纤维支气管镜与肺泡灌洗术对老年重症肺部感染患者治疗前后PaO_2、PaCO_2、SpO_2及pH指标变化的影响

目的探讨老年重症肺部感染患者经纤维支气管镜与肺泡灌洗术治疗对其血氧分压(PaO_2)、血二氧化碳分压(PaCO_2)、血氧饱和度(SpO_2)及pH指标的影响。方法从肺部感染患者中选取114例老年重症患者,并根据其入院顺序随机分为两组,每组57例。对照组采用常规治疗,观察组采用纤维支气管镜与肺泡灌洗术治疗,比较两组治疗效果、临床症状的改善时间、治疗前后的动脉血气指标及不良反应发生情况。结果观察组总有效率高于对照组(P<0.05),肺部啰音的改善时间和住院时间均明显短于对照组(均P<0.05)。组间不良反应发生率比较无统计学意义(P>0.05)。治疗后,两组PaO_2、PaCO_2、SpO_2和治疗前比较差异有统计学意义,且观察组显著优于对照组(均P<0.05);治疗前后和组间pH值差异均无统计学意义(P>0.05)。结论采用纤维支气管镜与肺泡灌洗术治疗老年重症肺部感染患者可以显著改善PaO_2、PaCO_2、SpO_2及pH等动脉血气指标,提高治疗效果,迅速缓解临床症状,预防不良反应的发生,疗效显著。     

纤维支气管镜支气管肺泡灌洗并局部注药治疗支气管扩张合并感染的疗效观察

目的观察对支气管扩张合并感染患者进行纤维支气管镜支气管肺泡灌洗、局部注药的效果。方法选择64例支气管扩张合并感染的患者,将其随机分成两组,对照组进行常规治疗,观察组在常规治疗的基础上进行纤维支气管镜支气管肺泡灌洗、局部注药,然后观察两组的治疗效果。结果对照组总有效率为84.4%,观察组总有效率为96.9%,观察组疗效优于对照组,差异有统计学意义(P<0.05)。观察组患者症状缓解时间短于对照组、平均住院天数少于对照组、治疗后血气分析指标优于对照组,差异有统计学意义(P<0.05)。结论对支气管扩张合并感染患者进行纤维支气管镜支气管肺泡灌洗、局部注药的效果很好,能够明显提高治疗效果,值得在临床上推广使用。     

支气管肺泡灌洗术在支气管哮喘中的应用

目的探讨应用支气管镜行支气管肺泡灌洗术治疗支气管哮喘的作用。方法将常规治疗无效的61例支气管哮喘患者随机分成两组,对照组继续采用支气管舒张剂等常规治疗,支气管镜肺灌洗组在常规治疗基础上加用支气管肺泡灌洗术。治疗前及治疗后48小时观察患者的临床表现,检测第1秒用力呼气容积(FEV1)、呼气峰流速(PEF)等,选用改良英国MRC呼吸困难指数(mMRC)进行病情评估。并对两组患者住院天数进行比较。结果两组患者治疗后哮喘症状、体征好转,肺功能指标及mMRC均得到改善,两组比较,经支气管镜肺灌洗组显著优于对照组,且住院天数缩短,差异具有统计学意义(P0.05)。结论经支气管镜行肺泡灌洗术能清除支气管内黏性分泌物,通畅气道,改善气道的炎症反应,是治疗由黏液栓引起的哮喘急性发作最有效手段,且见效快。     

纤支镜下肺泡灌洗联合依替米星局部给药治疗支气管扩张并感染患者疗效观察

目的观察纤支镜下肺泡灌洗联合依替米星局部给药治疗支气管扩张并感染患者的临床效果。方法选取2016年7月至2018年6月我院收治的支气管扩张并感染患者160作为研究对象,随机分为对照组(75例)与观察组(85例)。在常规对症及抗感染治疗的基础上,对照组患者给予纤维支气管镜下肺泡灌洗治疗;观察组患者在对照组组治疗基础上,给予依替米星局部给药治疗。治疗2周,比较两组患者的疗效、临床表现、动脉血氧分压(PaO_2)、血氧饱和度(SaO_2)、动脉血二氧化碳分压(PaCO_2)以及并发症发生率。结果观察组患者的治疗总有效率(95.3%)明显高于对照组(84.0%),差异有统计学意义(P0.05)。观察组患者发热消退时间、咳嗽咳痰改善时间、肺部炎性病灶消失时间均显著短于对照组,差异有统计学意义(P0.05)。治疗2周后,两组患者的PaO_2、SaO_2、PaCO_2均显著改善,观察组患者的改善情况优于对照组,差异有统计学意义(P0.05)。治疗期间两组患者的并发症发生率比较,差异无统计学意义(P0.05)。结论纤维支气管镜下肺泡灌洗联合依替米星局部给药治疗支气管扩张并感染患者临床疗效显著,可显著改善临床症状及血气状况,治疗安全性高,值得推广应用。     

