支气管镜检查中引起的严重并发症及其防治对策分析

目的探讨支气管镜检查引起的严重并发症及其防治对策。方法回顾分析该院呼吸科1983年7月至2010年12月接受支气管镜检查的5 986例患者出现的严重并发症及其防治对策。结果 5 986例接受支气管镜检查的患者中出现严重并发症35例(5.85‰),其中,喉、气管或支气管痉挛16例(2.67‰),大出血14例(2.34‰),严重心律失常4例(0.67‰),因大出血抢救无效死亡1例(0.17‰)。结论支气管镜检查可引起严重并发症,规范操作、严格掌握适应证及检查前的充分准备是预防严重并发症的关键。     

髂内动脉介入化疗治愈难治性恶性葡萄胎1例

患者23岁,住院号221284,孕1产0。葡萄胎术后两月余,尿妊免试验持续阳性,阴道出血入院,入院检查子宫鹅蛋大、软,血 HCG 放免>1720ml~/ml(正常<120ml~/ml),B 超子宫后壁肌层浸润诊断为恶性葡萄胎行全身化疗,第一疗程5—Fu 1400mg静滴1/日×10,病情不见好转;第二疗程5—Fu 1300mg、更生霉素250μg 静滴1/日×8,化疗后子宫比入院时增大,B 超子宫后壁肌层浸润扩大,内向宫腔突出,内膜线显示不清,外向浆膜层有穿破之势,尿妊免试验仍持续阳性,血清 HCG浓度14.4毫微克/毫升(正常<3.1),化疗反应极重,恶心、呕吐、拒食、腹泻4—10次/     

伊洛前列素对低氧性肺动脉高压大鼠肺部内皮素-1表达的影响

目的 探讨伊洛前列素对低氧性肺动脉高压(HPH)大鼠肺部内皮素-1(ET-1)的影响.方法 雄性SD大鼠32只,分为正常(NC)组,正常治疗(NT)组,低氧(HC))组,低氧治疗(HT)组,每组8只.NC组和NT组在常氧条件下饲养3周;HC和HT组放置于低氧舱(O2浓度10％)进行缺氧处理3周(8 h/d);NT和HT组每天进行伊洛前列素雾化吸入治疗(2μg/kg).第3周结束时,测量各组平均肺动脉压(mPAP),右心室收缩期末压力(RVSP),右心室肥厚指数.HE染色观察各组肺动脉形态学变化,计算肺小动脉的血管壁厚百分比(WT％),RT-PCR分析各组肺组织匀浆中ET-1的变化趋势.结果 HC组大鼠血流动力学指标较其他组明显升高,HT组相关指标表达与NC组比较差异无统计学意义(P＞0.05).HC组较其他组肺动脉管壁增厚、管腔狭窄明显;HT组则有不同程度逆转.HC组大鼠肺组织匀浆中ET-1表达较NC组明显升高,HT组中ET-1表达与NC组比较差异无统计学意义(P＞0.05).结论 伊洛前列素对HPH有明显的治疗作用,可以降低HPH大鼠肺部ET-1的释放,阻止肺血管重塑.     

The Effect of Ginkgo Biloba Extract on the Expression of PKCα in the Inflammatory Cells and the Level of IL-5 in Induced Sputum of Asthmatic Patients

