立复欣与利福平治疗复治肺结核的临床对照研究

目的　比较静脉应用立复欣 3HR*ZE/ 6 HR和口服利福平 3HRZE/ 6 HR方案在复治肺结核治疗中的临床效果和副作用。方法　选择确诊的复治涂阳肺结核病例 2 4 9例 ,随机分为立复欣组和利福平组 ,立复欣组 12 7例用静脉制剂立复欣 3HRf ZE/ 6 HR治疗 ,利福平组 12 2例用口服利福平治疗 3HRZE/ 6 HR方案为对照。结果　显示立复欣组和利福平组痰菌阴转率 1个月分别为 5 1.6 % ,2 9.4 % ,3个月分别为 70 .6 % ,4 7.9% ,9个月分别为 91.3% ,73.1% ,空洞关闭率 3个月分别为 5 5 .3% ,4 2 .9% ,6个月分别为 71.1% ,5 4 .3% ,9个月分别为 84 .2 % ,6 0 .0 % ,病灶改善率 3个月分别为 80 .2 % ,6 9.7% ,6个月分别为 87.3% ,74 .7% ,9个月分别为 92 .9% ,80 .7% ,两组比较有显著性差异 (P<0 .0 5 ) ,立复欣组在肝功能损害 ,血象影响等方面与利福平组无明显差异。结论　应用立复欣方案在复治肺结核的治疗中具有良好的临床应用价值     

立复欣与利福平短化方案治疗初治涂阳肺结核108例疗效及副作用比较

目的:评价含立复欣与利福平联用方案治疗初治涂阳肺结核108例临床疗效及副作用发生率,探讨立复欣在结核病化疗中的应用前景.     

立复欣治疗结核性脑膜炎之临床观察

结核性脑膜炎是一种常见的重症结核病,其早期诊断及加强抗结核药物的应用是其治疗的关键,立复欣作为利福霉素的衍生物,在临床应用过程中,因其毒性小,体内吸收好,对结核菌具有与利福平相似,甚至稍强的抗菌作用,为结核性脑膜炎的治疗方案组成提供了新的可靠的保证,为了考核立复欣治疗结核性脑膜炎的临床疗效及副作用,我们选择了2003年1月-6月间结核性脑膜炎病人31例采用立复欣治疗,同时选对照组29例用利福平治疗,疗程均有3个月.     

舒兰新治疗复治肺结核病人的临床观察

目的评价利福平注射液（舒兰新）治疗复治肺结核的有效性和安全性,并与利福霉素钠注射液比较。方法将复治肺结核患者采用1：1随机分为实验组和对照组,前者应用利福平注射液,后者使用利福霉素钠注射液,观察两组治疗2个月后痰菌阴转率、X线检查结果和不良反应等。结果完成疗程可评价疗效者共102例,实验组52例,治疗组50例。治疗2个月后,两组痰涂片阴转率分别为92．8％、80．8％,痰培阴转率分别为96．2％、85．0％;X线检查显效率分别为78．2％、58．9％,病灶吸收有效率分别为97．1％、86．3％;两组空洞闭合率分别为51．3％、27．5％,空洞治疗有效率分别为91．8％、75％;实验组的胃肠道反应发生率11．6％明显低于对照组26．0％,以上各对应指标之间均有显著差异,P〈0．05。而实验组的总不良反应发生率（20．5％）与对照组的总不良反应发生率（26．5％）无显著差别（Х^2=0．51,P〉0．05）。结论利福平注射液治疗复治肺结核的疗效高于利福霉素钠注射液,安全性相似。     