经纤维支气管镜局部冲洗治疗支气管扩张症53例报告

目的探讨经纤维支气管镜（以下简称纤支镜）局部灌洗注药治疗支气管扩张症的疗效。方法53例支气管扩张病人除常规治疗外，还采用纤维支气管镜反复气道灌洗和注药，在纤维支气管镜治疗前后常规监测患者临床情况、通气换气功能及血气指标。结果灌洗注药后患者体温迅速下降，外周血白细胞、痰液量明显减少，X线胸片明显改善。灌洗后血气指标（PaO2，SaO2及PaO2／FiO2）改善；肺通气功能检测（VC、FEVI、FEVI％、VS0、V25及MVV）明显改善（P〈0．05）。结论经纤维支气管镜肺泡灌洗和注药能有效清除痰痂和气道分泌物，解除支气管的阻塞，改善患者通气换气功能，是一种安全、简便实用的治疗支气管扩张的有效手段。     

支气管肺泡灌洗术治疗重症支气管哮喘30例

目的观察经支气管镜肺泡灌洗治疗重症支气管哮喘的临床应用价值。方法对常规治疗无效的30例重症支气管哮喘患者,行支气管肺泡灌洗治疗。结果 22例患者支气管黏膜明显充血、肿胀,管腔狭窄,腔内可见中等量到大量粘稠分泌物,段支气管可见痰栓形成,其痰液粘稠非常容易堵塞支气管镜,需退出支气管镜冲洗后再次进镜清理,最多1例反复进镜8次才清理干净,一般1-2次即可;5例患者黏膜表面有白色膜状物附着;2例可见支气管异物,为尖椒皮,分别卡在右中叶及左舌叶,并伴有轻度肉芽组织增生;1例由于长期吸入糖皮质激素并发支气管结核,经抗结核治疗后症状缓解。灌洗液培养阳性率66.7%,使后续目标治疗成为可能。结论支气管镜下灌洗治疗重症支气管哮喘可以起到:清理粘液栓,改善通气,缩短抗生素的使用时间;灌洗液培养结果,可指导临床治疗;发现影像学阴性的支气管异物;发现早期支气管结核;可以减少重症哮喘患者对机械通气的需求。而且不良反应少,患者可耐受,改变了以往认为重症支气管哮喘不能行支气管镜检查的观念。因此,对于常规治疗无效的重症支气管哮喘患者,行支气管镜肺泡灌洗治疗可改善预后,值得临床推广应用。     

支气管肺泡灌洗术在支气管哮喘中的应用简

目的 探讨应用支气管镜行支气管肺泡灌洗术治疗支气管哮喘的作用.方法 将常规治疗无效的61例支气管哮喘患者随机分成两组,对照组继续采用支气管舒张剂等常规治疗,支气管镜肺灌洗组在常规治疗基础上加用支气管肺泡灌洗术.治疗前及治疗后48小时观察患者的临床表现,检测第1 秒用力呼气容积（FEV1）、呼气峰流速（PEF）等,选用改良英国MRC呼吸困难指数（mMRC）进行病情评估.并对两组患者住院天数进行比较.结果 两组患者治疗后哮喘症状、体征好转,肺功能指标及mMRC均得到改善,两组比较,经支气管镜肺灌洗组显著优于对照组,且住院天数缩短,差异具有统计学意义（ P ＜ 0.05）.结论经支气管镜行肺泡灌洗术能清除支气管内黏性分泌物,通畅气道,改善气道的炎症反应,是治疗由黏液栓引起的哮喘急性发作最有效手段,且见效快.     

