重视复治肺结核化疗方案的制定

标准的初治肺结核化疗方案加上严格的化学治疗管理（DOTS策略）可使约90％的初治肺结核患者获得痊愈，但因为复治肺结核的情况复杂，治疗效果不尽如人意，这类患者已经成为我国耐药结核病，尤其是多耐药结核病（PDR—TB）、耐多药结核病（MDR—TB）和严重耐药结核病（XDR—TB）等多重耐药性结核病产出的主要群体。因此，重视复治肺结核化疗方案的制定，将有助于控制耐药结核病的流行。     

378例涂阳肺结核临床疗效分析

目的了解结核病短程化疗全程间歇疗法临床疗效，分析治疗失败原因并寻求解决办法。方法初治涂阳肺结核化疗方案2H3R323E3／4H3R3；复治涂阳肺结核化疗方案：2s3H3R323E3／6H3R3E3。使用板式抗结核组合药，门诊医师指导下不住院家庭督导化疗。结果治疗涂阳肺结核378例，平均治愈率83．6％，初治涂阳治愈率87．3％，治疗成功率87．62％，复治涂阳治愈率67．61％。结论初治涂阳治愈率达到国家结核病控制项目要求（≥85％），治疗失败以肺结核空洞者为主（75％），对初治涂阳无空洞病例宜选择2H3R323E3／4H3R3方案，初治涂阳空洞病例宜选择2s（E）HRZ／4HR或2s（E）HRZ/4HRE方案。     

福建省龙岩市涂阳肺结核病人督导执行情况分析

肺结核病人的直接观察下的治疗（DOT）是现代结核病控制DOTS策略的一个重要因素。DOT意味着督导者看着病人服药。2002年我市各县（市、区）开始实施“世行贷款/英国赠款结核病控制项目”（以下简称“项目”）工作。该项目对发现的涂阳肺结核病人实施免费化疗和全程DOT管理。为了解项目病人DOT执行情况,2003年我们对项目肺结核病人治疗管理进行调查。     

137例复治肺结核的治疗探讨

近十多年，以异烟肼、利福平、毗嗪酰胺、乙胺丁醇为主体的联合化疗方案用于短程化疗（DOTS），初治肺结核可获90％以上的治愈率。但是不规律用药、不合理的化疗方案，再加上细菌耐药性等原因，复治肺结核、耐多药结核病明显增加，给结核病的控制带来很大困难。本文通过对137例复治8市结核治疗问题进行探讨。     

北海市实施DOTS项目后涂阳肺结核患者治疗失败影响因素分析

目的探讨北海市实施DOTS项目后涂阳肺结核患者治疗失败的因素。方法运用Logistic回归分析法对北海市2004-2008年实施DOTS项目新登记涂阳肺结核病人登记资料进行统计分析。结果年龄、未规则治疗、肺部空洞性病灶、合并其他疾病是肺结核治疗失败的主要因素。而女性比男性治疗失败的风险小。结论未规则治疗是结核病治疗失败的重要危险因素,既往用药不规律是造成耐药的主要原因。老年空洞型涂阳肺结核治疗失败率高,应作为重点管治人群,加强督导管理,并采取有针对性的治疗方案。     

短程督导化疗治疗涂阳肺结核729例

1992-2002年民勤县开展世行贷款结核病控制项目施行直接面视下的短程督导化疗（DOTS）治疗涂阳肺结核729例,现报告如下。     

高州市实施结核病控制项目十年效果评价

目的　高州市实施结核病控制项目的评价。方法　因症就诊胸透筛选痰检确诊病人 ,按统一化疗方案治疗 ,实行全程督导管理。结果　 10年间共接诊可疑肺结核症状者 2 0 12 4人 ,可疑者检痰率为 37.77% ,发现活动性肺结核 5 10 8例 ,其中涂阳肺结核、新发涂阳肺结核分别为 3971和 3317例。涂阳登记率由 13/ 10万提高到 33/10万 ;初治涂阳治愈率达 97.71%、复治涂阳治愈率达 84 .10 %。结论　 10年来结核病控制水平全面提高 ,是实施DOTS现代结核病控制策略的结果。     

