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1.
目的 :评价呼出气一氧化氮(Fe NO)检测单独或联合咳嗽变异性哮喘(cough variant asthma,CVA)相关因素对诊断CVA的有效性和准确性。方法:连续纳入2010年8月至2011年10月本院呼吸科门诊因慢性咳嗽行支气管激发试验检查的患者297例,记录病史并测定呼出气Fe NO水平,以支气管激发试验阳性作为CVA诊断的金标准,绘制ROC曲线,探讨诊断CVA的Fe NO临界点。建立Logisitic回归模型,通过分析筛选与CVA相关的因素,根据ROC曲线评价Fe NO联合其他相关因素对CVA的诊断价值。结果:145例患者支气管激发试验阳性并排除其他疾病被诊断为CVA(哮喘组),152例支气管激发试验阴性患者诊断为非哮喘的慢性咳嗽(非哮喘组)。1哮喘组患者Fe NO水平明显高于非哮喘组[(45.33±38.86)ppb比(26.28±23.86)ppb,P  相似文献   

2.
Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n=53) or nasotracheal (n=58) intubation. All had a nasogastric feeding tube. Patients with head trauma or mechanical ventilation for less than 48h were excluded. Sinusitis diagnosis was made by radiography (waters' view) at the bedside. The two groups were similar in age, SAPS, duration of ventilation. Maxillary sinusitis occurred in 1/53 (1.8%) of the orotracheal group (on the nasogastric tube side), and in 25/58 (43.1%) of the nasotracheal group (7 on the nasogastric tube side, 11 on the endotracheal tube side, 7 bilateral;p<0.001). Nine of the 26 cases of sinusitis were initially treated by sinus drainage because of signs of infection (3 failures) and the 17 others were treated by tube removal. This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p<0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.  相似文献   

3.
目的探讨老年与非老年组患者慢性咳嗽病因构成及咳嗽严重程度。方法 58例老年和82例非老年不明原因慢性咳嗽患者,按照慢性咳嗽的解剖学诊断程序,根据病史、体格检查、实验室检查及相关辅助检查明确病因,咳嗽积分评价咳嗽严重程度。结果老年组常见病因依次为:咳嗽变异性哮喘(CVA)23例,上气道咳嗽综合征(UACS)16例,胃食管反流性咳嗽(GERC)8例;非老年组常见病因依次为:CVA 31例,UACS 26例,GERC 10例。两组主要病因构成比较差异无统计学意义(P〉0.05)。两组患者各病因间的日间咳嗽积分比较差异无统计学意义(P〉0.05),CVA的夜间积分明显高于其他病因(P均〈0.01)。结论与非老年组类似,CVA、UACS、GERC也是老年不明原因慢性咳嗽的常见病因,不同病因慢性咳嗽的日间咳嗽程度类似,但CAV夜间咳嗽程度显著高于其他病因的咳嗽。  相似文献   

4.
目的:了解儿童慢性咳嗽的病因及随访情况,做出准确诊断。方法对汕头市澄海区人民医院134例慢性咳嗽患儿按《儿童慢性咳嗽诊断与治疗指南》的诊断流程询问病史,行体格检查,在初步确定病因后,针对病因进行特异性治疗并进行随访,根据辅助检查及疗效做出最终诊断,并进行病因分析。结果1)134例慢性咳嗽患儿病因依次为咳嗽变异性哮喘(CVA)52例(38.81%),呼吸道感染和感染后咳嗽(PIC)39例(29.10%),上气道咳嗽综合征(UACS)30例(22.39%),胃食道反流性咳嗽(GERC)3例(2.24%),气管异物2例(1.49%),不明原因8例(5.97%)。2)不同年龄组病因构成比不同:≤3岁组中,主要病因为PIC(28例,49.12%),>3~6岁组中,主要病因为CVA (29例,59.18%),>6~14岁组中,主要病因为UACS(15例,53.57%)。3)总诊断修正率为8.96%(12/134)。结论汕头市澄海区人民医院儿童慢性咳嗽的病因前3名依次为CVA、PIC、UACS;不同年龄组病因构成比不同;儿童慢性咳嗽的诊治的过程要遵循观察、等待、随访的原则。  相似文献   