To investigate the effect of the Ginkgo Biloba Extract （GBE） on the asthma and examine its possible mechanisms, 75 asthma patients were divided into 4 groups and the patients were respectively treated with fluticasone propionate for 2 weeks or 4 weeks, or treated with fluticasone propionate plus GBE for 2 weeks or 4 weeks. Fifteen healthy volunteers served as healthy controls. Sputum inhalation with inhaling hypertonic saline （4%-5%） was performed. Lung ventilatory function and forced expiratory volume in one second （FEVI） were measured. The numbers of different cells in induced sputum were calculated. The expression of PKCα in the cells was immunocytochemically detected and the percentages of positive cells in different cells were counted. Interleukin-5 （IL-5） in sputum supernatants was detected with enzyme-linked immunosorbent assay. The percentage of eosinophils, lymphocytes, PKCα positive inflammatory cells and the concentration of IL-5 in asthmatic patients were higher than those in the controls （P〈0.05）, and the eosinophils, lymphocytes, positive expression of PKCα and the level of IL-5 were significantly decreased in asthmatic patients after they were treated with fluticasone propionate or fluticasone propionate plus GBE. However, they were still significantly higher than those of the controls. Compared to the group treated with glucocorticosteroid for 2 weeks, no significant decrease was found in the percentage of eosinophils, lymphocytes, PKCα positive inflammatory cells and the IL-5 in the supernatant of induced sputum. Compared with the group treated with glucocorticosteroid for 2 or 4 weeks, significant decrease in the same parameters was observed in the group treated with fluticasone propionate and GBE for 4 weeks. The IL-5 level in the supernatant of induced sputum was positively correlated with the percentage of PKCα-positive inflammatory cells and the percentage of eosinophils in the induced sputum in asthma patient groups respectively （n=150, r=0.83, P〈0.01; n=150,     

微波消融治疗恶性肺结节进展

近年肺结节检出率逐渐升高。微波消融治疗肺结节具有疗效确切、安全性高等优势。利用影像学引导下穿刺病理活检同步微波消融可实现同时诊断和治疗肺结节。本文对微波消融治疗恶性肺结节进展进行综述。     

变态反应性支气管肺曲菌病1例

患者 男,56岁.因反复咳嗽、咳痰20年,加重伴气喘4月,于2010年6月4日入院.患者20余年前开始每因受凉后或秋冬季节即反复出现咳嗽、咳白色痰,在当地医院诊断慢性支气管炎,给予抗炎对症处理症状可好转.4月前患者受凉后再次出现咳嗽,咳少许白色粘痰,有数次咳出黄褐色硬块样痰,伴发作性气喘夜间明显,有时可自行缓解,无发热.在当地镇医院间断给予抗炎治疗效果不佳,来我院.患者系村干部,居住环境良好,既往有过敏性皮炎病史.入院查体:口唇无紫绀,双肺叩诊清音,听诊双肺呼吸音稍减低,未闻及干湿性啰音.心脏及腹部未见阳性体征.     

筛选反义寡核苷酸抑制哮喘大鼠CD4+T细胞IL-4表达的研究

目的探讨不同序列的反义寡核苷酸对哮喘大鼠CD4+T细胞IL-4表达的抑制作用.方法采用脂质体转染技术,将不同的反义寡核苷酸(AS-1反外显子-1;AS-2反外显子-2;AS-3反翻译终止部位)和空白对照分别转入经免疫磁珠阴性分离的哮喘大鼠CD4+T淋巴细胞,细胞培养28小时后,用ELISA和半定量RT-PCR分别检测细胞培养上清IL-4和细胞内IL-4 mRNA的水平.结果不同组RT-PCR结果(IL-4/β-actin相对吸光度)AS-1、AS-2、 AS-3及空白组分别为0.261 5±0.147 6、0.288 5±0.141 1、1.101 2±0.364 1及1.206 8±0.383 6(F=22.597,P＜0.01).ELISA检测培养上清液IL-4结果AS-1、AS-2、 AS-3及空白组分别为13.800±7.233、15.329±7.358、52.643±12.075及58.286±14.100(F=34.976,P＜0.01).经AS1、2干预后细胞内IL-4mRNA和细胞培养上清IL-4的水平均较AS-3和空白组干预后 IL-4的水平低(P＜0.01).结论IL-4反义寡核苷酸能够抑制哮喘大鼠CD4+T淋巴细胞IL-4和IL-4mRNA表达;不同序列IL-4反义寡核苷酸抑制作用存在差异.