老年初治痰涂片阳性肺结核病患者化疗方案选择的对比研究

目的　观察不含吡嗪酰胺 (Z)方案在老年营养不良肺结核病患者治疗中的疗效及副作用。　方法　采用随机配对分组法将 92例老年营养不良肺结核病患者分为试验组 (46例 )和对照组(46例 ) ,两组分别采用 2HR(L)E/ 7HR(L)和 2HR(L)ZE/ 4HR(L)治疗 (H异烟肼 ,R利福平 ,L利福喷丁 ,E乙胺丁醇 )。同期选择初治涂阳肺结核非老年组 40例 ,治疗方案同对照组。　结果　疗程结束后 ,试验组 (9个月后 )、对照组 (6个月后 )、非老年组 (6个月后 )痰菌阴转率分别为 89 1%、80 4%、97 5% (P >0 0 5) ,胸部X线片病灶吸收率分别为 86 9%、82 6%、95 0 % (P >0 0 5) ,肝功能损害发生率分别为 15 2 %、3 9 1%、15 0 % ,对照组肝功能损害发生率显著高于试验组与非老年组 (P <0 0 5) ,停药率分别为 2 2 %、2 1 7%、2 5% ,对照组较试验组及非老年组停药率显著增高 (P <0 0 1) ;1年细菌学复发率分别为 4 8%、2 1 6%、2 7% ,试验组、非老年组低于对照组 (P <0 0 5)。　结论　不含Z初治化疗方案治疗老年痰涂片阳性营养不良肺结核病患者 ,治愈率与常规初治化疗方案相近 ,且发生肝损害率低 ,停药率低 ,值得进一步行远期临床观察研究     

立复欣与利福平治疗肺外结核的临床对照研究

目的:分析比较静脉应用立复欣3HRZS(E)/9HR和口服利福平3HRZS(E)/9HR的方案在肺外结核治疗中的作用.     

局部注射药物治疗颈淋巴结结核疗效

目的 探讨局部注药治疗颈淋巴结核的疗效。方法 把颈淋巴结结核63例随机分两组，在用2HRZK／7HR方案的同时，给实验组30例肿大淋巴结内注入1NH Amikacin；对照组33例不作局部肿大淋巴结注药。结果 实验组2周内10例肿大淋巴结缩小，2个月强化治疗后缩小占80％。3个月时缩小占90％。经论 颈淋巴结结核局部注药治疗优于保守治疗。     

环丙沙星和立复欣同时应用时的注意点

环丙沙星和立复欣均为广谱抗生素 ,临床常用。立复欣对结核杆菌有较强的抑制作用 ,广泛应用于结核病的治疗。笔者发现两种药物联合应用时引起输液管内液体浑浊及产生块状物的现象。患者 ,男 ,30岁 ,因患“肺结核”收入结核科治疗。入院后医嘱 :环丙沙星 10 0 ml静滴 bid,5 % GS2 5 0 ml+立复欣 0 .5静滴qd,口服异烟肼 0 .5 qd,肌肉注射链霉素 0 .75 qd。护士遵医嘱用药 ,先滴环丙沙星 ,续接立复欣静滴 ,当立复欣滴入茂菲氏滴管与环丙沙星混合时可见明显浑浊 ,并逐渐产生砖红色块状物。立即更换药液及输液器 ,严密观察病人 ,经观察病人无不…     

胸腔注射立复欣治疗结核性胸膜炎临床应用

目的:研究立复欣胸腔注射治疗结核性胸膜炎的疗效方法:根据我科结核性胸膜患者58例,按年龄、性别、病情轻重均衡分成二组,A组和B组.A组为治疗组:常规用药异胭肼300毫克/日、复合利福平450毫克/日、吡嗪酰胺1.5克/日顿服;SM0.75/日肌注,A组在常规治疗基础上行胸腔穿刺术,并向胸腔内注射立复欣注射液750毫克至1000毫克、1～2次.B组为对照组,常规应用抗结核治疗2HBZS/4HB,行胸腔穿刺术时不向胸腔内注射立复欣.结果:胸腔注射立复欣治疗结核性胸腔炎患者,缩短胸腔水吸收时间,并且减少胸膜粘连,预后较好.     

立复欣在结核性胸膜炎短化中的临床应用

目的通过对立复欣与利福平治疗结核性胸膜炎的临床对照观察,评价立复欣在结核性胸膜炎短化中的效果,以及在短化中寻找最佳治疗效果与治疗成本比的价值.     

Shortening the duration of treatment for cervical tuberculous lymphadenitis.

