特发性肺含铁血黄素沉着症患儿的护理

目的:探讨特发性肺含铁血黄素沉着症患儿的护理。方法:总结2011年1月~2014年2月我科收治的6例特发性肺含铁血黄素沉着症患儿的护理经验。结果:6例患儿经积极治疗和有效护理后,病情均好转出院。结论:正确采集标本是特发性肺含铁血黄素沉着症确诊的关键;严密的病情观察,合理的饮食及健康教育是提高疾病治疗效果的主要措施。     

特发性肺含铁血黄素沉着症的诊治护理和随访

诊治肺含铁血黄素沉着症（ＩＰＨ）２０例，其中男１５例，女５例，３～１２岁。临床特点为反复呼吸道感染、咳喘、咯血和缺铁性贫血。１０例在院外误诊为肺炎和缺铁性贫血。根据发病经过，临床表现与实验室检查，在痰液和胃液中找到含铁血黄素巨噬细胞而确诊。用氟美松和硫唑嘌呤治疗有效。可长期抗炎，减少肺纤维化，稳定肺部病变。护理着重以下几点：（１）重点观察是否过敏体质。（２）查找咯血患儿痰液中的含铁血黄素巨噬细胞。（３）饮食护理，禁食可致过敏的食物，并予以高蛋白、高热量富营养的食物。（４）心理护理，保持患儿良好的精神状态，消除对疾病的恐惧，咯血期间卧床休息，以防咯血过多致窒息死亡。（５）注意激素的副作用。长时间应用激素可致肾上腺皮质萎缩，不可立即停药，应逐渐减量。本组１５例患儿全部存活，５例失访，本病预后尚好     

巯嘌呤剂量个体化治疗儿童特发性肺含铁血黄素沉着症15例

目的 总结特发性肺含铁血黄素沉着症(IPH)的诊断,评估剂量个体化的巯嘌呤(6MP)治疗IPH的长远疗效.方法 IPH的诊断是通过住院检查和随访1年以上排除其他疾病后确定.15例患儿符合诊断并纳入分析,诊断时的年龄2～13岁(中位7岁).疾病急性期口服泼尼松2 mg/(kg·d),4周减停,6MP同时开始口服,60 ms/(m2·d),维持治疗3年.结果 多数患儿由于起病症状不典型而被延误诊断,延误的时间是2周～108个月(中位8个月).所有病例经治疗后都能缓解并成功撤除激素.随访2.5～9.5年(中位6年),15例患儿在6MP维持治疗期间有相对低白细胞血症(3×109/L～6×109/L)的患者8例中只有1例复发,而另外7例有5例复发(P<0.05).复发的5例将6MP剂量上调使白细胞降低后4例未再复发.结论 诊断延误仍然是突出的问题.本组多数IPH患儿对6MP维持治疗耐受好且获长期缓解,提示有可能避免长期依赖激素治疗及因此对生长发育带来长远的不良影响;6MP代谢个体差异大,剂量个体化治疗可避免部分病例未得到足够治疗剂量或治疗过度,有助于改善预后,白细胞计数可能是一个简单而有用的衡量指标.     

特发性肺含铁血黄素沉着症1例报告及文献复习

目的总结儿童特发性肺含铁血黄素沉着症（idiopathic pulmonary hemosiderosis,IPH）的临床表现、实验室检查、影像学、病理学特点,并探讨诊断、治疗方法和预后。方法本例患者进行实验室、影像学、深部吸痰并行组织病理学检查确诊,糖皮质激素治疗并随访,探讨本例患者并结合国内外相关报道文献进行复习。结果临床表现主要是反复发作咯血、咳嗽、贫血,部分心慌、胸闷、乏力,肺部体征不明显,影像学改变可见肺部弥漫性毛玻璃样改变,相关免疫学检查（如抗核抗体、抗中性粒细胞包浆抗体）均阴性,血分析呈小细胞低色素性贫血,血清铁降低,胆红素升高,反复深部痰液可找到含铁血黄素巨噬细胞。结论儿童特发性肺含铁血黄素沉着症临床表现多样,需与缺铁性贫血、支气管肺炎、肺结核相鉴别,容易误诊、漏诊,痰、胃液及支气管肺泡灌洗液活检可提高阳性率,应加强对本病的认知,及早诊断和干预;长时间糖皮质激素治疗后可使病情处于较稳定状态;预后不良。     

