呼吸机相关肺炎的发生原因及护理对策探讨

目的　为进一步探讨发生呼吸机相关肺炎的因素和护理措施。方法　对 70例使用机械通气辅助治疗的重症监护病房 (ICU)病人 ,取深部痰液进行细菌培养与分离及药敏试验 ,并采用综合护理措施。结果　 70例患者除 4例因原发病病情恶化死亡外 ,无一例因呼吸机相关肺炎而导致病情恶化 ,延误治疗 ,且缩短了住院时间。结论　正确的气道管理 ,合理应用抗生素 ,良好的饮食护理等辅助治疗 ,能够降低呼吸机相关因素肺炎的发病率     

短波紫外线照射对小儿肺炎及中性粒细胞吞噬功能和IL－2的影响

用短波紫外线照射患儿腰背部皮肤辅助治疗小儿肺炎，提示紫外线治疗组与对照组相比，显著缩短患儿发热。咳嗽及肺部湿罗音消失时间（Ｐ＜０．０１）。用化学发光法测定中性粒细胞吞噬功能，治疗组患儿血液内中性粗细胞吞噬功能显著提高（Ｐ＜０．０５）。同时测定治疗组患儿血中ＩＬ－２低于对照组（Ｐ＜０．０５），并对上述结果机理进行了探讨。     

酚妥拉明与多巴胺治疗难治性肺炎20例

目的 :观察酚妥拉明与多巴胺治疗难治性肺炎的疗效。方法 :对 2 0例难治性肺炎的患儿 ,在常规治疗的基础上 (予抗生素、止咳化痰、超声雾化、拍背 ) ,用酚妥拉明和多巴胺静点 ,每日 1次。结果 :总有效率 90 %。结论 :酚妥拉明与多巴胺治疗难治性肺炎疗效好、价格低、副作用小 ,值得临床推广     

老年精神分裂症合并肺炎临床分析

目的：通过对精神分裂症合并肺炎患者和老年肺炎患者进行对照观察分析，探索老年精神分裂症合并肺炎的临床特点，为临床诊治提供资料。方法：对35例CCMD-2-R精神分裂症合并肺部感染的患者及35例同期老年肺炎患者对照分析。结果：发现老年精神分裂症合并肺炎患者与老年肺炎患者在神经精神症状和消化系统症状方面差异有显著性。结论：对老年精神分裂症合并肺炎患者更要细致观察，精心护理，早发现、早诊断、早治疗，以降低其死亡率。     

Indium-111 labelled pooled human immunoglobulin imaging to monitor the efficacy of specific therapy for Pneumocystis carinii pneumonia

Functional imaging is ideally suited to monitoring the effect of specific therapy on disease processes. In this pilot study five patients with AIDS and Pneumocystis carinii pneumonia (PCP) were imaged with Indium-111 labelled pooled human immunoglobulin (111In-HIG) during infection and after therapy for PCP. The lung activity of t t tln-HIG, measured as a lung/heart ratio, was calculated in a study performed during infection with PCP and after therapy. In all five patients the lung/heart ratio of t t 1ln-HIG was reduced after treatment. The mean reduction in heart/lung ratio was 27% (range 12%-53%). If these results are confirmed by a larger study, ¹¹In-HIG will be useful in monitoring the response of PCP to therapy in patients with AIDS.     

Coexisting Endogenous and Exogenous Llpold Pneumonia and Pulmonary Alveolar Proteinosis in a Patient with Neurodevelopmental Disease

We report a unique case of coexistingexogenous lipoid pneumonia, endogenous lipoid pneumonia (EU), and pulmonary alveolar proteinosis (PAP) in a 5-year-old patient with severe neurodevelop mental disease. The patient presented with gastroesophageal reflux and presumed chronic lung disease resulting from recurrent aspiration pneumonias and succumbed to respiratory failure. The autopsy showed lipid-laden macrophages and periodic acid-SchiJf9ositive granular matm'al i n alveolar spaces and multilamellated structures within both alveolar macrophages and extracellular debris.

