支气管肺泡灌洗术在颅脑损伤合并严重肺部感染中的治疗及临床对比研究

目的探讨支气管肺泡灌洗术(bronchoalveolar lavage,BAL)治疗颅脑损伤并发严重肺部感染的疗效和经验。方法共收治颅脑损伤并发严重肺部感染患者76例,随机分为两组:常规治疗组(A组)26例;BAL治疗组(B组)50例。结果A组22例肺部感染痊愈时间4～6周,死亡4例;B组44例肺部感染痊愈时间1～3周,死亡6例,两组病例的疗效有显著差异。结论在颅脑损伤并发严重肺部感染治疗中运用BAL明显缩短疗程,有较高的治疗价值。     

Cytomegalovirus (CMV) DNA quantification in bronchoalveolar lavage fluid of immunocompromised patients with CMV pneumonia

Cytomegalovirus (CMV) pneumonia causes major morbidity and mortality. Its diagnosis requires demonstration of viral cytopathic changes in tissue, entailing risks of lung biopsy. This study aimed to determine CMV viral load (VL) thresholds in bronchoalveolar lavage fluid (BALF) for diagnosis of CMV pneumonia in immunocompromised patients. CMV VL in BALF was studied in 17 patients (83% transplant recipients) and 21 control subjects with and without CMV pneumonia, respectively, using an FDA‐approved PCR assay (Cobas^® AmpliPrep/Cobas TaqMan^® CMV Test, Roche Molecular Systems, Inc.) calibrated to the WHO International Standard for CMV DNA (NIBSC: 09/162). Receiver operating characteristic curve analysis produced a BALF CMV VL threshold of 34 800, IU/mL with 91.7% sensitivity and 100.0% specificity for diagnosis of possible, probable, and proven CMV pneumonia in transplant patients, while a threshold of 656 000 IU/mL yielded 100% sensitivity and specificity among biopsy‐proven cases. For all immunocompromised patients, a VL threshold of 274 IU/mL was selected. VL thresholds also were normalized to BALF cell count yielding a threshold of 0.32 IU/10⁶ cells with 91.7% sensitivity and 90.5% specificity for possible, probable, and proven CMV pneumonia in transplant recipients. Monitoring CMV VL in BALF may be a less invasive method for diagnosing CMV pneumonia in immunocompromised patients.     

临床护理路径在支气管肺泡灌洗治疗重症肺炎患者护理中的应用效果

目的探究临床护理路径在支气管肺泡灌洗治疗重症肺炎护理中的应用效果。方法选取2018年1月至2019年8月在我院接受支气管肺泡灌洗治疗的重症肺炎患者129例,根据数字单双号法将其分为对照组(65例)和观察组(64例)。对照组采用常规护理干预,观察组在此基础上实施临床护理路径干预。比较两组临床症状改善时间、肺功能指标、疾病知识知晓率、治疗依从性和满意度。结果观察组患者的咳嗽、憋喘、肺啰音改善时间均短于对照组(P<0.05)。出院时,两组患者的FVC、FEV1、MVV均高于治疗前,且观察组高于对照组(P<0.05)。观察组患者的疾病知识知晓率、治疗依从性和满意度均高于对照组(P<0.05)。结论临床护理路径在支气管肺泡灌洗治疗重症肺炎患者的护理过程中效果明显,值得推广。     

纤维支气管镜下支气管肺泡冲洗在气管切开患者中的临床应用

目的研究纤维支气管镜下支气管肺泡冲洗在气管切开后肺部感染中的治疗作用及其安全性。方法选取神经外科重症气管切开患者50例,随机分为对照组和冲洗组:对照组患者呼吸道管理按抗感染、雾化吸入及负压吸痰等基本处理;冲洗组患者在常规处理基础上,并于气管切开后第2天开始行纤维支气管镜下支气管肺泡冲洗,2d一次。比较两组患者胸部X线、血氧饱和度、血气分析以及拔管时间等。结果冲洗组患者氧分压[(11.05±0.62)kPa]在2周后明显高于对照组[(8.74±1.06)kPa](P<0.01),胸片感染征象少于对照组,气管切开1个月内拔管例数差别明显:冲洗组19例,对照组11例(χ2=5.33,P<0.05)。结论支气管肺泡冲洗有助于改善气管切开患者缺氧,控制肺部感染,缩短带管时间,促进重症患者恢复。     

支气管肺泡灌洗治疗高龄老人肺部感染

目的了解支气管肺泡灌洗（BAL）治疗高龄老人肺部感染的作用。方法对43例高龄老人进行BAL治疗，观察首次行BAL治疗前及BAL治疗后1、6和24h的血气分析。在行BAL治疗后观察患者临床表现、X线胸片、致病菌被清除情况。结果首次行BAL治疗前与BAL后1h相比，pH、PO2、PCO2差异无显著性；而首次行BAL治疗前分别与BAL后6h、24h相比，pH、PO2、PCO2差异均有显著性。无1例在BAL治疗过程中死亡。BAL治疗总有效率达81．4％。结论BAL治疗高龄老人肺部感染是安全有效的，通过BAL治疗，低氧血症和二氧化碳潴留得到明显改善，呼吸衰竭得到纠正，肺部感染得到控制。     

