支气管镜肺泡灌洗在尘肺并阻塞性肺炎的应用价值

目的观察支气管镜肺泡灌洗在治疗尘肺合并阻塞性肺炎中的临床疗效及安全性。方法将168例尘肺并单纯阻塞性肺炎患者随机分为观察组及对照组各84例,对照组给广谱抗感染联合舒张支气管、祛痰等治疗,观察组在此基础上给予支气管镜肺泡灌洗治疗,治疗后比较临床疗效及抗生素使用天数、住院天数和住院费用。结果观察组有效率96.4%,对照组有效率69.1%,两组比较差异有统计学意义,P0.05;观察组平均抗生素使用天数、住院天数及住院费用均明显短于对照组,P均0.05。观察组未见严重并发症。结论经支气管镜肺泡灌洗治疗尘肺合并阻塞性肺炎能早期改善患者临床症状,提高疗效,缩短患者抗生素使用疗程,减少患者住院天数及住院费用,且安全,值得临床推广应用。     

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。     

支气管镜治疗支气管扩张症重症感染患者的疗效分析

目的观察支气管扩张症重症感染患者应用支气管镜吸痰及抗生素灌洗治疗的疗效。方法选择我院100例支气管扩张症重症感染患者,随机分为治疗组(50例),对照组(50例),两组的年龄、性别、血气分析、血常规等检查方面,比较无差异(P0.05)。对照组给予常规的吸氧、化痰、敏感抗生素、必要时的机械通气治疗,治疗组在常规治疗的基础上,联合纤维支气管镜吸痰及敏感抗生素肺泡灌洗治疗,对比两组的临床症状缓解时间、血气分析、血常规、住院时间。结果治疗组比较对照组,临床症状缓解时间、住院时间均明显缩短,血气分析及血常规改善明显。结论支气管镜吸痰及抗生素灌洗治疗是治疗支气管扩张症重症感染患者的有效方法。     

经支气管镜肺泡灌洗对支气管扩张合并感染的疗效观察

目的:观察经支气管镜行肺泡灌洗对支气管扩张合并感染的疗效。方法:选取58例支气管扩张合并感染患者,随机分为对照组和灌洗组,各29例。对照组采取吸氧、拍背排痰、全身应用抗菌药和维持水电解质平衡、营养支持等常规治疗;灌洗组在对照组基础上,经支气管镜进行肺泡灌洗治疗。比较2组患者的总有效率、治疗后病原菌清除率、住院时间、半年内再次就诊次数。结果:治疗后灌洗组的总有效率高于对照组(93.1%vs 75.9%,P0.05);病原菌清除率高于对照组(86.2%vs 65.5%,P0.05);住院时间及半年内再次就诊次数少于对照组(均P0.05)。结论:经支气管镜肺泡灌洗对支气管扩张合并感染患者疗效显著,值得临床普及应用。     

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。     

纤支镜深部痰培养在支气管扩张症外科治疗中应用价值

目的探讨纤维支气管镜深部痰培养在支气管扩张症外科治疗中的应用价值。方法分析本院胸外科确诊并行手术治疗支气管扩张症临床病历资料。结果 53例分两组,深部痰培养组36例,未行深部痰培养组17例,术后总有效率(治愈+好转)96.2%;两组患者治愈率、术后并发症及平均住院天数有统计学差异(P<0.05)。结论纤维支气管镜术前术后深部痰培养明显提高支气管扩张症病原检出率,抗生素有效应用提高手术疗效,降低术后并发症。     

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。     

支气管灌洗术在支气管扩张症治疗中的作用

目的 分析支气管灌洗术在支气管扩张症治疗中的效果.方法 选取82例支气管扩张症者予以支气管灌洗术作为观察组,再抽取予以抗生素等常规治疗的80例支气管扩张症者对比作为对照组;观察、分析两组临床疗效等.结果 观察组近期疗效（总有效率86.59%）、远期效果（82.93%）,均高于对照组;且观察组临床症状、体征消失或改善时间和抗生素应用时间和住院时间较对照组缩短（P〈0.05）.结论 支气管灌洗术在支气管扩张症治疗中应用效果显著且起效迅速.     

支气管肺泡灌洗联合注药治疗支气管扩张合并感染的疗效观察

目的探讨支气管肺泡灌洗联合注药治疗支气管扩张合并感染的疗效。方法选取支气管扩张合并感染患者86例,随机分为治疗组和对照组,各43例,对照组给予常规治疗,治疗组在此基础上采取支气管肺泡灌洗联合局部注入敏感抗生素治疗。结果治疗组治疗后,总有效率显著高于对照组,差异有统计学意义(P0.05);咳嗽、咳痰等症状及体征缓解时间明显短于对照组,差异有统计学意义(P0.05);两组治疗前血气分析中PaO_2(mmHg)对比,差异无统计学意义(P0.05),治疗后治疗组PaO_2(mmHg)明显好对于对照组(P0.05);治疗组细菌清除率明显好于对照组,差异有统计学意义(P0.05)。结论支气管肺泡灌洗联合局部注药治疗支气管扩张合并感染的疗效快速、安全、有效。     

支气管肺泡灌洗治疗支气管扩张合并感染的临床研究

目的观察对支气管扩张合并肺部感染患者经纤支镜支气管肺泡灌洗治疗的临床疗效。方法将48例支气管扩张合并肺部感染患者随机分为灌洗组及对照组,灌洗组26例,对照组22例,均在全身应用抗菌药物及祛痰药的基础上,灌洗组在生命体征监护下进行床旁纤支镜吸痰及支气管肺泡灌洗术治疗,对照组体位引流排痰。分析比较两组临床表现、化验和影像学变化以评价肺部感染控制情况。结果纤支镜支气管肺泡灌洗治疗后较治疗前动脉血氧分压（PaO2）、氧合指数（PaO2／FiO2）明显提高,治疗后动脉血氧分压（PaO2）、氧合指数（PaO2／FiO2）灌洗组较对照组明显增高,灌洗组有效率明显高于对照组。灌洗组显效10例,好转12例,有效率为85％;对照组显效5例,好转9例,有效率为64％,两组有效率比较,P〈0．05。无气胸及严重气道内出血等并发症。结论经纤支镜支气管肺泡灌洗是治疗支气管扩张合并肺部感染的有效方法。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。