纤维支气管镜治疗重症肺部感染的临床应用

目的观察经支气管镜对局部病灶行支气管肺泡灌洗加全身抗感染治疗重症肺部感染患者的疗效。方法52例重症肺部感染患者随机分为2组,观察组（26例）给予纤维支气管镜行支气管肺泡灌洗及局部用药,每周2次,并全身抗感染及支持对症治疗,根据药敏选用抗生素;对照组（26例）单用抗生素全身抗感染及对症支持治疗。结果观察组26例中治愈15例,好转9例,无效2例,总有效率92.3%明显高于对照组,两组比较有显著性差异（P〈0.05）。结论经支气管镜行支气管肺泡灌洗起到及时吸引分泌物,可明显提高重症肺部感染患者的治愈率,是一种安全、有效、简便、经济,易被患者接受的治疗方法。     

纤支镜灌洗与常规治疗重症肺部感染合并肺不张137例对比分析

目的探讨经纤维支气管镜支气管肺泡灌洗治疗重症肺部感染合并肺不张患者的临床疗效及其临床价值。方法将137例重症肺部感染合并肺不张患者随机分为观察组及对照组,对照组给予抗感染、吸氧、体位引流、对症支持治疗等常规措施治疗,观察组在常规治疗基础上采用纤维支气管镜肺泡灌洗治疗,对比两组患者的临床疗效。结果患者咳嗽等临床症状消失时间、体温正常时间、白细胞恢复正常时间、炎症吸收时间及住院时间观察组明显短于对照组,比较差异具有统计学意义(P0.05);观察组肺复张有效率94.37%,对照组有效率78.79%,比较差异具有统计学意义(P0.05);观察组灌洗后PH值、Sa O2、Pa O2、Pa CO2较灌洗前明显改善,比较差异具有统计学意义(P0.05)。结论经纤支镜肺泡灌洗治疗重症肺炎并肺不张能够有效解除支气管阻塞,更快地改善症状,提高疗效,减少住院时间。     

床边支气管肺泡灌洗治疗术后肺不张

目的探讨床边纤维支气管镜支气管肺泡灌洗治疗术后肺不张的效果及安全性。方法术后肺不张患者25例在床边监护吸氧或机械通气下,表面麻醉后纤维支气管镜插至堵塞部进行支气管肺泡灌洗,观察对比检查前后的胸片、临床表现、经皮血氧饱和度等指标。结果发现22例患者粘稠痰液阻塞一侧主支气管或叶支气管,为阻塞性肺不张,3例在支气管腔内只有少许黏液,为非阻塞性肺不张,治疗后肺完全复张21例(84%),部分肺复张3例(12%),未复张1例(4%);临床表现、血氧饱和度和X线胸片有不同程度改善者24例(94%)。结论术后肺不张均为炎症导致大量痰液堵塞支气管引起,纤维支气管镜床边支气管肺泡灌洗治疗术后肺不张效果确切、安全。     

BiPAP面罩式双水平正压通气治疗重症支气管哮喘33例临床分析

目的探讨BiPAP面罩式双水平正压通气治疗重症支气管哮喘的疗效。方法选择重症支气管哮喘患者68例,随机抽样分为治疗组（33例）和对照组（35例）。治疗组在常规药物治疗基础上行BiPAP面罩式双水平正压通气治疗;对照组予单纯常规药物治疗。观察两组治疗前后的临床症状和血气分析的变化情况。结果治疗组临床症状明显改善,血氧分压（PaO2）、血氧饱和度（SaO：）显著升高,二氧化碳分压（PaCO2）显著降低,与对照组比较差异有统计学意义（P〈0．05）。结论重症支气管哮喘在常规治疗的基础上加用BiPAP面罩式双水平正压通气治疗,可有效改善患者的临床症状、血气分析指标,疗效满意,安全,值得临床推广应用。     

两种治疗联合对危重型哮喘的临床疗效分析

目的分析支气管肺泡灌洗术联合利多卡因雾化吸入对危重型哮喘的临床疗效。方法抽取我院确诊为危重型哮喘的患者72例作为临床研究对象,将其分为两组,对照组予利多卡因雾化吸入治疗,观察组予支气管肺泡灌洗术联合利多卡因雾化吸入治疗,测定并进行分析患者治疗后的作用与手术安全性。结果组间治疗后记录心率、气道压力、动脉血PH的变化比较,P<0.05,具有统计学意义。对照组经过治疗后总有效率仅为55.56%而观察组经过治疗总有效率高达88.89%,P<0.05,具有统计学意义。结论支气管肺泡灌洗术联合利多卡因雾化吸入通过缓解支气管痉挛及减轻支气管阻塞治疗危重型哮喘,能够明显减轻哮喘症状改善患者的生命质量,值得临床研究并大量应用。     