5.
The aim of this study was to determine the frequency of misdiagnosis of sinus headache in migraine and other primary headache types in the children and adolescents with chronic or recurrent headaches. Children with chronic or recurrent headaches (n = 310) were prospectively evaluated. Data collection for each patient included history of previously diagnosed sinusitis due to headache, and additional sinusitis complaints (such as fever, cough, nasal discharge, postnasal discharge) at the time of sinusitis diagnosis, and improvement of the headache following treatment of sinusitis. If sinus radiographs existed they were recorded. The study included 214 patients with complete data. One hundred and sixteen (54.2%) patients have been diagnosed as sinusitis previously and 25% of them had at least one additional complaint, while 75% of them had none. Sinusitis treatment had no effect on the headaches in 60.3% of the patients. Sinus graphy had been performed in 52.8%, and 50.4% of them were normal. The prevalence of sinus headache concomitant with primary headache, and only sinus headache was detected in 7 and 1%, respectively, in our study. Approximately 40% of the patients with migraine and 60% of the patients with tension-type headache had been misdiagnosed as “sinus headache”. Children with chronic or recurrent headaches are frequently misdiagnosed as sinus headache and receive unnecessary sinusitis treatment and sinus graphy.  相似文献   

6.
目的 探讨常见慢性咳嗽的病因及疾病表现的临床意义,为经验性治疗提供依据.方法 按慢性咳嗽的病因诊断流程对160例患者的病因构成进行分析,比较常见病因慢性咳嗽患者的咳嗽时相、性质、诱发因素及相关伴随症状,统计方法采用U检验,计算P值.结果 共入选160例2009年1月至12月宜昌市中心人民医院呼吸科门诊慢性咳嗽患者,其中常见病因分布依次为咳嗽变异性哮喘(CVA) 72例占45.00%、上气道咳嗽综合征(UACS) 54例占33.75%、嗜酸性粒细胞性支气管炎(EB) 14例占8.75%、胃食管反流性咳嗽(GERC)9例占5.63%,其他病因共11例、占6.87%.不同病因组临床表现有差异.CVA患者夜间咳嗽构成比为52.8(38/72),明显高于其他病因;UACS患者以白天咳嗽为主,70.2%伴有鼻后滴流症状,且绝大部分伴有鼻炎相关症状或有鼻炎病史,高于其他各组;GERC患者饮食相关咳嗽占66.7%,77.8%伴有反流症状明显高于其他病因组;上述症状差异均有统计学意义.但EB患者临床症状无特异性.结论 各种病因的慢性咳嗽具有一定的临床特征,慢性咳嗽病因构成及咳嗽时相、部分伴随症状对病因诊断具有一定的参考价值.  相似文献   

7.
OBJECTIVES: Prolonged hypokinesia (HK) induces significant electrolyte changes, but little is known about the effect of prolonged periodic hypokinesia on plasma, urinary, and fecal K. The aim of this study was to measure potassium (K) changes during prolonged periodic (PHK) and continuous (CHK). DESIGN AND METHODS: Studies were done during the pre HK and HK periods. Thirty male athletes were chosen as subjects. They were divided equally into three groups: unrestricted ambulatory control subjects (UACS), continuously hypokinetic subjects (CHKS), and periodically hypokinetic subjects (PHKS). The CHKS group was kept on a running distance of 0.7 km/day, while the PHKS group kept on a running distance of 0.7 and 11.7 km/day for 5 days and 2 days per week, respectively. The UACS group was on a running distance of 11.7 km/day. RESULTS: The following were measured: fecal K excretion; urinary K; sodium (Na) and chloride (CI) excretion; plasma K; Na and CI concentration; plasma renin activity (PRA) and plasma aldosterone (PA) concentration; physical characteristics; and peak oxygen uptake. Fecal K, urinary K, Na and CI excretion, plasma K, Na and CI concentration, and PRA and PA concentration, increased significantly (p< or =0.01) in the CHKS and PHKS groups when compared with the UACS group. Body weight and VO2 peak decreased significantly (p< or =0.01) in the CHKS group, while body weight increased and VO2 peak decreased significantly (p< or =0.01) in the PHKS group when compared with the UACS group. The measured parameters changed much more in the PHKS group than in the CHKS group. By contrast, the measured parameters did not change significantly in the UACS group when compared with the baseline control values. CONCLUSION: It was shown that prolonged PHK and CHK induce significant plasma and excretory K changes; however, plasma and excretory K changes were much greater in the PHKS group than in the CHKS group. It was concluded that the greater the stability of muscular activity, the smaller the plasma, urinary, and fecal K changes during prolonged HK.  相似文献   

