特点及高危因素,为临床及时准确的治疗提供依据。方法回顾性收集2018年1月1日至2019年12月31日在首都医科大学附属北京友谊医院儿科因EBV-IM住院患儿的临床及实验室检查资料,按是否存在MP感染,分为单纯EB病毒感染组(IM组)62例及合并MP感染组(MP-IM组)36例。比较2组患儿的一般资料(性别、年龄、发病季节)、临床表现(热峰、热程)以及实验室检查结果。结果MP-IM组的患儿平均年龄大于IM组的患儿,其中学龄期儿童占比明显高于IM组,差异有统计学意义(P<0.05)。MP-IM组的患儿热程明显长于IM组,差异有统计学意义(P<0.05)。2组患儿在实验室检查方面:MP-IM组的患儿中性粒与淋巴细胞比值(NLR)、C反应蛋白、IgG、IgM水平明显高于IM组患儿,差异有统计学意义(P<0.05)。年龄和热程是合并MP感染的独立危险因素,年龄大于6.085岁、热程大于9.5 d具有较高的诊断价值。结论在EBV-IM儿童的诊治过程中,合并MP感染的患儿病情及炎症反应相对较重,体液免疫紊乱更为明显。对于发热时间长、学龄期的儿童需进行MP的检测,及早进行抗感染治疗。     

脑卒中后吞咽困难的临床及影像学表现对不良结局的预测价值

目的探讨临床及电视透视检查下特征对误吸、安静误吸、肺炎、营养状态等结局的预测价值。方法对临床评定及电视透视检查下的各种表现分别与穿透、误吸、安静误吸、住院期间肺炎、出院时营养状态分级等作 χ2 检验 ,以有统计学意义的表现为自变量对结局作Logistic回归分析。 结果临床表现可预测某些电视透视检查下的特征。并得出能够预测误吸、安静误吸、住院期间的肺炎及出院时的营养状态的临床表现和电视透视检查表现。结论了解临床和影像学检查对误吸、肺炎及营养状态的预测价值对临床有指导意义