重视复治肺结核化疗方案的制定

标准的初治肺结核化疗方案加上严格的化学治疗管理(DOTS策略)可使约90%的初治肺结核患者获得痊愈,但复治肺结核因为情况复杂,治疗效果不尽人意,这类患者已经成为我国耐药结核病尤其是多耐药结核病、耐多药结核病和超级耐药结核病等多重耐药性结核病产生的主要群体。因此,重视复治肺结核化疗方案的制定,将有助于控制耐药结核病的行。     

1993-2005年霍城县结核病控制项目涂阳病人化疗效果

新疆霍城县自1993年启动世界银行贷款中国结核病控制项目（即卫V项目）和2002年利用世界银行贷款英国增款中国结核病控制项目以来,严格按照卫V项目工作手册规定的要求,全面落实现代结核病控制（DOTS）策略,制定和实施严格的涂阳病人管理措施,积极建立健全推行三级防痨网的管理模式,对发现的涂阳肺结核病人进行免费治疗,全程督导管理,取得了明显的化疗效果,[第一段]     

阜康市新登记涂阳肺结核病人治疗管理情况分析

阜康市1992年开始实施世界银行贷款中国结核病控制项目以来,采用世界卫生组织推荐的短程督导化疗管理（DOTS）技术。通过市、乡（镇）、村三级防痨网对涂阳肺结核病人进行免费治疗,不断完善全程监督化疗的各项措施,使结核病控制工作质量有所提高,对传染源的控制已初见成效。在取得成绩的同时,也存在着对结核病控制的不利因素。现将1992—2002年本市新登记涂阳病人的发现、管理和治疗转归情况分析如下。     

33例慢性肺源性心脏病死亡原因分析

目的分析33例慢性肺源性心脏病死亡原因,总结临床经验。结果慢性肺源性心脏病死因有:肺性脑病致中枢性呼衰、右心衰竭、心律紊乱、上消化道出血、电解质酸碱失衡、急性肾功能衰竭、全身多器官衰竭等。结论及时发现并发症,及时处理,可降低病死率。     

Effectiveness of home versus hospital care in the routine treatment of cystic fibrosis

Many cystic fibrosis patients with Pseudomonas lung infections receive intravenous (IV) antibiotics and chest physiotherapy (CPT) at home. Previous studies have suggested that home care, in the setting of a clinical study, is as efficacious as hospital care. This report compares the outcomes of home care with minimal supervision to outcomes of hospital care. We compared two groups of similar age and severity of lung impairment. Patients met strict definitions for home or hospital treatment (27 home care courses/33 hospital care courses). Five patients completed six courses of both home care and hospital treatment. Treatment in both groups included intravenous antibiotics and CPT. Primary outcome measures included changes in pulmonary function between the start of treatment and after 2 weeks of therapy, duration of treatment, and intervals between antibiotic courses. In hospitalized patients, forced vital capacity (FVC) increased by 17.4 ± 3.1% (mean SEM), and forced expiratory volume in one second (FEV 1) increased by 23.3 ± 4.1%, both significant at P < 0.001. The FVC and FEV₁ of patients treated at home increased by 10.2 ± 2.0% and 13.7 ± 2.6% respectively, neither of which was a significant improvement. Similar results were found in the five patients completing both home and hospital courses. The average duration of treatment was twice as long and time between IV antibiotic courses only two-thirds as long for those treated at home compared with the hospitalized patients. Previous reports have claimed that home care in the setting of a prospective study is as efficacious as hospital care. Our experience indicates that routine home care with minimal supervision of patients is less effective than hospital care. Furthermore, home care as delivered to patients in this report increased the overall cost of care by as much as 30% because of longer and more frequent courses of antibiotic therapy. Pediatr. Pulmonol. 1997;24:42–47. © 1997 Wiley-Liss, Inc.     

High-flow Nasal Cannula therapy: A feasible treatment for vulnerable elderly COVID-19 patients in the wards

BackgroundInvasive mechanical ventilation is the treatment of choice in COVID-19 patients when hypoxemia persists, despite maximum conventional oxygen administration. Some frail patients with severe hypoxemic respiratory failure are deemed not eligible for invasive mechanical ventilation.ObjectivesTo investigate whether High-flow nasal cannula (HFNC) in the wards could serve as a rescue therapy in these frail patients.MethodsThis retrospective cohort study included frail COVID-19 patients admitted to the hospital between March 9th and May 1st 2020. HFNC therapy was started in the wards. The primary endpoint was the survival rate at hospital discharge.ResultsThirty-two patients with a median age of 79.0 years (74.5–83.0) and a Clinical Frailty Score of 4 out of 9 (3–6) were included. Only 6% reported HFNC tolerability issues. The overall survival rate was 25% at hospital discharge.ConclusionsThis study suggests that, when preferred, HFNC in the wards could be a potential rescue therapy for respiratory failure in vulnerable COVID-19 patients.     