8.
Aspergillosis typically occurs in patients with reduced host defenses; such patients include renal and marrow recipients as well as patients with chemotherapy-induced myelosuppression. Pulmonary structures are most frequently involved; non-pulmonary involvement (including sinus) has not been frequently reported. In the present study, paranasal sinusitis occurred in 52 myelosuppressed cancer patients treated over 5 years at the UMCC with chemotherapy. Twenty-one patients had Aspergillus sinusitis; Aspergillus spp., including flavus and niger, were directly recovered from sinus in 19 of the 21 infections. Two other patients were considered clinically, although not microbiologically, documented. Multiple predisposing factors for Aspergillus sinusitis during the 60 days prior to infection diagnosis appear to exist; these include: 1) granulocyte count less than 500 mm3 (mean duration, 42 days versus 14 days for sinusitis of other etiology; P less than 0.001); 2) prolonged hospitalization (mean duration, 22 days versus 14 days for patients with non-fungal sinusitis; P less than 0.001); and 3) prolonged antibiotic therapy (mean duration, 22 days versus 9 days; P less than 0.001). The Aspergillus sinusitis resolved in 18 of 21 patients following treatment with amphotericin B; however, 11 of 18 patients had infection recurrence that always developed when tumor recurred and chemotherapy was reinstituted.  相似文献   

9.
BACKGROUND: Nasal nitric oxide (nNO) values are reduced in patients with cystic fibrosis (CF). Humming during nNO measurement increases nNO values in healthy subjects. Nasal NO is reduced in patients with CF, sinus disease or nasal polyps. Humming nNO values have not been reported in CF patients yet. Our aim was to explore humming nNO values in CF patients and assess whether nNO during humming is a better discriminator than silent nNO measurements in this patient group. MATERIALS AND METHODS: In a cross sectional study we measured nNO concentrations in healthy controls (HC) and in CF patients (n = 23 and 31, respectively). The participants held their breath for 10 s while air was passively extracted from one nostril with 700 mL min(-1) for direct NO measurements (NIOX chemiluminescence analyser). Subsequently nNO was measured during humming with the mouth closed for 10 s. RESULTS: Mean nNO in parts per billion (p.p.b.) (SD) during breath hold was 499 (164) and 240 (139), respectively. The median nNO peak (p.p.b., minimum-maximum) during humming was 1500 (425-4100) for HC and 120 (23-500) for CF. There was a highly significant difference between nNO both with and without humming between CF and HC (P < 0.01). The sensitivity and specificity of nNO for detecting CF were better with humming. CONCLUSION: Nasal NO concentrations with and without humming are significantly decreased in CF. Humming nNO is an excellent discriminator between HC and CF and performs better than silent nNO.  相似文献   

10.
Objectives: Patients with chronic viral hepatitis usually present metabolic abnormalities and hemodynamic changes, which are known factors associated with the development of coronary artery disease (CAD). This study aims to determine the risk factors of incident CAD in these patients. Methods: We identified 193 patients who subsequently developed CAD amongst 37,840 cases diagnosed as chronic viral hepatitis from January 2007 through December 2013. Results: In these patients, 141 had hepatitis B virus infections and 52 had hepatitis C virus infections. There was a male preponderance (65.9%). The median age at the diagnosis of hepatitis was 51 years. In the univariate analysis, patients aged ≥ 51 years had shorter median periods from the diagnosis of hepatitis to the onset of CAD than patients aged < 51 years (50 versus 96 months, p < 0.001), and patients with hypertension had shorter median durations compared to those without hypertension (48 versus 96 months, p < 0.001). Statistical significance also existed between patients with different etiologies (p = 0.004). In the multivariate analysis by Cox regression, age at the diagnosis of hepatitis (p < 0.001; hazard ratio (HR), 1.041; 95% CI, 1.027–1.056) and hypertension (with versus without, p < 0.001; HR, 1.925; 95% CI, 1.419–2.611) were revealed. Conclusions: Age at diagnosis of hepatitis and hypertension appeared to be independent risk factors of incident CAD in these patients. This topic deserves further studies.  相似文献   

