肺脏超声对新生儿肺炎诊断价值的Meta分析

目的　采用 Meta 分析方法来评价肺脏超声对新生儿肺炎的诊断价值。方法　检索PubMed、Cochrane library、Embase、CNKI 和万方数据库,按照诊断性试验的纳入和排除标准,获取符合本研究要求的文献,检索时间为建库至 2018年9月。共检索到907篇文献,选取其中8篇进一步分析,并对文献质量进行QUADAS2标准评价,采用Q检验和I 2统计量进行异质性检验,采用 Meta-Disc 1.4 软件进行统计学分析,评价肺脏超声对新生儿肺炎的诊断价值。 结果　共纳入8篇文献、1078例。采用随机效应模型对纳入的研究进行统计分析,合并敏感度为0.96（95%CI：0.95～0.98）,合并特异度为0.98（95%CI：0.95～0.99）,合并阳性似然比为19.52（95%CI：5.00～76.15）,合并阴性似然比为0.04（95%CI：0.01～0.16）,合并诊断优势比为565.45（81.80～3908.58）,拟合ROC 曲线下面积0.9950。结论　肺脏超声诊断新生儿肺炎的敏感度和特异度较X线高。鉴于其相对容易操作、实时可用、低成本和无电离辐射,目前的证据支持超声作为新生儿肺炎诊断的替代手段。     

腺病毒肺炎12例临床特点和鉴别诊断分析

目的提高对腺病毒肺炎的再认识。方法选取2001年3月至2005年4月确诊的12例腺病毒肺炎患儿为对象,对其临床特点和辅助检查进行分析,并且与10例肺炎链球菌肺炎、10例呼吸道合胞病毒肺炎患儿的临床特点进行比较。结果12例腺病毒肺炎患儿均持续高热、有细湿罗音,10例(83.3%)患儿有持续性的喘鸣音、并出现合并症,其中合并心力衰竭10例(83.3%),呼吸衰竭6例(50.0%),中毒性肝炎6例(50.0%),脑病2例(16.7%),心肌炎1例(8.3%)。死亡2例。影像学特点:为假大叶5例,有大片影5例,小片融合灶1例,薄片影1例,有肺气肿9例,有肺门增大7例。10例(83.3%)患儿的胸片示病灶逐渐增多成为多叶的病灶。与其他两种肺炎比较,腺病毒肺炎合并症发生率高,需用IVIG和全身激素的比率明显较对照组为高。结论腺病毒肺炎的合并症发生率高,病死率高,治疗难度大。     

Management of the wound care clinic during the novel coronavirus pneumonia pandemic period: Sharing of management experience in a general hospital of China

With the surge in the confirmed cases of the novel coronavirus pneumonia, medical resources in many countries have been put on red alert levels. The operation management systems of hospitals, including wound care clinics, must be innovated to ensure the normal operation of the hospital and meet the medical care needs of the people. At the same time, scientific control measures are also required to prevent the spread of the novel coronavirus pneumonia in the hospital. Actually, during the novel coronavirus pneumonia pandemic, emergency management methods for wound care clinics such as online appointments and remote online diagnosis and treatment, the rational arrangement of human resources, the scientific implementation of epidemic prevention and control measures, and the strict implementation of the management of the clinic environment and item disinfection measures to strengthen the management of protective materials, wound care materials, and dressing equipment by partition have been introduced and innovated, thus helping reduce the gathering of people in wound care clinics, create a safe medical environment, and avoid the spread of the novel coronavirus pneumonia caused by diagnosis and treatment.     

早期无创正压通气治疗在重症肺炎中的观察

目的：探讨早期无创正压通气在重症肺炎中的效果。方法：选取2010年1月～2013年10月我科收治的重症肺炎46例,在常规治疗上,治疗组31例给予早期无创通气,记录二组呼吸频率、心率、PH、PaO2、PaCO2、气管插管率等,作统计学分析。结果：治疗48h后,治疗组呼吸窘迫得到明显缓解,氧分压改善,心率下降,气管插管率降低,有显著差异（P＜0.05）, PH、PaCO2的变化无统计学意义（P＞0.05）。结论：重症肺炎患者早期使用无创正压通气治疗,可以纠正缺氧,改善氧合及自觉症状,一定程度上避免有创通气,从而改善预后。     

儿童甲型H1N1流感病毒肺炎的胸部影像学特征

<正>2009年3月墨西哥暴发甲型HIN1流感疫情,随后出现了全球大流行。此次疫情的病原为变异后的新型甲型H1N1流感病毒,人类普遍易感[1-2]。甲型H1N1流感是一种急性呼吸系统传染病,多数病例临床表现温和,少数病例病情进展迅速,可出现病毒性肺炎,合并呼吸衰竭、多脏器功能损伤,严重者可导致死亡。据文献报道,甲型H1N1流感病毒性肺炎患者中71%为严重肺炎,发生年龄为5～59岁[3],     

Association of admission blood glucose level and clinical outcomes in elderly community‐acquired pneumonia patients with or without diabetes