儿童特发性肺含铁血黄素沉着症患儿的护理

目的探究儿童特发性肺含铁血黄素沉着症患儿的护理特点及护理效果。方法选取50例儿童特发性肺含铁血黄素沉着症患儿50例,随机分为观察组(采用针对性护理)和对照组(采用常规性护理),各25例,观察比较2组患儿的临床护理效果、并发症发生情况以及护理前后患儿及其家长对临床护理工作的总评分情况。结果观察组的临床护理总有效率为92%,显著高于对照组的76%(P0.05);观察组的并发症发生率为32%,显著低于对照组的56%(P0.05);临床护理后,观察组对临床护理工作的总评分显著高于对照组(P0.05)。结论对儿童特发性肺含铁血黄素沉着症患儿实施针对性护理,可提升临床护理效果,降低并发症发生率,提升护理工作综合评分。     

特发性肺含铁血黄素沉着症的X线和CT诊断

目的 探讨特发性肺含铁血黄素沉着症（IPH）的X线和CT诊断。方法 收集2000年1月-2004年12月我院诊治的IPH15例，所有病例均行X线胸片及CT常规检查。其中10例加行HRCT检查。回顾性分析其X线和CT影像表现。结果 X线表现：9例表现为双肺小片状阴影或（和）磨玻璃样改变。8例表现为肺内弥漫性分布的片絮状阴影，6例表现为肺内弥漫分布网格影，4例表现为双肺散在分布的粟粒状、结节状阴影。CT表现：6例表现为双肺广泛结节及小片状阴影，5例表现为双肺不同程度纤维化。结论 IPH的X线和CT表现多样化，不具有特征性，当l艋床具有反复咳嗽咯血、呼吸困难和不明原因缺铁性贫血时，应考虑本病的诊断。     

肺含铁血黄素沉着症26例的临床特点和预后分析

目的:探讨儿童特发性肺含铁血黄素沉着症(Idiopathic Pulmonary Hemosiderosis,IPH)的临床特点、诊断、治疗以及预后的危险因素。方法:对我院2004-2011年收治的26例特发性肺含铁血黄素沉着症患儿资料进行临床回顾性分析及追踪随访。结果:临床症状主要为面色苍白20例(76.9%),咳嗽或咳喘22例(84.6%),发热12例(46.1%),咯血或痰中带血10例(38.5%)。痰或胃液中可找到含铁血黄素细胞(88.4%)。从出现症状到确诊的平均时间为18.9月。26例中死亡3例,好转或无症状17例,但其中8例存在病情反复,6例失访。从发病到确诊的时间长短是预后危险因素。结论:IPH临床表现多样,容易误诊。激素冲击治疗或大剂量丙种球蛋白联合泼尼松口服可较好地控制IPH急性期病情。通过长期激素治疗可维持长期生存,但部分患儿仍反复发作。及时诊断,及早治疗,有助于控制病情,改善预后。     

Child with idiopathic pulmonary hemosiderosis: a case report from Pakistan with multiple ethical and moral issues

This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.     

特发性肺纤维化合并肺动脉高压的诊治进展

特发性肺纤维化(idiopathic pulmonary fibrosis, IPF)是病因不明,组织病理学主要为普通间质性肺炎,局限于肺部的慢性纤维化型间质性肺炎。该病致死率高,对人群健康危害性高。近年来,随着人口老龄化、空气污染的加剧导致其发病率逐年上升,我们对于IPF的认识也在不断提高,研究发现IPF患者常合并其他疾病,包括肺气肿、肺癌、心血管疾病等。存在合并症的IPF患者临床症状更多,患者的生存质量差。其中合并肺动脉高压会降低IPF患者的生存率,本文就IPF合并肺动脉高压进行综述,以期为IPF合并肺动脉高压的诊疗方案与进一步研究提供新思路,以期提高 IPF患者的生活质量及改善预后。     