These findings were similar to those in previous reports of coexisting E I P and PAP in the setting of gastroesophageal refux [I] . However, the present case diJfered by the presence of scattered large osmiophilic extracellular lipid vacuob. Besides strengthening the association between EIP and PAP and their relationship to gastroesophageal refux, this case suggests that t h q may arise together with exogenous lipoid pneumonia, through related mechanisms, in the setting of neurodevelopmental disease.     

肾移植术后并发卡氏肺孢子虫病活检的病理学研究

报告肾移植术后５例并发卡氏肺孢子虫肺炎。采用纤维支气管镜活检，分别对印片及组织进行银染和ＨＥ染色。病变为上皮细胞脱落，有时增生呈立方状；炎症反应；各种类型渗出物（包括泡沫状渗出物、泡沫细胞团及絮状蛋白渗出物）等３种改变。重点讨论了本病的组织病理学特征，并对不典型病变形成机理加以讨论。     

Daily variation in circulating cytokines and acute-phase proteins correlates with clinical and laboratory indices in community-acquired pneumonia

Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-α), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Thirty otherwise healthy hospitalized patients aged 48 ± 3 years (mean ± SEM) and with bacteriologically confirmed CAP were studied prospectively. IL-1β and IL-6 were found to be 15-fold higher on admission (122 ± 9 pg mL^?1 and 60 ± 4 pg mL^?1 respectively), whereas TNF-α was three-fold higher (102 ± 5 pg mL^?1) than those of controls, all of them showing a decline towards normal. Initial CRP levels were increased 90-fold (416 ± 1 mg L^?1), whereas fibronectin levels were reduced (242 ± 9 mg dL^?1). The presence of parapneumonic effusion was associated with a higher TNF-α serum level (127 ± 7 vs. 86 ± 4 pg mL^?1, P = 0.0002), a more rapid daily decline in TNF-α (–7.2 ± 0.7 vs. ?3.8 ± 0.5 pg mL^?1 day^?1, P = 0.0005), a slower rate of decline in CRP (?42.8 ± 3.0 vs. ?54.6 ± 3.0 mg L^?1 day^?1, P = 0.02) and a slower rate of increase in FBN (5.9 ± 1.0 vs. 11.7 ± 1.0 mg dL^?1 day^?1), P = 0.001]. Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar–arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.     

军团菌肺炎的临床特点探讨

作者对１０例军团菌肺炎和１０例非军团菌肺炎患者临床资料进行分析。本组军团菌肺炎特点为：病情重、进展快、消化道症状及肌肉关节痛、低钠血症、低氧血症、代酸或呼碱发生率较高，Ｘ线胸片多见双侧或多叶肺浸润伴胸膜反应，病死率高。     

河南省传染性非典型肺炎患者胸部X线表现

目的 :探讨传染性非典型肺炎的X线表现及变化规律。方法 :对河南省临床诊断的 1 5例患者发病后不同时间的系列胸片和CT进行回顾性分析。结果 :1 5例胸部X线病灶初始形态为斑片状 1 1例 (73.3% ) ,大片状 4例 (2 6 .7% ) ;双侧 9例 (6 0 .0 % ) ,单侧 6例 (4 0 .0 % ) ,均为中、下肺野 (1 0 0 % )。动态观察发现病变进展快 ,病变发展到高峰期时间为 4～ 1 4d , x±s(7.7± 3.2 )d ,双侧 1 3例 (86 .7% ) ,单侧 2例 (1 3.3% ) ,两肺叶及两肺叶以上病变者 1 4例 (93.3% )。病变开始吸收时间为 6～ 2 1d , x±s(1 1 .3± 4 .1 )d ;完全或基本吸收时间 8～ 2 6d , x±s(1 6 .4± 5 .0 )d。1 5例经治疗均痊愈出院。住院时间 1 8～ 4 2d , x±s(31 .9± 7.9)d。 结论 :传染性非典型肺炎的胸部X线特点为急性双侧或单侧多叶炎性浸润阴影 ,以中、下野常见 ,进展迅速 ,及时复查胸部X线对临床诊断及判断病情具有重要价值。