11.
目的探讨慢性咳嗽患者的呼吸道嗜酸性粒细胞炎性反应特征。方法使用诱导痰嗜酸性粒细胞计数检查123例慢性咳嗽患者的呼吸道嗜酸性粒细胞性炎性反应情况,其中咳嗽变异型哮喘(CVA)44例、嗜酸性粒细胞性支气管炎(EB)27例、上气道咳嗽综合征(UACS)26例、变应性咳嗽(AC)17例和胃食管反流相关性咳嗽(GERC)9例。收集56例典型哮喘(CA)患者和25例健康者的诱导痰嗜酸性粒细胞计数结果进行统计学比较。结果慢性咳嗽患者呼吸道嗜酸性粒细胞炎性反应的阳性率为0.487 8(60/123),其中,CVA组和EB组分别为0.750 0(33/44)和1.000 0(27/27),其他病因组均为0.000 0。CVA组与EB组之间的差异具有统计学意义(P=0.005),CVA组与CA组[0.821 4(46/56)]之间的差异无统计学意义(P=0.507),EB组与CA组之间差异具有统计学意义(P=0.019),CVA组、EB组分别与UACS组、AC组、GERC组、健康对照组比较,差异具有统计学意义(P值均为0.000)。呼吸道嗜酸性粒细胞炎性反应患者的诱导痰嗜酸性粒细胞比值,EB组低于CVA组(Z=-2.551,P=0.011)和CA组(Z=-3.190,P=0.001),CVA组与CA组之间差异无统计学意义(Z=-0.801,P=0.423)。结论嗜酸性粒细胞性炎性反应是慢性咳嗽患者的一种主要的呼吸道炎性反应类型,主要见于CVA和EB患者。CVA和EB的呼吸道嗜酸性粒细胞性炎性反应程度不同。  相似文献   

12.
目的:探讨原发性纤毛运动障碍(primary ciliary dyskinesia,PCD)患者的临床特征.方法:回顾性分析2009年1月至2020年12月复旦大学附属中山医院收治的20例PCD患者的临床特征,包括人口学资料、家族史、既往史、发病时主要症状、影像学资料、痰培养结果、肺通气功能及弥散功能检查结果、血气分析...  相似文献   

13.
OBJECTIVE: Cough frequency and severity with fosinopril and enalapril were assessed in hypertensive patients with previous angiotensin-converting enzyme inhibitor (ACEI)-associated cough. DESIGN: Prospective, multicenter, randomized, 8-week double-blind treatment. PATIENTS: One hundred seventy-nine patients (mild-to-moderate hypertension, nonsmokers, mean age 58 years; 55% females; 72% Caucasian, 6% black, 19% Hispanic) were studied. Patients with other cough etiologies, significant co-morbidity, or confounding medications were excluded. INTERVENTIONS: Patients were randomized to fosinopril 10 mg (n = 85) or enalapril 5 mg (n = 94) once daily. Dosage could be doubled for blood pressure control after 4 weeks. Outcome measurements: The primary end point was all-cough frequency based on patient daily diary ratings; a cumulative cough frequency score was calculated. Secondary end points included cough severity, nonproductive cough frequency, night awakenings, cough time of day, and spontaneously reported cough. RESULTS: Fosinopril and enalapril demonstrated similar blood pressure control. Significant cough profile differences were observed in favor of fosinopril: all-cough frequency was 40.6 plus minus 3.8 (mean plus minus SE) versus 52.8 plus minus 3.6 (p = 0.02); nonproductive cough frequency was 26.7 plus minus 3.5 versus 40.3 plus minus 3.4 (p less-than-or-equal 0.01); and cough time of day was 49.2 plus minus 5.2 versus 66.0 plus minus 5.0 (p = 0.02), for fosinopril and enalapril, respectively. Subgroup analysis revealed all-cough frequency was 33.5 plus minus 6.3 versus 56.6 plus minus 5.3 (p = 0.006) for fosinopril and enalapril, respectively, in patients who previously had cough on one of these two ACEI (predominantly enalapril). Ten (12%) fosinopril and 25 (27%) enelapril patients spontaneously reported cough (p = 0.01). CONCLUSIONS: Hypertensive patients with previous ACEI-associated cough reported less frequent cough with fosinopril compared to enalapril, based on cumulative patient diary scores and spontaneously reported cough. This difference was most apparent in the subgroup of patients who previously experienced cough associated with enalapril therapy. Patients with prior ACEI-associated cough may experience less frequent with fosinopril.  相似文献   

