目的:探讨雾化激素是否可作为全身激素的替代方法用于慢性阻塞性肺疾病急性加重期(AECOPD)的治疗。方法:因AECOPD住院的患者随机分为常规治疗组、雾化激素组、静脉激素组3组,后两组分别在常规治疗组的基础上加用布地奈德雾化或甲基强的松龙静滴,疗程10d。结果:(1)常规治疗组于入组后10dPaO2、FEV1改善(P<0.05)。雾化激素组于入组后24hPaO2改善,3d时FEV1、FVC改善,10d时FEF50改善(P<0.05)。静脉激素组于入组后24hPaO2改善,3d时FEV1、FVC、FEF50改善(P<0.05)。与雾化激素组比,静脉激素组3d时FEV1、FVC改善更明显(P<0.05),10d时两组改善值相似(P>0.05)。(2)治疗后静脉激素组痰IL-6下降幅度高于常规治疗组(P<0.05),与雾化激素组比无差异(P>0.05)。仅静脉激素组痰TNF-α降低(P<0.05)。(3)静脉激素组高血糖发生率(20.0%)高于常规治疗组(P<0.05),与雾化激素组(3.3%)比无差异(P>0.05),雾化激素组与常规治疗组比无差异(P>0.05)。结论:雾化激素治疗AECOPD疗效与静脉激素相似,可作为AECOPD的一种替代治疗方案。

Objective To explore the clinical diagnostic value of LTA in lung canaer Methods Patients were divided into two groups: non-small cell lung cancer(n=72);bengin lung disease(n=68).The LTA levels in BLAF、pleural effusion f;luid and serum were detected by latex agglutination method.Results The NSCLC group:positive rate for LTA in BLAF、pleural effusion and serum were 58%、67%、75%.While 22%、17%、20% in the control group.The difference between the two groups is significant(P0.05).Positive rate of LTA in serum of the NSCLC group was the highest,75%.The peculiarty for LTA in pleural effusion at the NSCLC group was the highest,82%.Conclusion These results suggested that detection of LTA in BLAF、pleural effusion and serum is a valuable method for the diagnosis of lung cancer.

Objective To determine the causes and risk factors of antimicrobial treatment failure in patients with community-acquired pneumonia(CAP). Methods Hospitalized adults with CAP from January 2006 to December 2006 were analyzed retrospectively. Treatment failure was defined as appearance of nonresponding pneumonia and progressive pneumonia. Patient's clinical features were analyzed. Results All of 378 patients were involved in this study. Total antimicrobial treatment failure was happened in 50 patients(32 patients with non-responding pneumonia and 18 patients with progressive pneumonia). The causes were infectious (35 patients,70% ), non-infectious (11 patients,22% ) and undetermined (4 patients,8% ).Mortality of antimicrobial treatment failure was 18%(9/50, 8 patients died of infectious cause, 1 patient had no clear cause of death). Stepwise Logistic regression analysis showed that C-reactive protein, multilobar pneumonia,albumin < 30 g/L,renal function lesion,liver function lesion were related with antimicrobial treatment failure. Independent factors of treatment failure were multilobar pneumonia (P= 0.002) ,albumin <30 g/L(P = 0.001 ) and renal function lesion (P = 0.000). Conclusion The major challenge associated with antimicrobial treatment failure in hospitalized patients with CAP is infection, most of which is infection of drug resistant strain.

毛滴虫属原生动物门,鞭毛虫纲,是以鞭毛作为运动细胞器的原虫,有一根或数根鞭毛从各自的基体发出伸向体外,基体后方可有杆状的动基体.虫体以纵二分裂进行无性生殖.其中有阴道毛滴虫、人毛滴虫、口腔毛滴虫等多种类型.

目的提高对无肌炎性皮肌炎引起的急性肺间质病变（ADM-ILD）的临床表现诊断及治疗的认识。方法报道1例死亡及1例成功救治的无肌炎性皮肌炎引起的急性肺间质病变,并结合国内文献报道35例ADM-ILD患者的临床资料进行分析。结果临床上表现为胸闷?气促、干咳、发热、进行性呼吸困难、紫绀,并很快到严重的低氧血症和呼吸衰竭,高分辨率CT有很大的诊断价值。治疗效果欠佳。结论无肌炎性皮肌炎引起的急性肺间质病变死亡率很高,临床治疗过程中应该引起重视。

Objective To assess the influencing factors of the patients’ quality of life in chronic obstructive pulmonary disease (COPD QOL) in non-invasive positive pressure ventilation(NIPPV) for the treatment of COPD in acute exacerbation with respiratory failure(RF).Methods According to sex,age,lung function,ABG’s,nutrition status,education status,monthly pay and living status.The patients were divided into two groups.52 patients (control group) and 55 patients(treatment group) were evaluated by COPD QOL.Results Compared with the control group,the treatment group’s TMS and FS of COPD QOL decreased singnificantly with AECOPD.The difference is substantial(P<0.05).That is to say the quality of life decreased.Conclusion Treated by NIPPV,COPD patients’ quality of life improve obviously.

