自发性气胸多见于瘦高型人群,多为特发性自发性气胸(primary spontaneous pneumothorax,PSP).一般认为PSP与胸膜下肺大泡破裂有关,目前其原因考虑多为先天肺发育不良.PSP是一常见病,青年、体型瘦长者多发,并多见于40岁以下男性.据文献报道,男性年发病率为7.4～18.0/10万,女性年发病率为1.2～6.0/10万,并且抽烟及低体质指数(BMI)是PSP的危险因素[1-4].

目的 对重症肺泡蛋白沉着症(PAP)患者合并呼吸衰竭临床资料结合文献复习进行总结,以提高对该疾病的认识.方法 对我科2008年6～9月收治的2例PAP合并呼吸衰竭病例进行回顾性分析.结果 2例患者为男性,有吸烟史和粉尘接触史,1例病史短期内进展,1例缓慢进展,均表现为进行性加重的呼吸困难,肺功能表现为弥散功能障碍,血气分析提示呼吸衰竭;2例在高频呼吸机辅助通气情况下行床边纤支镜下肺组织活检及电镜观察确诊;2例在全麻下行左、右全肺灌洗,其症状、氧合、肺功能及胸部影像学均得到明显改善,治疗后均脱离粉尘.随访至今无复发.结论 PAP合并呼吸衰竭应尽早在保证氧供下取得病理诊断,全肺灌洗治疗短期内效果佳,粒细胞-巨噬细胞集落刺激因子应用为可供选择的方法,可脱离粉尘或可预防复发.

OBJECTIVE:to investigate the clinical features of 127 cases of the novel influenza A/H1N1 infection in Fujian Province. METHODS:this study included 127 human cases with the novel influenza A/H1N1 infection in Fujian Province from May 2009 to July 2009. Data were collected and reviewed from hospital medical records. The statistical analyses were performed with SPSS 11.5. RESULTS:the median age of the 127 patients (55 were females) was 21 years (range 0.4 - 58). The median incubation period was 2 d (range 1 - 12 d). The typical clinical symptoms included fever, cough, sputum, and sore throat. The duration of symptoms in patients less than 5 years old and in patients more than 5 years old were (8.2 +/- 4.1) and (5.4 +/- 3.0) d respectively, the difference between these 2 groups being significant (z = 3.182, P < 0.01). There was also a statistically significant difference in the duration of symptoms between the high-temperature group and the low-temperature group [(6.8 +/- 3.2) vs (4.8 +/- 2.1) d, Hc = 9.729, P < 0.05]. The duration of symptoms in the high, the normal and the low white blood cell groups were (6.3 +/- 4.7) d, (5.4 +/- 2.8) d, and (8.5 +/- 4.2) d respectively, but the differences were not statistically significant (Hc = 4.729, P = 0.094). However, the duration of symptoms in the higher lymphocyte count group was significantly longer than that in the lower and normal lymphocyte count groups [(6.8 +/- 3.3) vs (5.4 +/- 3.4), (5.2 +/- 3.2) d, Hc = 10.105, P < 0.01]. Chest radiography showed patchy infiltrates in 6 patients, and their duration of symptoms was longer than patients with normal chest radiography [(8.1 +/- 5.7) vs (5.6 +/- 3.1) d], but the difference was not statistically significant (z = 1.286, P > 0.05). 125 patients received antiviral treatment with oseltamivir and they all had a good prognosis. There was a statistical difference in the duration of symptoms between the patients who used oseltamivir within 48 h after disease onset and patients who used the drug beyond 48 h [(4.7 +/- 2.2) vs (7.4 +/- 4.1) days, z = 4.907, P < 0.01]. All of the patients survived. CONCLUSIONS:the clinical symptoms of this series of patients with the novel influenza A (H1N1) infection appeared to be mild. There were several factors associated with longer duration of symptoms, including aged 5 years or younger, higher fever (body temperature > 38 degrees C), higher white blood cell count and lymphocyte count. The early use of anti-retroviral treatment with oseltamivir was useful in shortening the duration. The novel influenza A (H1N1) infection was a self-limited disease, and patients with no complications had a good prognosis.

Objective To evaluate the clinical efficacy and safety of piperacillin/tazobactam in the treatment of hospital acquired pneumonia(HAP).Methods A multicenter,open-labeled,non-comparative clinical trial was conducted.Patients with HAP were administered intravenously with piperacillin/tazobactam(4.5 g) every 8 h for 7-14 days.Results A total of 250 patients were enrolled in this study and 246 subjects were clinical valuable.At the end point,the clinical efficacy rate was 81.7%(201/246) and the bacterial eradication rate was 74.1%(83/112).The rate of drug related adverse events was 2.8%(7/250),in which 4 cases had clinical significance(rash,dyspnea,injection site pain and diarrhea,respectively) and 3 cases had abnormal laboratory findings(hepatic dysfuction,eosinophilia and so on).All events were mild and transient.ConclusionsPiperacillin/tazobactam is effective and safe in the treatment of HAP,therefore,it is recommended as one of the first-line antibiotics to treat the patients with HAP.