IntroductionCommunity‐acquired pneumonia (CAP) is the major cause of infection‐related mortality worldwide. Patients with CAP frequently present with admission hyperglycemia.ObjectivesThe aim of this study was to evaluate the association between admission blood glucose (ABG) level and clinical outcomes in elderly CAP patients (≥80 years of age) with or without diabetes.MethodsIn this single center retrospective study, 290 elderly patients diagnosed with CAP were included. Demographic and clinical information were collected and compared. The associations between admission blood glucose level and the 30‐day mortality as well as intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) in elderly CAP patients with or without diabetes were assessed.ResultsOf the 290 eligible patients with CAP, 159 (66.5%) patients were male, and 64 (22.1%) had a known history of diabetes at hospital admission. After adjusting for age and sex, the logistic regression analysis had identified several risk factors that might be associated with clinical outcomes in elderly patients with CAP. Multivariable logistic regression analysis revealed that admission glucose level > 11.1 mmol/L was significant associated with ICU admission, IMV, and 30‐day mortality both in non‐diabetic and diabetic patients. Furthermore, Kaplan–Meier analysis indicated that patients with higher admission glucose level were correlated statistically significantly with 30‐day mortality in patients with CAP (P < 0.001).ConclusionAdmission blood glucose is correlated with 30‐day hospital mortality, ICU admission, and IMV of CAP in elderly patients with and without diabetes. Specially, admission glucose > 11.1 mmol/L was a significant risk factor for 30‐day hospital mortality.     

Qiangli Wuhu mixture alleviates LPS-induced pneumonia by inhibiting the TLR4/NF-κB/NLRP3 pathway: a study based on network pharmacology

ContextQiangli Wuhu (QLWH) mixture is a concoction approved and registered by Ningxia Medical Products Administration. It has therapeutic effects on various types of pneumonia.ObjectiveTo clarify the mechanisms of QLWH in treating pneumonia.Materials and methodsThe potential targets of QLWH in the treatment of pneumonia were predicted by network pharmacology. Male, Institute of Cancer Research (ICR) mice were randomly divided into five groups of 12 mice, control, vehicle, QLWH (10 and 20 mg/kg) and dexamethasone (DXM), and orally treated twice daily with normal saline, QLWH or DXM. The pneumonia model was established by tracheal instillation of lipopolysaccharide (LPS). After treatment five days, ELISA, H&E staining and Western blot were used to investigate protective effects of QLWH.ResultsNine hundred and ninety-four active ingredients were found through network pharmacology, corresponding to 135 targets for the treatment of pneumonia; compared to the vehicle group, QLWH (10 and 20 mg/kg) significantly decreased the levels of TNF-α (14.3% and 28.8%), IL-1β (23.9% and 42.8%) and IL-6 (13.2% and 16.1%), increased the levels of IL-10 (134.3% and 172.9%); in terms of mechanism, QLWH down-regulated TLR4/NF-κB/NLRP3 axis related proteins in lung tissue of pneumonia model mice (p < 0.05).Discussion and conclusionsThis study combined network pharmacology and animal experiments, providing effective evidence for the clinical promotion of QLWH. Meanwhile, it is of significance for further development.     

The association of clinical features and laboratory findings of COVID-19 infection with computed pneumonia volume

Coronavirus disease 2019 (COVID-19) was first detected in China in December 2019, and declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.To study the clinical features of patients with COVID-19, we analyzed the correlation between some inflammation-related indicators in patients’ serum and the severity of the disease, especially PV (pneumonia volume under CT scan) and pneumonia volume ratio (PVR).Sixty-six COVID-19 patients in Huai’an, China were selected as the research subjects. We collected the clinical data, including general characteristics, clinical symptoms, serum test results and CT performance, explored the relationship between inflammation-related indexes, oxygenation index, PV, PVR, while indicators of mild to moderate patients and severe patients were compared.The most prominent manifestations of COVID-19 patients were fever (47, 71.2%); cough (41, 62.1%), with or without respiratory and other systemic symptoms; There was no difference in gender (P = .567) and age (P = .865) between mild to moderate and severe groups. High sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6) of overall patients were higher than the normal range (P < .001, respectively). hs-CRP was negatively correlated with oxygenation index (OI) (r = –0.55), whereas positively correlated with PV, PVR and ESR (r = 0.89; r = 0.87; r = 0.47, respectively); ESR was negatively correlated with OI (r = –0.45), meanwhile it was positively correlated with PV and PVR (r = 0.44; r = 0.46, respectively). OI was negatively correlated with PV and PVR (r = –0.6, respectively). PV had a clear correlation with PVR (r = 1). Severe patients’ hs-CRP, PV, PVR were higher than mild to moderate group (P = .006; P = .001; P < .001, respectively), but OI was lower (P < .001).The clinical features of COVID-19 were similar to general viral pneumonia. hs-CRP, ESR showed a certain correlation with the PV and PVR, which might play a certain role in assessing the severity of COVID-19.     

清肺止痉活血法治疗儿童支原体肺炎的临床效果观察

目的 探究清肺止痉活血法治疗儿童支原体肺炎的临床疗效.方法 我院收治的支原体肺炎患儿92例,随机均分为两组,对照组予以阿奇霉素治疗,观察组在此基础上予以清肺止痉活血法治疗,观察对比两组临床疗效及用药安全性.结果 观察组总有效率为93.5％,明显高于对照组的78.3％,差异有统计学意义(x2=4.39,P＜0.05);观察组退热时间[(3.1±1.2)d]、止咳时间[(4.1±1.4)d]、肺部啰音消失时间[(5.2±1.6)d]、住院时间[(7.4±1.5)d]均短于对照组[(5.6±1.5)d、(7.8±1.6)d、(7.9±1.3)d、(9.8±1.4)d],差异均有统计学意义(P＜0.05);两组用药期间未发生严重药物不良反应.结论 小儿支原体肺炎患儿予以清肺止痉活血法治疗的效果明显,安全可靠.