本研究运用无反应肺炎(NRP)的概念,回顾性分析上海交通大学附属第六人民医院18个月内老年社区获得性肺炎(CAP)患者治疗失败的可能原因和危险因素.

慢性阻塞性肺病(COPD)是一种以气流受限为特征的疾病,通常呈进行性发展,不完全可逆.多与肺部对有害颗粒和气体的异常炎性反应相关,主要是吸烟.近年来国内外对COPD的研究及临床诊治日益重视.2004年美国胸科协会和欧洲呼吸协会,提出了COPD的治疗目标:防止病情进展,缓解症状,提高运动耐量,改善生活质量,防治合并症,防治急性发作以及降低病死率.主要的目标是提高COPD患者的生活质量,主要由两部分组成,一方面专业医师要不断提高COPD认识,了解COPD的病理、诊断、治疗和监控,宣传COPD是能治疗的疾病的观念.另一方面,为COPD患者提供所有的这一方面的信息,提倡健康的生活方式,大力倡导戒烟,避免职业和环境污染,除宣传教育外,诊治方面有以下进展[1].

目的提高对少见病韦格纳肉芽肿(Wegener's granulomatosis,WG)的认识.方法对1例临床和病理诊断的WG伴气道狭窄患者的临床资料进行分析,并结合文献复习.结果WG是一种累及多器官的坏死性肉芽肿性血管炎疾病,可累及的全身器官包括上呼吸道(耳、鼻窦、鼻黏膜)、肺、肾,还有皮肤、关节、外周和中枢神经系统,上呼吸道病变最常见,70%以上上呼吸道受累起病,肺部可有多发结节表现,累及气管黏膜可致气道狭窄.病因与发病机制可能与免疫有关.结论不但耳鼻喉医师应提高对本病的认识,注重病理检查,以期早期诊断WG,呼吸内科医师也应对本病有深刻的认识,对久治不愈的上呼吸道疾病(耳炎、鼻炎、鼻窦炎、眼炎)的此类患者,发生咳嗽久治不愈、呼吸困难进行性加重、肺内多发结节影,要想到WG的可能.

目的分析3年来我院收治严重胸部创伤的病例特点,围绕其院内死亡原因总结成功救治经验及体会.方法将147例严重胸伤构成比及住院病死率之关系,对伤后常见致死原因失血性休克,成人呼吸窘迫综合症和多系统器官衰竭等进行分析.结果全组生存135例,死亡10例,住院病死率6.8%,住院早期死亡原因以失血性休克为主,晚期死亡原因多为成人呼吸窘迫综合征(ARDS)和多系统器官衰竭(MSOF).结论严重胸部创伤,急诊救治的时限是有重要意义.应针对胸部外伤特点,围绕严重胸伤常见的致死原因,进一步改进急救和后续处理,降低病死率.

目的:探讨血浆中血管活性肠肽(vasoactive intestinal peptide,VIP)含量与非哮喘性缓解期慢性阻塞性肺病(COPD)患者吸入糖皮质激素疗效的关系.方法:采用放免法(RIA)测定非哮喘性COPD及健康正常人(HS)血浆VIP含量.选择74例非哮喘性COPD患者,以健康正常人血浆VIP含量x-2S为标准,分为两组:血浆VIP含量低于x-2S为VIPL组(38例),血浆VIP含量高于x-2S为VIPH组(36例).74例均予布地奈德800μg@d-1吸入治疗,共6周.治疗前、后检测常规肺功能、血浆VIP含量并进行比较.结果:VIPL组,吸入糖皮质激素治疗后FEV1.0显著提高(治疗前1.49±0.26L,治疗后1.75±0.52L,P＜0.05),有效率为92.1%(35/38);血浆VIP含量亦有不同程度升高(治疗前9.74±4.47,治疗后15.02±7.12)两者具有相关性(r=0.62,P＜0.01).VIPH组治疗前、后各项指标无显著差异(P＞0.05),有效率为2.8%(1/36).两组比较,有显著差异(P＜0.01).结论:血浆VIP含量较低的缓解期COPD患者吸入糖皮质激素治疗可能有效.提示我们可以根据缓解期COPD患者血浆VIP含量来判断该患者是否需要使用糖皮质激素治疗.