特发性肺纤维化的HRCT表现与肺功能及支气管肺泡灌洗液细胞学相关性研究

目的认识特发性肺纤维化(IPF)的HRCT影像表现,探讨各征象与肺功能各项指标、支气管肺泡灌洗液细胞学之间有无相关性。方法选取符合IPF诊断标准的患者31例,进行吸气后屏气HRCT扫描,并进行肺功能测定,其中26例患者进行了支气管肺泡灌洗检查。对其中14例患者进行HRCT追踪随访。结果HRCT扫描出现最多的征象是网格影(96.8%)、蜂窝影(74.2%);磨玻璃影与FEV1、FEV1/FEV轻度负相关,网格影与DLco显著负相关,蜂窝影和CT总评分与FVC、FEV1、TLC和DLco均具有很好的负相关性,PaO2与磨玻璃影和CT总评分呈显著负相关。支气管肺泡灌洗液中性粒细胞与磨玻璃影轻度正相关,嗜酸细胞与网格影和CT总评分呈轻度正相关。结论在IPF的HRCT诸多征象中,网格影和/或蜂窝影最具有诊断意义。HRCT主要征象与肺功能参数间有一定的相关性,磨玻璃影反映了肺功能通气障碍,网格影反映了肺功能的弥散障碍,蜂窝影的出现说明了肺的通气功能和弥散功能均受累,CT总评分能很好反映肺功能变化。磨玻璃影与支气管肺泡灌洗液中性粒细胞轻度正相关,嗜酸细胞与网格影和CT总评分呈轻度正相关。     

早期实施肺部物理治疗对降低高龄脑出血患者肺部感染的效果观察

目的探讨高龄脑出血患者早期实施肺部物理治疗对肺部感染的影响及其安全性。方法选择2009～2010年68例高龄脑出血患者,随机分为观察组与对照组,每组34例。观察组患者入院或手术后2h开始肺部物理治疗;对照组患者入院或手术后24h开始肺部物理治疗。观察两组操作前后SaO2、血压变化;24h、72h平均排痰量、排痰效果;及肺部感染发生率、住院天数。结果两组患者肺部物理治疗前、后SaO2差异有显著意义(P<0.01、P<0.05)、24h日均排痰量、排痰效果两组比较差异有显著意义(P<0.01),72h排痰效果比较差异有显著意义(P<0.05),两组患者肺部感染发生率分别为5%与29%,差异有显著意义(P<0.01);两组患者住院天数分别为(14.77±2.84)d与(21.72±3.96)d,差异有显著意义(P<0.05)。结论高龄脑出血患者早期实施肺部物理治疗可减少肺部感染的发生,操作安全、有效,缩短了住院时间,对控制医院感染有良好效果。     

Combined effect of pulmonary rehabilitation and music therapy in patients with chronic obstructive pulmonary disease

[Purpose] We aimed to analyze parameters of pulmonary function and physiological, psychological, and physical factors in patients with chronic obstructive pulmonary disease (COPD) receiving pulmonary rehabilitation (PR) and music therapy (MT). [Participants and Methods] This randomized crossover comparative study included in-patients diagnosed with COPD and a ratio of forced expiratory volume measured at the first second and forced vital capacity (FEV1/FVC) of <70% after administration of a bronchodilator. Patients were randomly divided into two groups that received either PR only or MT and PR (n=13 each). The PR program included conditioning, respiratory muscle training, and endurance training, whereas the MT program included vocal, singing, and breathing exercises using a keyboard harmonica. The programs lasted 8 weeks, in which pre- and post-intervention data were compared every 4 weeks. [Results] The FEV1/FVC in the MT group improved after the intervention. Expiratory volume control was obtained better with feedback by sound than with expiration practice. In the MT and PR program, it was easier to adjust the timing and volume of breathing, obtain expiratory volume control, and, thus, improve FEV1/FVC than in conventional practice. [Conclusion] Combining MT with PR improves parameters of pulmonary function in patients with COPD. Music therapy is a novel approach that, in combination with PR, may be used in COPD management.     