ACEI联用ARB治疗慢性心力衰竭的疗效和安全性Meta分析

目的通过对慢性心力衰竭患者在接受相关治疗后的总体死亡率、住院情况、副反应进行比较,对血管紧张素转换酶抑制剂(ACEI)联用血管紧张素受体拮抗剂(ARB)治疗慢性心力衰竭的疗效和安全性进行评价。方法检索MEDLINE(1966-2008)、Cochrane图书馆(1980-2008)、中国生物医学文献数据库(1980-2008),万方数据库(1980-2008),纳入比较ACEI单用与ACEI和ARB合用治疗慢性心力衰竭的随机对照试验,对纳入研究的方法学进行评价,并应用RevMan5.0软件进行统计分析。结果共有7个随机对照研究入选,病例数总计5 853例,其中治疗组2 945例,对照组2 908例。Meta分析结果显示联合治疗组在全因死亡率和全因住院率方面与对照组相比无统计学意义。而在减少全因死亡与全因住院的联合终点事件、降低心衰住院事件、增加副反应方面有统计学意义,合并效应量分别为(RR:0.94;95%CI:0.90～0.98)、(RR:0.86;95%CI:0.79～0.93)、(RR:1.40;95%CI:1.24～1.58)。结论 ACEI基础上加用ARB与单用ACEI相比,可以使慢性心衰患者受益,但同时副反应的发生率有所增加。因此对于慢性心衰在ACEI基础上加用ARB应采取审慎的策略。合用则需要严密监测,防止副反应发生。     

心室率控制与节律控制治疗心房颤动合并心力衰竭的系统评价

目的对心室率控制和节律控制治疗心房颤动(房颤)合并心力衰竭(心衰)的疗效进行Meta分析。方法检索Pubmed(1966～2009年)、ScienceDirect(1966～2009年)、Cochrane图书馆临床对照试验资料数据库(1980～2009年)、Google学术网站,纳入房颤合并心衰患者以药物作为一线治疗,进行心室率控制(室率组)或节律控制(节律组)的随机对照试验,评价纳入研究的方法学,并应用Revman 5.0软件进行分析。结果共4个随机对照研究2486例患者入选。Meta分析结果显示,节律组与室率组全因病死率、心血管病死率比较,差异均无统计学意义,室率组的全因住院率低于节律组(OR=0.79,95% CI:0.66～0.94)。结论对于房颤合并心衰并以药物作为一线治疗的患者,节律控制不优于心室率控制,且增加住院概率。     

A practical guide for ultrafiltration in acute decompensated heart failure

Acute decompensated heart failure is the most common reason for inpatient hospital admission. Most patients admitted for decompensated heart failure are by definition diuretic-resistant. The therapeutic objective for these patients is volume and sodium removal and restoration of diuretic sensitivity. In a significant proportion of patients, this objective is not met, subjecting patients to readmission for recurrent heart failure decompensation. Ultrafiltration therapy offers the potential of greater volume and sodium removal as compared with conventional therapies in a more expeditious manner. Ultrafiltration can be safely and effectively accomplished in a non-intensive care setting but relies on earlier discharge with reduced readmission rates to be economically feasible. This paper reviews the current data regarding ultrafiltration therapy and provides a practical guide to patient selection, implementation and management of this therapy.     