无创正压通气间断雾化吸入在重症哮喘患者中的应用

目的对无创正压通气并经管道雾化吸入治疗重症哮喘的临床疗效进行研究。方法以95例住院治疗的重症哮喘患者为研究对象,随机分为研究组48例和对照组47例,研究组在常规治疗的基础上给予经鼻(面)罩无创正压通气并雾化吸入治疗,对照组给予单纯常规治疗,比较治疗后两组患者的临床疗效及治疗前后的血气情况。结果研究组总有效率为91.66%,明显高于对照组,两组相比差异有统计学意义(P<0.05),两组患者治疗前PH值、PaO2、PaCO2、SaO2及治疗后SaO2相比差异无统计学意义(P>0.05),而治疗后研究组PH值、PaO2及PaCO2得到了明显改善,两组相比差异有统计学意义(P<0.05)。结论无创正压通气并经管道雾化吸入治疗重症哮喘,提高了患者治疗的有效率,降低了并发症的发生率,值得临床推广应用。     

双水平正压无创机械通气治疗重症支气管哮喘的探讨

目的探讨双水平正压无创机械通气治疗重症支气管哮喘的临床效果。方法60例重症支气管哮喘患者随机分为观察组和对照组各30例,对照组采用传统治疗方法,观察组采用无创机械通气模式和基础治疗。比较两组实施治疗前、治疗3d后患者临床症状、体征变化及动脉血气指标（PaCO2、PaO2、SaO2）变化。结果两组患者比较差异有统计学意义,P〈0．01。结论在常规治疗的基础加用无创通气治疗,可有效改善患者的临床症状,安全有效,减少患者痛苦。     

Emergency room assessment and treatment of patients with acute asthma: Adequacy of the conventional approach

The adequacy of emergency room treatment of patients with acute severe asthma was assessed by analyzing the course of 127 visits to the emergency room by 102 patients. Using conventional clinical criteria as an end point (i.e., disappearance of dyspnea, elimination of labored breathing and reduction or elimination of wheezing) in 85.4 per cent of these episodes the patients responded sufficiently to emergency room treatment to allow their discharge. However, the relief of airway obstruction measured directly (1 second forced expiratory volume, FEV₁) was modest (mean FEV₁ on discharge was 57 per cent of the predicted normal value). Approximately one-quarter of those episodes that ended in the patient's discharge from the emergency room were followed by equally severe episodes within 10 days (relapse); 6 per cent of the patients initially discharged who returned to the emergency room required hospitalization. Subjects who had a relapse had significantly less improvement in FEV₁ during treatment and lower FEV₁ values at discharge than those who did not have a relapse (p < 0.05). Finally no clinical or conventional laboratory parameter (e.g., pulsus paradoxicus, sternomastoid muscle contraction, arterial carbon dioxide [PaCO₂] or oxygen [PaO₂] tension) was sufficiently reliable as an index of the degree of obstruction to substitute for the FEV₁. We conclude that (1) the success of emergency room treatment depends on the degree of improvement in pulmonary function achieved; and (2) objective measures (e.g., FEV₁) of the degree of airway obstruction are helpful in predicting the outcome of emergency room treatment of patients with acute asthma.     

急性重症哮喘的临床特点和诊疗分析

目的探讨重症哮喘的临床特点和急诊治疗的方法与临床疗效。方法对我院收治的35例重症哮喘患者的临床资料进行分析,总结重症哮喘的临床特点与急诊治疗方法。并观察对比患者治疗前后的生活质量。结果 35例重症哮喘患者经10～30 min急诊抢救处理后,憋喘、呼吸困难、气促、胸闷、紫绀等临床症状明显缓解,哮鸣音减少,缺氧症状显著改善。34例(97.14%)患者2周后病情稳定后出院,1例(2.86%)患者因年龄大,合并心肺等多器官功能衰竭,抢救无效而死亡。结论重症哮喘患者由于发病突然,病情多变,必须给予及时有效的急救治疗,以取得较好的临床治疗效果。     

