老年人呼吸机相关性肺炎的危险因素及病原学分析

目的研究老年人呼吸机相关性肺炎（VAP）的病原学和预后情况。方法选择老年科行呼吸机治疗的患者92例,采用回顾性队列研究方法,分析临床资料、病原菌构成、耐药性情况。结果VAP组和无VAP组之间的性别、呼吸末正压,是否服用H：受体阻滞剂、利尿剂、糖皮质激素,是否经口气管插管,是否气管插管后改气管切开等情况均差异无统计学意义（P〉0．05）;而两组患者的年龄、慢性阻塞性肺疾病（COPD）病程、白蛋白、机械通气时间、抗生素连续使用情况、是否昏迷等方面均差异有统计学意义（P〈0．05）。VAP患者的呼吸道分泌物培养分离出109株细菌,其中革兰阴性茵74株（67．89％）,革兰阳性茵22株（20．18％）,真茵13株（11．93％）。氨苄青霉素和头孢唑林对铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌及葡萄球菌属的耐药率较高,在70％-100％之间;而庆大霉素和丁胺卡那霉素对以上病原菌的耐药率较低,在19％-42％之间;泰能对以上病原菌的耐药率更低,在5％～22％之间。结论年龄、COPD病程、白蛋白、机械通气时间、抗生素连续使用天数、抗生素舍用种类、是否气管切开及是否昏迷均是发生VAP的危险因素,革兰阴性菌是VAP的主要病原茵,合理应用抗生素对VAP具有重要的防治意义。     

Factors Associated with Pneumocystis jirovecii Pneumonia in Patients with Rheumatoid Arthritis Receiving Methotrexate: A Single-center Retrospective Study

Objective To investigate the risk factors for the development of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy. Methods This single-center retrospective cohort study included consecutive patients with RA who received MTX for at least one year. The study population was divided into PCP and non-PCP groups, depending on the development of PCP, and their characteristics were compared. We excluded patients who received biologic disease-modifying anti-rheumatic drugs (DMARDs), Janus kinase inhibitors, and anti-PCP drugs for prophylaxis. Results Thirteen patients developed PCP, and 333 did not develop PCP. At the initiation of MTX therapy, the PCP group had lower serum albumin levels, a higher frequency of pulmonary disease and administration of DMARDs, and received a higher dosage of prednisolone (PSL) than the non-PCP group. A multivariate Cox regression analysis revealed that the concomitant use of PSL [hazard ratio (HR) 5.50, p=0.003], other DMARDs (HR 5.98, p=0.002), and serum albumin <3.5 mg/dL (HR 4.30, p=0.01) were risk factors for the development of PCP during MTX therapy. Patients with these risk factors had a significantly higher cumulative probability of developing PCP than patients who lacked these risk factors. Conclusion Clinicians should pay close attention to patients with RA who possess risk factors for the development of PCP during MTX therapy.     

喜炎平注射液联合头孢呋辛钠治疗小儿肺炎的临床效果

目的：探讨喜炎平注射液联合头孢呋辛钠治疗小儿肺炎的疗效。方法：选取本院2013年1月-2014年7月收治的80例小儿肺炎患者作为研究对象,按照随机数字列表法将其分为研究组和对照组,每组40例。对照组单纯采用头孢呋辛钠进行治疗,研究组在对照组的治疗基础上联合喜炎平注射液进行治疗,7 d为一疗程。治疗1个疗程后,观察比较两组患儿的临床疗效、临床症状消失时间、住院天数及并发症发生情况。结果：经1个疗程的治疗后,研究组的治疗总有效率97.5%明显高于对照组的80.0%,且患儿发热症状、咳嗽及胸部湿啰音等临床症状消失时间及住院天数均明显短于对照组,差异均有统计学意义（P<0.05）。而两组患儿的并发症发生率比较差异无统计学意义（P>0.05）。结论：对小儿肺炎患者采用喜炎平注射液联合头孢呋辛钠进行治疗具有良好的临床疗效,患儿的症状消退时间和住院时间短,且不会增加并发症的发生率,值得在临床上进一步推广。     

重症婴幼儿肺炎的耳廓微循环动态观察

采用微循环显微镜对临床确诊的24例重症婴幼儿肺炎的不同时期进行耳廓微循环的动态观察与比较,证实了耳廓微循环的改善与病情的好转基本同步,但耳廓微循环的改善常在临床症状好转后24～48小时才比较稳定,提示了在临床工作中见到症状虽有好转而微循环尚未恢复时不能放松治疗,仍需巩固治疗1～2天,以防止病情反复。     

Clinical characteristics of patients with chronic eosinophilic pneumonia in a Chinese tertiary‐care hospital: A 6‐year retrospective study