康复治疗对慢性阻塞性肺疾病患者肺功能影响的临床调查

目的观察康复治疗对慢性阻塞性肺疾病(COPD)患者肺功能的影响。方法将2003年1月~2004年1月在深圳第四人民医院就诊的30例COPD患者随机分为训练组和对照组,各15例,训练组除基本治疗外,每天需进行多项康复治疗。对照组进行常规对症治疗及一般的肢体活动,治疗前及治疗后24周分别检查两组肺功能,并进行评估。结果治疗前两组肺功能评分无统计学意义(P>0.05)。治疗组治疗后肺功能较治疗前及对照组治疗后明显改善(P<0.05)。结论康复治疗能明显改善COPD患者的肺功能。     

Effect of pirfenidone on pulmonary fibrosis due to paraquat poisoning in rats

Background. This study investigated the effectiveness of pirfenidone compared with antioxidants, in the prevention of pulmonary fibrosis and increasing the survival in acutely paraquat poisoned rats. Methods. Five groups of ten rats were included in this study. Three groups were poisoned with intraperitoneal injection of 15 mg/kg paraquat. Among these poisoned groups, one group was treated with vitamin C (500 mg/kg, intraperitoneal), vitamin E (200 mg/kg, intraperitoneal) and N-acetylcysteine (250 mg/kg, intravenous); two others were treated with either normal saline or pirfenidone (200 mg/kg, intravenous); two groups were not poisoned and received normal saline or pirfenidone (200 mg/kg, intravenous). All injections except paraquat were repeated in four consecutive days. On the 15th day of study a semi-quantitative determination of lung fibrosis was done using Ashcroft staging criteria on the lung sections. Results. Pirfenidone decreased paraquat induced lung fibrosis (p?<?0.001) while antioxidants did not decrease the lung fibrosis (p =?0.413). Life expectancy decreased in paraquat + normal saline (11 days, 95% CI 7.94–14.05) and paraquat + antioxidant (11 days, 95% CI 7.77–14.23) groups. The increase in the survival of rats in paraquat/pirfenidone group was insignificant (13.4 days, 95% CI 11.13–15.67). Conclusion. This study showed that pirfenidone is able to decrease pulmonary fibrosis following paraquat poisoning in a rat model.     

微创颅内血肿清除术治疗高血压性脑出血40例围术期护理体会

目的:探讨微创颅内血肿清除术治疗高血压性脑出血围术期的护理方法.方法:将80例均符合高血压性脑出血急性期诊断标准、出血量均＞30ml患者随机分为实验组和对照组各40例,对照组行内科常规治疗,实验组行微创颅内血肿清除术治疗.对两组患者有效率、病死率、神经功能缺损评分进行比较.结果:两组有效率、病死率、神经功能缺损评分差值比较均有显著性差异(P＜0.01).结论:应用微创颅内血肿清除术治疗高血压性脑出血,可使患者治疗有效率明显提高,病死率和致残率明显下降,创伤小,适应范围广,值得临床推广应用.     

亚低温治疗高血压脑出血患者改善功能预后及相关因素分析

Endothelin（ET）isthestrongestvasoconstrictivepeptide，whichisfoundbyJapanesescholarin１９８８，itsrelationshipwithcere－brovasculardiseasehasbeenpaidgreatattention．Thisarticleaimstoresearcheffectofsubhypothermiaonhypertensioncerebralhemor－rhageandcontentchangeofET．１Subjectandmethod１．１Subject８７casesfromAugust１９９６toAugust２０００wereconfirmedbycerebralCT，whoaccompaniedwithhypertensionhis－toryfor８～１０years，including６０malesand２７females，aged２８～７６averageage５０．３…     

Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial.

Study design: Randomized clinical trial.

Objective: To investigate the effect of including manual therapy (MT) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD).

Background: The primary source of exercise limitation in people with COPD is dyspnea. The dyspnea is partly caused by changes in chest wall mechanics, with an increase in chest wall rigidity (CWR) contributing to a decrease in lung function. As MT is known to increase joint mobility, administering MT to people with COPD carries with it the potential to influence CWR and lung function.

Methods: Thirty-three participants with COPD, aged between 55 and 70 years (mean?=?65·5±4 years), were randomly assigned to three groups: pulmonary rehabilitation (PR) only, soft tissue therapy (ST) and PR, and ST, spinal manipulative therapy (SM), and PR. Outcome measures including forced expiratory volume in the 1st second (FEV₁), forced vital capacity (FVC), 6-minute walking test (6MWT), St. George's respiratory questionnaire (SGRQ), and the hospital anxiety and depression (HAD) scale were recorded at 0, 8, 16, and 24 weeks.