14.
目的:观察美敏伪麻溶液(商品名:惠菲宁)治疗上呼吸道咳嗽综合征(UACS)的临床疗效。方法:治疗组服用美敏伪麻溶液,对照组服以复方甘草片,观察14天。结果:临床治愈率治疗组为77.50%,总有效率为95.00%。临床治愈率对照组为50.00%,总有效率为82.50%。治疗效果有显着差异(P<0.05)。结论:美敏伪麻溶液治疗UACS效果良好且优于复方甘草片。  相似文献   

15.
目的比较单纯慢性牙周炎、牙周牙髓联合病变及慢性根尖周炎引起牙源性上颌窦炎(OMS)的影像学特征,探讨3种口腔慢性炎症导致的骨质破坏情况与上颌窦粘膜的形态学变化。方法选择未经治疗的3种口腔慢性炎症引起OMS患者各50例,对其锥形束CT影像学表现进行分析和精确测量,记录病源牙及其周围骨质破坏情况、上颌窦炎性肥厚的最大厚度值(DSM),进行统计分析。结果3种OMS中,病源牙为上颌第一磨牙者最多,占35.33%;其次为上颌第三磨牙,占27.33%;再次为上颌第二磨牙,占20.00%;病源牙超过2颗者占14.67%。颊/腭侧骨壁破坏患者上颌窦粘膜DSM为9.04±5.04 mm,高于无颊/腭侧骨壁破坏患者的6.94±5.03 mm(t=2.560,P=0.011);上颌窦底壁瘘患者上颌窦DSM为11.49±6.68 mm,高于无上颌窦底壁瘘患者的6.67±3.75 mm(t=5.541,P<0.001)。单纯慢性牙周炎、牙周牙髓联合病变及慢性根尖周炎上颌窦底壁瘘发生率分别为40%、34%和24%,组间差异无统计学意义(χ2=2.703,P=0.259)。单纯牙周炎源性(9.26±5.33 mm)和牙周牙髓联合病变(10.24±4.93 mm)的DSM显著高于慢性根尖周炎(4.26±2.49 mm)(F=26.157, P<0.001)。结论单纯慢性牙周炎和牙周牙髓联合病损骨质破坏范围较广,上颌窦粘膜炎性肥厚改变的程度较重,相对于慢性根尖周炎更易发生牙源性上颌窦炎。  相似文献   

16.
Objective The study was conducted to examine factors associated with hospital deaths among a group of cancer patients.Patients and methods A retrospective chart review of the M. D. Anderson Cancer Center Tumor Registry was conducted. Participants were all adult cancer patients, residents of the State of Texas diagnosed and treated since January 1, 1990, and who died during the years 1999 and 2000. The study outcome was the site of death.Main results The inclusion criteria were met by 866 patients of whom 504 (58%) died in a hospital. The group included 489 (56%) men. A number of 641 (74%) were White, 104 (12%) Hispanic, 92 (11%) Black, and 29 (3%) of other origin. The majority, 501 (58%), had been diagnosed with stage IV disease, and the median survival time was 14 months. Multivariate logistic regression analysis showed patients diagnosed with hematologic cancers to be significantly more likely (p<0.001) of dying in hospitals, odds ratio [OR 2.88] and confidence interval [95% CI 1.79–4.63], women diagnosed with breast and gynecological cancers were significantly less likely (p=0.03) of dying at hospitals odds ratio [OR 0.64] and confidence interval [95% CI 0.42–0.96], when compared with patients diagnosed with other cancers. Lower household income per zip code of residency was marginally associated (p=0.06) with hospital deaths.Conclusions The study identified groups of cancer patients at risk of hospital death. These results should account when planning the allocation of hospital palliative care services as well as when informing policy decisions about health care financing and delivery of these services.We want to state that no financial support was provided for this study  相似文献   