IntroductionChronic eosinophilic pneumonia (CEP) is a rare disease with unknown etiology. Due to lack of specificity of CEP symptoms, clinicians are not experienced in establishing its diagnosis.ObjectivesTo summarize the clinical data of CEP patients to improve the understanding of CEP and reduce misdiagnosis.MethodsData of patients pathologically diagnosed with CEP in the PLA General Hospital between May 2013 and May 2019 were collected, and clinical manifestations, imaging characteristics, pathological features, and treatment were retrospectively analyzed.ResultsTwenty patients, including 6 males and 14 females, were diagnosed with CEP. The average age was 47.0 ± 10.2 years. The main clinical manifestations were cough and dyspnea. The average duration of CEP was 15.5 ± 11.5 months. The average proportion of eosinophils in the peripheral blood was 18.9 ± 17.8%, and the average proportion of eosinophils in the bronchoalveolar lavage fluid was 41.5 ± 19.4%. The main imaging features were patchy shadows and consolidation shadows. The most common manifestations on bronchoscopic examination were congestion and edema of the bronchial mucosa. Two patients had granular protrusions of the endotracheal membrane. Histological examination indicated infiltration of numerous eosinophils. All patients improved after prednisone therapy.ConclusionCEP onset is insidious, and clinical manifestations lack specificity. Typical imaging features are peripheral and subpleural distribution of lung infiltrates. Some patients have a normal proportion of eosinophils in the peripheral blood, but most have an increased number of eosinophils in the BALF, which contributes to CEP diagnosis. A biopsy is necessary when differential diagnosis is difficult. A systemic glucocorticoid is effective.     

Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer

BackgroundPostoperative pneumonia (PP) is the most common pulmonary complication of esophagectomy. It is of great importance to identify any high-risk factors and prevent pulmonary complications to improve the prognosis of patients with esophageal cancer undergoing esophagectomy. Thus, we established a predictive model of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma (ESCC), and provide suggestions for the best strategy for the perioperative period of the patients.MethodWe retrospectively analyzed 78 patients who underwent esophagectomy for squamous cell carcinoma after neoadjuvant immunochemotherapy between September 2019 and August 2021.We used the “glmnet” language package in R to perform least absolute shrinkage and selection operator (LASSO) regression to screen the best predictors of PP, and nomograms predicting PP were constructed utilizing screened factors. The performance of nomograms was internally validated by calibration curves, concordance index (C-index), and the Brier score for overall performance.ResultsTwenty-six patients (33.3%) had postoperative pneumonia. After LASSO regression, the factors that were independently associated with PP were diffusing capacity of the lungs for carbon monoxide (DLCO) (P=0.0002), white blood cell (WBC) difference before vs. after neoadjuvant immunochemotherapy (P=0.0133). We constructed a prediction model, plotted the nomogram, and verified its accuracy. Its Brier score was 0.147, its calibration slope was 0.98, and its C-index was 0.85 (95% CI: 0.75–0.95). Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.ConclusionsOur prediction model can predict the possibility of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.     

甲氰咪胍与硫糖铝对老年食管癌术后院内感染性肺炎的观察

目的观察甲氰咪胍与硫糖铝对老年食管癌术后院内感染性肺炎的影响.方法将60岁以上食管癌病人分为甲氰咪胍组、硫糖铝组、对照组,术后观察院内感染性肺炎情况.结果院内感染性肺炎发生率:甲氰咪胍组30.6%,硫糖铝组8.6%,对照组10.7%,甲氰咪胍组分别与硫糖铝组、对照组相比,差别有统计学意义.硫糖铝组与对照组相比,差別无统计学意义.结论甲氰咪胍组与硫糖铝组相比,可引起较高的院内感染肺炎的发生率,硫糖铝在老年食管癌病人术后可替代甲氰咪胍应用.     

传染性非典型肺炎17例临床分析

目的 分析四川地区传染性非典型肺炎(非典)的流行病学和临床特点。方法 对2003年2月以来四川省已临床诊断的非典患进行回顾性分析。结果 迄今四川省已临床诊断非典患17例，均为来自广东和北京疫区的输入性病例，发病年龄以青壮年为主，起病较急骤，88％(15／17)的患体温超过38℃，咳嗽较常见，部分有血丝痰，周围血白细胞计数减少或正常居多，X线片显示多叶多段病变特点，初期进展较快而后期恢复较慢。4例作血清学试验，2例阳性。1例尸检标本在电镜下检出冠状病毒颗粒和衣原体样颗粒，RT-PCR扩增出冠状病毒RNA聚合酶基因片段。死亡2例，已痊愈出院7例。结论 四川地区非典型肺炎均为输入性病例，临床表现与其他地区报道相似，但病情相对较轻，传染性较弱．未造成继发件感染。     

后疫情时代的肺移植临床研究发展和未来展望

肺移植技术在全球经历了近半个世纪的发展,在中国也高速发展了二十余年,中国肺移植逐渐融入国际肺移植大家庭。2020年新型冠状病毒肺炎(新冠肺炎)疫情暴发,既是对中国肺移植发展的挑战,也使得全球同行关注中国肺移植发展,加速了国际间的交流与合作。随着对新冠肺炎重症患者肺移植的临床和基础研究逐步深入,移植科医师对于未来中国肺移植在供者的维护、高龄和儿童受者的选择、围手术期管理等方面有了更多的认知和思考。对于肺移植相关学科交叉领域的研究,需要开展设计优良、多方协作的临床试验,不断推进学科理论和实践的创新。