Clinical efficacy of omalizumab in an elderly veteran population with severe asthma

Severe asthma in elderly patients is underdiagnosed, difficult to treat, and often accompanied by atopy. This study was designed to compare clinical outcomes of omalizumab therapy in an elderly veteran population with severe allergic asthma. A retrospective, observational data analysis was performed over 2 years. Cohort outcome measures 1 year before omalizumab therapy were compared with 1 year of active treatment. Statistical analysis included two sample t-tests. The total number of patients enrolled was 17 with median age of 60 years. Omalizumab therapy was associated with a significant reduction in acute asthma exacerbations requiring prednisone treatment (p < 0.01), a significant improvement in forced expiratory volume in 1 second of 0.28 L (p < 0.01), and significantly higher Asthma Control Test (ACT) scores at 3 (p = 0.043), 6 (p = 0.039), and 12 months of therapy (p < 0.01). Two of five patients on daily prednisone for >6 months were able to discontinue systemic steroid use within 3 months of omalizumab treatment. Our study suggests elderly patients with severe atopic asthma show a significant positive clinical response to omalizumab.     

Clinical properties of community-acquired pneumonia in patients with asthma]

PURPOSE: Many reports were found on the clinical properties of community-acquired pneumonia. The clinical properties of community-acquired pneumonia in patients with asthma have not been elucidated, and we therefore investigated such properties. MATERIALS AND METHODS: Asthmatic patients who required hospitalization for community-acquired pneumonia from the beginning of 1989 through the end of 2001 were enrolled in this study. We performed the study in a retrospective manner. Patients were divided into two groups based on severity of their asthma (mild to moderate asthma vs severe asthma), and we studied the clinical properties of the pneumonia. RESULT: No significant difference was seen in body temperature, white blood cell counts, or CRP value on admission between the two groups. No significant difference was seen in the resolving period of the pneumonia. The frequency of common pathogens (Streptococcus pneumoniae + Haemophilus influenzae) was lower in patients with severe asthma. Asthmatic patients not taking daily oral corticosteroids were divided into two groups based on whether or not they were using a inhaled corticosteroid, and we examined the frequency of pathogendetection. The percentage of common pathogens was almost the same in the two groups. CONCLUSION: The frequency of common pathogens was lower in patients with severe asthma than in those with mild to moderate asthma. This fact is worth considering when empiric therapy for pneumonia is performed in patients with asthma. Inhaled corticosteroid therapy seems to have no influence on the pathogens of pneumonia in patients with asthma.     

无创双水平气道正压通气治疗中重症支气管哮喘的临床效果观察

目的观察无创双水平气道正压通气(BiPAP)治疗中重症支气管哮喘的临床效果。方法选取2011年4月—2014年2月江西省湘雅萍矿合作医院收治的中重症支气管哮喘患者46例,随机分为对照组和观察组,各23例。对照组采用常规综合治疗,观察组在常规综合治疗基础上加用无创Bi PAP治疗。比较治疗前和治疗72 h后两组患者肺功能指标〔第一秒用力呼气末容积占预计值百分比(FEV1%)和最大呼气流量占预计值百分比(PEF%)〕及血气分析指标(PaO2、PaCO2及SaO2)。结果两组治疗前FEV1%和PEF%比较,差异无统计学意义(P0.05);治疗后观察组FEV1%和PEF%高于对照组(P0.05)。两组治疗前PaO2、PaCO2及SaO2比较,差异无统计学意义(P0.05);观察组治疗后PaO2和SaO2高于对照组,PaCO2低于对照组(P0.05)。结论无创Bi PAP治疗中重症支气管哮喘效果确切,可有效改善患者肺通气功能,迅速纠正低氧及CO2潴留情况。     

无创性正压通气与安定联用救治重症哮喘的疗效分析

目的探讨无创性正压通气与安定联用治疗重症支气管哮喘。方法采用经鼻(口)面罩无创性正压通气,联合应用安全治疗16例重症支气管哮喘患者。结果对此组患者的临床征象有显著改善,无任何并发症。动脉血气治疗前后也有明显差异(P均<0.01)。结论无创性正压通气联合安定是一种重症支气管哮喘有效的治疗手段,且有易于操作、不损害上呼吸道防御功能、减少误吸及无创伤等优点。