17.
目的探讨鼻内镜在儿童后鼻滴漏综合征诊断中的作用。方法回顾性分析2004年1月~2006年7月该院在鼻内镜下诊断的48例以后鼻滴漏为主要临床特点而并发慢性咳嗽的鼻-鼻窦疾病患儿的诊治过程。结果该组患儿中变应性鼻炎、鼻窦炎混合感染25例(52.1%)(其中并发鼻息肉2例)、慢性鼻窦炎13例(27.1%)、慢性鼻炎8例(16.7%)、急性腺样体炎2例(4.17%)。均以慢性咳嗽为主诉,平均咳嗽时间达3.1个月。经过积极的抗炎与抗变态反应治疗以及必要的手术治疗,35例(72.9%)咳嗽症状消失,13例(27.1%)症状明显减轻。结论鼻内镜视野清晰,镜体纤细,弥补了儿童检查不配合、鼻咽部难窥视的缺点,因此,鼻内镜在儿童后鼻滴漏综合征诊断中具有重要作用。  相似文献   

18.
19.
OBJECTIVE: To evaluate our experience with patients who presented with chronic cough and how exhaled nitric oxide predicted response to inhaled corticosteroid (ICS) therapy. PATIENTS AND METHODS: This retrospective observational study of 114 patients evaluated for chronic cough with measured exhaled nitric oxide and methacholine challenge testing was conducted from December 1, 2004, through November 30, 2005. Clinical records were extracted. Patients with no documented follow-up were contacted by telephone and administered a questionnaire. RESULTS: In 64 patients, ICS therapy was started or the current ICS dose increased. Forty-one patients had elevated exhaled nitric oxide levels (defined as >or=35 ppb), 36 (88%) of whom had significant improvement in their chronic cough (likelihood ratio of a positive response, 4.9; 95% confidence interval, 2.2-10.9). Twenty-three patients with exhaled nitric oxide levels in the reference range were also prescribed ICS, and only 2 had cough improvement (likelihood ratio of a negative response, 0.07; 95% confidence interval, 0.02-0.25). Patients had documented follow-up that ranged from 4 weeks to 16 months. A cutoff of 38 ppb was found to best differentiate ICS responders and nonresponders. CONCLUSIONS: Measurement of exhaled nitric oxide accurately predicted response to ICS therapy for chronic cough. Patients with a positive exhaled nitric oxide test result had a strong likelihood of response to ICS, whereas a negative exhaled nitric oxide test result indicated an unlikely response to ICS. This finding may potentially have an impact on how patients with chronic cough are evaluated and treated.  相似文献   

20.
目的探讨鼻咽喉内镜检查对儿童上气道咳嗽综合征(UACS)的病因分析及诊断方面的应用价值。方法对该院2014年1月-2016年12月确诊为UACS的132例患儿经鼻咽喉内镜检查的结果进行分析研究。结果 132例患儿中发现有上气道病变因素者125例(94.70%)。其中,常见因素为鼻窦炎43例(32.58%),慢性鼻炎32例(24.24%),腺样体肥大13例(9.85%),慢性咽炎11例(8.33%),慢性扁桃体炎(扁桃体肥大)9例(6.82%)。在不同年龄段中,上气道病变因素分布有所不同,差异有统计学意义(P0.05)。结论鼻咽喉内镜检查在UACS病因分析及诊断中能够准确、及时发现上气道局部病变情况,为临床精准诊治提供良好帮助,是一种安全有效的检查方法,在临床上值得推广使用。  相似文献   

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