肺泡灌洗对肺源性急性呼吸窘迫综合征肺复张容积和肺力学的影响

目的评价肺泡灌洗(BAL)对肺原性急性呼吸窘迫综合征(ARDSp)肺复张和肺力学的影响,以探讨BAL对ARDSp的治疗作用。方法以9例血液动力学稳定、接受机械通气的ARDSp患者为研究对象,采用压力-容积曲线法分别测定BAL前与后呼气末正压(PEEP)为5、10和15cmH2O(1cmH2O=0.098mmHg)时的肺复张容积,并对BAL前后气道峰压(PIP)、气道平台压(Pplat)、平均气道压(Pm)和静态顺应性(Cst)在不同PEEP下的趋势变化进行比较。结果BAL前PEEP至5、10和15cmH2O时肺复张容积分别为([35.89±3.93)mL(、124.56±9.68)mL和(161.70±8.50)mL,P<0.01],BAL后分别为[(42.27±4.27)mL、(139.70±17.59)mL和(160.16±9.43)mL,P<0.01]。但BAL前后组间趋势变化差异无显著性(F=2.749,P=0.079)。不同PEEP条件下BAL后PIP、Ppla和Pm较BAL前趋势有显著下降(P<0.05),Cst在BAL前后比较差异无显著性(P>0.05)。结论BAL对肺复张容积无显著影响,但显著降低ARDSp的气道压力,改善通气功能。     

Reduced phagocytic activity of human alveolar macrophages infected with Mycobacterium avium complex

IntroductionCo-infection of nontuberculous mycobacteria (NTM) with other bacteria is associated with increased frequency of hospitalization and reduced quality of life. However, the clinical significance of co-infection with NTM and other bacteria remains unclear. Here, we investigated the distribution of alveolar macrophage populations, characterized their phagocytic function in bronchoalveolar lavage fluid (BALF), and assessed the bactericidal function of macrophages infected with NTM using cell lines.MethodsBALF samples were prospectively obtained from 30 patients with suspected NTM lung disease to evaluate phagocytic activities of macrophages using immunostaining. Bactericidal activities of Staphylococcus aureus (S. aureus) and Mycobacterium intracellulare (M. intracellulare)-infected or -non-infected macrophages were evaluated using macrophage cell lines.ResultsEleven patients with Mycobacterium avium complex (MAC) infection and 19 patients with chronic lower respiratory tract infections except for NTM infection (controls) were enrolled. The percentage of non-polarized (HLA-DR⁺, CD40^?, and CD163^?) macrophages in patients infected with MAC was significantly higher than that in controls; non-polarized macrophages demonstrated an impaired ability to phagocytose S. aureus. In vitro experiments revealed higher intracellular S. aureus colony-forming unit counts and proinflammatory cytokine levels in M. intracellulare-infected macrophages than in non-NTM-infected macrophages. Electron microscopy showed morphologically damaged macrophages and M. intracellulare and S. aureus growing in the same phagosome.ConclusionThe proportion of alveolar macrophages (HLA-DR⁺, CD40^?, and CD163^?) with impaired phagocytosis increased in MAC-infected individuals. M. intracellulare-infected macrophages reduced bactericidal activity in vitro. Dysfunction of alveolar macrophages may contribute to persistent infection by other bacteria, leading to MAC lung disease progression.     

不同采样技术对呼吸机相关性肺炎的诊断价值

目的比较不同采样技术对呼吸机相关性肺炎(VAP)的诊断价值及安全性。方法对30例呼吸机相关性肺炎同时行支气管镜下支气管肺泡灌洗(BAL)及经人工气道吸痰做定量培养。结果 BAL阳性率86.7%(26/30),经人工气道吸痰阳性率为46.7%(14/30)。两组间阳性率有显著性差异。结论 BAL能提高呼吸机相关性肺炎的病原学诊断率,而且安全、可重复进行。     

荧光定量PCR测定支气管肺泡灌洗液中TbDNA诊断肺结核的临床价值

目的探讨纤支镜肺泡灌洗液中结核分枝杆菌DNA在肺结核诊断中的价值。方法对187例初治肺结核患者及41例肺炎患者分别应用荧光定量聚合酶链反应(FQ-PCR)技术检测结核分枝杆菌DNA、肺泡灌洗液结核菌培养、纤维支气管镜刷片抗酸染色。结果肺结核患者肺泡灌洗液结核分枝杆菌DNA阳性率为:78.6%、肺泡灌洗液结核菌培养阳性率为28.8%、刷片抗酸染色阳性率为21.9%。肺炎患者肺泡灌洗液结核分枝杆菌DNA、肺泡灌洗液结核菌培养、刷片抗酸染色均阴性。结论荧光定量聚合酶链反应检测肺泡灌洗液结核分枝杆菌DNA,特异性高,用于肺结核诊断可提高肺结核诊断的敏感性和准确性,明显优于纤维支气管镜刷片抗酸染色,亦较肺泡灌洗液结核菌培养诊断灵敏、快速,可作为肺结核诊断较可靠指标。     

Anti-asthmatic effects of Angelica dahurica against ovalbumin-induced airway inflammation via upregulation of heme oxygenase-1

Asthma is a chronic immune inflammatory disease characterized by variable airflow obstruction. The present study was undertaken to assess the effects of an Angelica dahurica Bentham et Hooker ethanolic extract (AD) on airway inflammation in an ovalbumin (OVA)-induced airway inflammation model. Mice that received AD displayed significantly lower airway eosinophilia, cytokine levels, including interleukin (IL)-4, IL-5, and tumor necrosis factor (TNF)-alpha levels, mucus production and immunoglobulin (Ig)E, compared with OVA-induced mice. In our experiments, AD treatment reduced airway inflammation and suppressed oxidative stress in the OVA-induced asthma model, partly via induction of heme oxygenase (HO)-1. The effects of AD on OVA-induced HO-1 induction were partially reversed by the HO-1 inhibitor, tin protoporphyrin (SnPP). Our results clearly indicate that AD is a suppressor of airway allergic inflammation, and may thus be effectively used as an anti-inflammatory drug in the treatment of asthma.