Objective To evaluate the clinical merits and demerits of open heart operation on beating heart under mild hypothermia.Methods 21 patients (11 men and 10 women,age range,2.5～47 yr),hospitalized from May,2000 to December,2001,received open heart surgery under cardiopulmonary bypass (CPB) on beating heart under mild hypothermia,including atrial septal defect (ASD) 5 cases,ventricular septal defect (VSD) 11 cases,ASD combined with VSD 3 cases,tricaspid valve replacement 1 case and triology of fallot 1 case.Results The operating procedure in all patients was successful,without ventricle trembling and gas embolism and they all recovered.Conclusion The open heart surgery on beating heart under mild hypothermia has protective effect on myocardium,which maybe attributed to the reduction of ischemic reperfusion injury,this approach is safe and effective.Meanwhile,it is somewhat difficult to operate in complicated deformation cases because of beating heart and returned blood stream.

Objective To evaluate the safety and effectiveness of etimicin sulfate and amikacin sulfate on bacterial infection in lower respiratory tract infection.Methods Using the random,contrast and ope test method,in etimicin sulfate group (n=60) 100 mg in 100 ml NS was intravenously given,twice a day;in amikacin sulfate group  (n=60)  400 mg in 500 ml NS was intravenouly given,once a day,with a treatment course of 5～10 days for both groups.Results 30 cases in each group were evaluated for its effectiveness,the effective rates in etimicin sulfate group and in amikacin sulfate group were 90.0% and 86.7% respectively,the clearing bacteria rates were 88.5% and 88.0% respectively.The other 30 cases in each group were evaluated for its safety,the incidences of dys response of deafness were 3.3% and 3.3%,and the incidences of dys response of kidney were 3.3% and 3.3%.There was no significant difference between two group (P0.05).Conclusion Etimicin sulfate is safe and effective in treating bacterial infection in lower respiratory tract.

肺不张,肺部感染是老年患者胸部手术后最常见的并发症,特别是对于有长期吸烟史,慢性支气管炎症,慢性阻塞性肺部疾病基础的患者,其术后呼吸道并发症的发病率更高.临床上常采用加强药物抗炎,鼻导管或纤维支气管镜吸痰治疗.我们通过对同期临床术前采用呼吸道超声雾化150例及非超声雾化120例病人的治疗来观察其术后肺不张,肺部感染的发生情况,并对两组资料进行统计分析,现报告如下.

目的:比较氨力农与洋地黄治疗肺心病肺心功能失代偿期的安全有效性.方法:选择40例肺心病肺心功能失代偿期住院患者,随机分为氨力农组(n=20);洋地黄组(n=18/20).分别用氨力农200mg+NS250ml,以5～10mg·kg-1·min-1静滴,疗程7天;洋地黄首次以西地兰0.4～0.8mg静推,以后地高辛0.125mg口服,疗程7天.治疗前后观察患者的心功能级别、心动超声(PAP,EF)指标、肺功能(VC,RV/TCL,FEV1%)指标及不良反应情况.结果:氨力农组心功能改善总有效率为85%,洋地黄组为88.9%,同时,对肺动脉压、射血分数及肺功能指标治疗前后均有明显改善(P＜0.05).各指标两组对照无明显差异(P＞0.05).不良反应发生率氨力农组为0,洋地黄组为10%.结论:氨力农与洋地黄对治疗肺心病肺心功能失代偿期患者有明显的疗效,但是,氨力农治疗肺心病肺心功能失代偿期既有效又安全,而洋地黄对治疗肺心病心力衰竭应持慎重态度.

Objectives To investigate the effectiveness of PHV combined with low PEEP for severe asthma.Methods 12 severe asthma patients were treated with PHV combined with low PEEP ventilation. Ventilation modewas set as volume control or assistant/control with PHV (PaCO2＜10.6 kPa,pH＞7.15). 2 of them were treated withSIMV and PEEP. The tidal volume was set as 6 8 mi/kg. PEEP was set at 5～10 cm H2O. Breath frequency wasset at 14 - 16 per minute. FiO2,PIP,ABG,HR, and BP were all recorded. Results Before treatment, 12 patientswere all in the state of respiratory failure and mental confusion, including lethargy and coma with PaO2. 6.18 ± 0.64kPa, pH7.14 ± 0.07 kPa, and PaCO2 10.6 1.53 kPa. After 2 - 8 hours, 24 hours, 48 hours, and 72 hours of PHVcombined with PEEP treatment, pH and PaO2 were all raised remarkbly (P＜0.01). However, PaCO2 was loweredstep by step above the normal level in 72 hours. All 12 patients were alive without any complications. ConclusionWith sufficient oxygen support, PHV combined with PEEP may gradually decrease PaCO2 and raise pH to normal lev-el. It has been proved to be an effcctive mechanical ventilation therapy of severe asthma. (Shanghai Med J, 2000,23:491-492)