急性肺栓塞18例临床诊治分析

目的探讨急性肺栓塞的临床特点、诊断，以提高该病的诊治水平。方法对2002年6月～2007年8月人院并确诊的18例肺栓塞的临床表现、检查、诊断及治疗方法进行临床分析。结果急性肺栓塞临床表现不特异。易患因素有高龄、手术、心房纤颤、长期卧床等，主要症状表现为不明原因的呼吸困难、胸痛、晕厥、咯血等，影像学特点呈多样性改变。主要治疗方法为溶栓、抗凝治疗。18例患者治愈率（10例）占56％，好转率（4例）占22％，病死率（4例）占22％。结论肺栓塞的表现不典型，临床医师应提高对急性肺栓塞的诊治水平，逐步提高急性肺栓塞患者的生存率。     

Clinical evaluation of pneumonia-associated rhabdomyolysis with acute renal failure

This study aims to evaluate the clinical features, diagnosis, and treatment efficacy in patients with pneumonia-associated rhabdomyolysis and acute renal failure. The subjects included six patients who had presented with rhabdomyolysis and acute renal failure due to bacterial or viral pneumonia on admission to our university hospital and the Yokohama Social Insurance Central Hospital between 2004 and 2005. The causative organisms were identified as Legionella pneumophila (N = 1), Staphylococcus epidermidis (N = 2), Staphylococcus aureus (N = 1), and Unknown (N = 2). For anuric or oliguric patients (N = 4), a blood purification therapy was performed, while conservative therapy was administered to those with a normal urine volume (N = 2). The patient suffering from L. pneumophila pneumonia did not survive, while the other patients regained full kidney function. It is important to identify, evaluate, and treat patients with bacterial or viral pneumonia-associated rhabdomyolysis and acute renal failure.     

抗心衰治疗在重症急性胰腺炎中的作用评价

目的 评价抗心衰治疗在重症急性胰腺炎中的作用.方法 收集崇州市人民医院消化内科2011年10月-2012年10月收治的12例重症急性胰腺炎合并左心衰的患者作为研究组,评价早期抗心衰在重症急性胰腺炎治疗中的作用.早期抗心衰治疗措施包括：限制钠盐、严格控制液体滴速和液体总量、速尿推注和调整晶胶体比例等.对照组为崇州市人民医院2008年1月-2010年1月收治的10例重症急性胰腺炎合并左心衰,而未行早期抗心衰治疗的患者.结果 12例经早期抗心衰治疗的患者全部好转出院,其中3例并发胰腺假性囊肿,2例并发轻至中度肝肾功能损害;10例未经早期抗心衰治疗的患者,8例出现急性呼吸窘迫综合征（ARDS）,行有创呼吸机治疗后,其中2例早期死于多器官功能衰竭,2例后期死于腹腔脓肿感染,存活的6例患者均并发胰腺假性囊肿,4例并发中度至重度肝肾功能不全.结论 抗心衰在重症急性胰腺炎治疗中具有重要作用,可以延缓或消除ARDS,未重视或早期抗心衰治疗不及时,易导致ARDS,加重急性胰腺炎的并发症,使其病死率明显提高.     

Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction

INTRODUCTION: In patients with acute myocardial infarction (AMI), considerable time elapses from symptom onset until initiation of thrombolytic therapy or primary percutaneous coronary intervention. Prehospital diagnosing can reduce time delays, and remote diagnosing using telemedicine may be appropriate in areas and countries where ambulances are not staffed with physicians. OBJECTIVES: To evaluate whether it was technically feasible for physicians at a remote university hospital to diagnose ST-segment-elevation-AMI (AMI(STelev)) in patients suspected of AMI, who were transported by ambulances to a local hospital. To determine associated prehospital delays and in-hospital treatment delays. METHODS: Patients carried in telemetry equipped ambulances had 12-lead electrocardiograms (ECGs) acquired as soon as possible. En route to the local hospital the ECGs were transmitted to a remote university hospital, by use of the GSM-system. The physician on call at the university hospital interviewed the patients, who were provided with cellular phone headsets, and alerted the local hospital if signs of AMI(STelev), bundle-branch-block-AMI or malignant arrhythmia were detected. Patients transported by traditional ambulances were included in a prospective control group. RESULTS: In 214 (86%) of 250 patients prehospital diagnosing was successful. Geographically related transmission problems were the primary reason for failure. Ninety-eight per cent of transmitted electrocardiograms and obtained history takings were technically acceptable for diagnostic purposes. Door-to-needle times were shorter amongst patients with AMI(STelev) who were subjected to prehospital diagnosing (n = 13) as compared with patients transported by traditional ambulances (n = 14) (38 vs. 81 min) (P = 0.004). CONCLUSIONS: It was technically feasible to use telemedicine for remote prehospital diagnosing of patients suspected of AMI. Patients subjected to prehospital diagnosing had shorter door-to-needle times compared with a prospective control group.