Results: There was a significant difference in FVC between the three groups at 24 weeks (P?=?0·04). For the ST+SM+PR group versus PR only the increase was 0·40 l (CI: 0·02, 0·79; P?=?0·03). No major or moderate adverse events (AE) were reported following the administration of 131 ST and 272 SM interventions.

Discussion: The increase in FVC is a unique finding. Although the underlying mechanisms responsible for this outcome are not yet understood, the most likely explanation is the synergistic effect resulting from the combination of interventions. These results support the call for a larger clinical trial in the use of MT for COPD.     

老年继发性肺结核抗结核治疗后多排螺旋CT征象的演变

目的探讨老年继发性肺结核抗结核治疗后多排螺旋CT征象的演变特征。方法回顾性分析18例老年继发性肺结核抗结核治疗后MSCT基本征象的变化,并与44例中青年肺结核随访病例进行对比分析。结果①老年组肺叶/肺段实变和腺泡实变融合的发生率72.2%和88.9%高于对照组(22.7%,45.5%)(P<0.05),吸收多发生在4～12个月,对照组吸收多发生在1～6个月。老年组树芽征发生率5.6%低于对照组(43.2%)(P<0.05),5个月吸收;对照组多在3～9个月吸收。老年组空洞性病变20%完全吸收,对照组50%完全吸收。②老年组治疗过程中矛盾反应发生率44.4%高于对照组的9.1%(P<0.05),可出现在治疗后1～9个月;对照组多出现在3个月以内。结论老年肺结核抗结核治疗后征象吸收缓慢,并且容易发生治疗后矛盾反应,熟悉这些转归特征有利于提高老年肺结核的诊断并且判断其疗效。     

Anticoagulant treatment for pulmonary embolism in patient with cerebral hemorrhage secondary to mechanical thrombectomy: A case report

BACKGROUNDCerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy is characterized by high morbidity, disability and mortality. If the patient also has severe pulmonary embolism (PE) at the same time, the treatment becomes more complex. This report describes the treatment strategy for a patient with PE and cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy. CASE SUMMARYA 70-year-old woman presented to our emergency department with right-sided hemiplegia and mixed aphasia of 2.5 h duration. She was diagnosed with left cerebral embolism, left internal carotid artery occlusion, PE and left calf intramuscular vein thrombosis. Following mechanical thrombectomy, brain magnetic resonance imaging showed cerebral infarction with basal ganglia hemorrhage. We observed changes in cerebral hemorrhage on serial monitoring of brain computed tomography and adjusted the dose of anticoagulant drugs. After 3 wk of treatment, the patient’s neurological and respiratory symptoms significantly improved, and a favorable prognosis was obtained.CONCLUSIONAnticoagulation could be a potential option for PE accompanied by hemorrhagic transformation of an ischemic infarct.     

延迟复苏增加失血性休克犬肺组织含水量和血管通透性

目的:研究延迟补液对失血性休克犬肺组织含水量和血管通透性的影响.方法:Beagle犬14只,先期无菌手术行颈动、静脉置管,24 h后从颈动脉放血造成失血性休克,总失血量为全身血容量的42%.随机分为延迟补液组(n=8)和立即补液组(n=6).失血后第1个24 h延迟补液组无治疗,立即补液组静脉输入3倍失血量的乳酸林格氏液.失血后24 h起两组犬均实施静脉补液.于失血前(0 h)和失血后第2、4、8、24、48 h和72 h测定动物非麻醉状态下的呼吸频率(RR)、动脉氧分压(PaO2)、血管外肺水指数(ELWI)和肺血管通透性指数(PVPI),于失血后72h或动物濒死前测定肺组织含水率.结果:失血后72 h延迟补液组死亡率为5/8(62.5%),而立即补液组为0.失血后8 h,延迟补液组MAP[(55.8±4.1)mmHg]和PaO2[(86.3±2.9)mmHg]分别比失血前降低46.2%和22.4%:ELWI[(168.8±12.1)mL]和PVPI(5.9±0.6)增加31.4%和78.8%.立即补液组MAP和PaO2显著高于延迟补液组;ELWI和PVPI显著低于延迟补液组(均P＜0.05).延迟补液组肺组织含水率[(88.37±2.73)%]显著高于立即补液组[(81.52±2.13)%,P＜0.05].结论:延迟补液显著增加失血休克动物肺血管通透性和肺组织含水量,加重肺脏功能障碍.