The aim of the study was to determine the optimal duration of treatment for patients with tuberculous lymphadenitis. The Medline database was searched for relevant articles published between 1978-1997. Inclusion criteria were study populations of patients with predominantly cervical tuberculous lymphadenitis in whom the diagnosis had been confirmed bacteriologically and/or histologically, or was made probable by using clinical and laboratory markers. Treatment management had to include at least isoniazid, rifampicin and pyrazinamide and a follow-up of at least 12 months after the end of treatment. Patients with resistance to rifampicin and pyrazinamide and previous treatment for tuberculosis were excluded. The number of patients who relapsed after treatment was calculated. The study population in eight out of the 35 articles retrieved were suitable for analysis. Some concerned comparative studies. There were eight treatment schedules of 6 months' duration and three schedules of 9 months' duration. Treatment for 6 months resulted in a tuberculous lymphadenitis relapse rate of 13/422=3.3% (95% confidence interval: 1.7-5.5), with a mean follow-up of 31 months after completion of treatment. Treatment for 9 months resulted in a relapse rate of 3/112=2.7% (95% confidence interval: 0.6-7.8), with a mean follow-up of 20 months. Despite the limitations of the literature available, 6 months of therapy is probably sufficient for patients with tuberculous lymphadenitis.     

Clinical experience with short-course chemotherapy in patients with tubercular pleural effusion and lymphadenitis

Twenty-one patients with pleural effusion and 27 patients with lymphadenitis, both tubercular in origin, were administered isoniazid, rifampicin and ethambutol in a daily single dose for 9 months. 100% response was seen in patients with pleural effusion. In the case of tuberculous lymphadenitis the therapeutic response was unsatisfactory, and complete resolution of lymph nodes was achieved in 16 out of 27 patients only (59%). Drug treatment had to be extended for another 3 months which gave 89% response. In view of our present findings, short-course chemotherapy appears not to be the ideal mode of treatment for tuberculous lymphadenitis. There were no side effects from drug therapy in either group of patients.     

辅助超声电导靶位透药治疗结核性胸膜炎的效果分析

目的分析全身抗结核治疗联合超声电导靶位透药导入异烟肼和利福平局部处理在治疗结核性渗出性胸膜炎中的疗效。方法 120例初治结核性渗出性胸膜炎患者,随机分为对照组和超导组各60例;对照组给予常规规则抗结核治疗、胸穿抽液和胸腔内给药,超导组在对照组治疗基础上联合使用患侧胸部局部超声电导靶位透药导入异烟肼和利福平;分别于治疗15、30及60 d查胸腔B超、胸部X片,观察并记录患者的临床症状、胸水量、胸膜肥厚及包裹的情况。比较治疗15及30 d后两组疗效及胸水吸收情况,比较治疗30及60 d后两组胸膜增厚、粘连、包裹等并发症的发生率。结果治疗30 d后,两组所有病例临床症状均缓解,有效率均为100%,差异无统计学意义。治疗30 d后,超导组胸水完全吸收者56例(93.3%),对照组胸水完全吸收者46例(76.7%),超导组胸水完全吸收患者比例高于对照组(P0.05)。治疗30及60 d后,超导组发生胸膜增厚、粘连、包裹等并发症的发生率分别为6.6%及3.3%,对照组分别为23.3%及16.7%,差异均具有统计学意义(P0.05)。结论治疗结核性渗出性胸膜炎时,加用超声电导靶位透药导入异烟肼和利福平早期局部处理,有助于胸水吸收,并减轻胸膜肥厚、包裹等后遗症发生。     

Treatment of tuberculous meningitis in adults with a combination of isoniazid, rifampicin and streptomycin: a prospective study

15 patients with tuberculous meningitis were treated with isoniazid, streptomycin and rifampicin and 14 with isoniazid, streptomycin and ethambutol for 12 months. Both groups received prednisolone at the beginning of treatment. The two groups were compared with regard to clinical improvement, presence of neurological sequelae and mortality. No difference in recovery rate between the groups was observed. 6 patients (21%) died (5 in group I and 1 in group II). Residual sequelae developed in 9 cases (5 in group I and 4 in group II; 31%). The difference between the groups was not significant. The regimen including rifampicin for tuberculous meningitis did not result in any superiority compared to standard therapy.     

颈部淋巴结结核发生结核性脓肿的危险因素分析

目的 探讨颈部淋巴结结核患者发生结核性脓肿的相关危险因素。方法 分析2013年7月至2016年6月于同济大学附属上海市肺科医院住院确诊的符合纳入标准的280例颈部淋巴结结核患者临床资料,分析颈部结核性淋巴结脓肿发生的危险因素。结果 280例颈部淋巴结结核患者中有52例(18.6%)患者在治疗中出现淋巴结脓肿、自行破溃或需要淋巴结切开引流。发生脓肿者中不规范治疗者占38.5%(20/52)、肿大淋巴结直径≥2cm者占76.9%(40/52)、年龄≤45岁者占90.4%(47/52);未发生脓肿者中不规范治疗者占24.6%(56/228)、肿大淋巴结直径≥2cm者占55.3%(126/228)、年龄≤45岁者占77.6%(177/228);差异均有统计学意义(χ²值分别为4.14、8.23、4.30,P值均<0.05)。多因素logistic回归分析显示,不规范治疗(OR=2.53,95%CI:1.31~4.89)、肿大淋巴结直径≥2cm(OR=2.29,95%CI:1.12~4.66)和年龄≤45岁(OR=3.68,95%CI:1.21~11.17)为发生颈部结核性淋巴结脓肿的危险因素。结论颈部淋巴结结核患者治疗不规范、肿大淋巴结直径≥2cm及年龄≤45岁为发生结核性脓肿的独立危险因素,当颈部淋巴结结核患者出现上述危险因素时要警惕发生结核性脓肿的可能。     

含左氧氟沙星方案治疗溃疡型浅表淋巴结结核临床分析

目的分析含左氧氟沙星方案治疗溃疡型浅表淋巴结结核的效果。方法对117例溃疡型浅表淋巴结结核病人随机分成2组;对照组常规应用异烟肼、利福平、吡嗪酰胺抗结核治疗(2HRZ/4HR);治疗组在常规抗结核治疗的基础上,在强化期加用左氧氟沙星。结果治疗组2个月和4个月的临床治愈率36.1%、73.8%,明显高于对照组16.1%、46.4%(p<0.01),6个月治疗组临床治愈率88.5%,也高于对照组71.1%(p<0.05)。治疗组的平均疮口愈合时间56 d,明显短于对照组79 d(p<0.01)。结论溃疡型浅表淋巴结结核强化期抗结核治疗加用左氧氟沙星,能明显缩短疮口愈合时间,提高临床治愈率,近期疗效显著。     

结核性颈淋巴结脓肿治疗80例分析

８０例颈部淋巴结结核性脓肿应用全身化疗的同时，采用切开引流并ＩＮＨ、ＲＦＰ药液（ＨＲ液）治疗。近期治愈率１００％，复发率２．５％。此法切口愈合快、方法简便。     

Lymph node tuberculosis: 7-year experience in Veterans General Hospital, Taipei, Taiwan.

We retrospectively studied 71 cases of lymph node tuberculosis confirmed by culture or pathology from 1983 to 1989. Young adults were most frequently involved and the female to male ratio was 3:2. of 71 patients, three-quarters presented with palpable masses and two-thirds were asymptomatic. The cervical nodes were most frequently involved. Roentgenographic evidence of pulmonary tuberculosis was detected in 42% of patients and sputum culture-positive tuberculosis occurred in 7%. Tuberculin skin testing is less useful in our country due to routine BCG vaccination during infancy and early childhood. Selective excisional biopsy in addition to clinical information was necessary for differential diagnosis. 48 patients received regular treatment and were followed up for at least 1 year. Fresh nodes or enlargement of existing nodes developed in 10% of patients during treatment. Residual nodes were present in 10% of patients at the end of 9-month treatment with rifampicin, isoniazid and ethambutol, including prolonged or modified regimens in some individuals. In conclusion, in areas with a high frequency of tuberculous strains presenting a primary resistance to isoniazid, a 9-month regimen of rifampicin, isoniazid and ethambutol is recommended for lymph node tuberculosis.