OBJECTIVE:To summarize the clinical characteristics and therapeutic experience of A/H5N1 infected patient with intractable bronchopleural fistula.METHOD:The data of a patient with A/H5N1 infection complicated with bronchopleural fistula was collected and analyzed.RESULTS:A 44-year-old woman with pneuminian was diagnosed as A/H5N1 infection by reverse-transcription polymerase chain reaction (RT-PCR) in laboratory from the sample of secretion of respiratory tracts. She had exposed to sick or dead poultry 3 days before development of illness. She developed acute respiratory distress syndrome 7 days after onset of sickness. After comprehensive management with antiviral agents, antibiotics, convalescent serum and invasive ventilation, her clinical condition improved and turned to stable. However, 16 days after onset of illness, her clinical situation deteriorated due to ventilator-associated pneumonia, bilateral pneumothorax and persistent right bronchopleural fistula. After partly failure of beside assist thoracoscopy to fix the pleural fistula, transbronchoscopic bronchial occlusion by autoblood was explored and the air leakage stopped soon after occlusion. Three days after the autoblood clot was expectorated out and air leak recurred. Then, bronchopleural fistula on the surface of visceral pleura was successfully blocked by biogel and OB gel through pleural cavity by fibrobronchoscopy. The patient was discharged from the hospital 99 days after onset of illness (at the 94th hospital day).CONCLUSION:Bronchopleural fistula was an intractable complication for patient with A/H5N1 infection. Occlusion operation by biogel and OB gel through bronchoscopy might be an alternative choice for fixing the bronchopleural fistula.

OBJECTIVE To investigate the clinical pathologic features and therapeutic tools of pulmonary cryptococcosis.METHODS The clinical data about 16 cases of pulmonary cryptococcosis which were diagnosed by histopathologic examinations were reviewed.The survey data recorded over a 15-year period,from 1982 to 2007,were summarized.We analyzed their clinical situations,radiographic manifestations,final diagnosis and therapeutic tools.RESULTS The majority of the patients were middle-aged males.The health condition of the most of the patients was good before infection.six months to five years after surgery and antifungal theragy,no relapse,dissemination and death were observed.CONCLUSIONS The majority of primary pulmonary cryptococcosis patients have not underlying diseases,and their radiography manifestations show single or multiple nodular shadows,tumor shadows and infiltrative shadows.The limited pathological change can be excised and applied with the antifungal drugs.Fluconazole is the first-choice drug for curing pulmonary cryptococcosis.

[目的]探讨DNA修复和转录相关基因差异表达在普通型间质性肺炎发病中的作用。[方法]取2例普通型间质性肺炎患者肺组织,并以正常肺组织作对照。应用基因芯片技术测定其基因差异表达。[结果]DNA损伤修复相关基因(如RAD23A)明显下调,而转录因子相关基因(如C-MAF)明显上调。[结论]DNA修复和转录相关基因差异表达参与了肺组织损伤修复失衡的发生,与UIP的发病可能有关。

目的:探讨恙虫病并发多器官功能障碍综合征(MODS)的误诊原因.方法:对1993年8月～2006年8月我院收治的恙虫病MODS 15例进行回顾性分析.结果:15例中发生3个器官功能障碍9例,4个器官功能障碍6例,疾病的危重程度与器官损害数呈正相关.15例至我院就诊前已在当地医院误诊并予抗感染治疗无效,误诊时间为5～15天.15例均根据病史、临床表现和恙虫痛间接免疫荧光抗体阳性确诊恙虫病,9例经及时诊治,预后良好.6例死亡.结论:恙虫病临床表现多样化,常伴有MODS,应仔细收集病史和体征,及时正确诊治,以防MODS的发生.

成人Still病是一种原因不明的慢性系统性炎性疾患,属于全身性幼年型类风湿性关节炎的成人变异型,其主要临床表现为高热、多关节疼痛或肿胀、皮疹和中性粒细胞为主的白细胞增多,可累及多个系统.

骨化性气管支气管病是指气管、支气管黏膜下有多发性骨质或软骨组织结节状增生并突向管腔的良性病变[1].1855年,Rokitansky 等首次描述了本病,迄今为止国外已报道457例,国内报道较少,但随着对该病认识的不断加深以及支气管镜的普及应用,近年来诊断的病例正逐渐增多,至今已报道32例.

Objective To detect the levels and study the significance of serum soluble intercellular adhension molecule-1(sVCAM-1),soluble vascular cell adhension molecule-1(sVCAM-1)in patients with community-acquired pneumonia(CAP).Methods sICAM-1 and sVCAM-1 were detected by enzymelinked immunosorbent assy(ELISA)in 25 patients with CAP before and after treatment as well as in 10 healthy controls.Results Before treatment,the levels of serum sICAM-1 and sVCAM-1 in the patients with CAP[(2.658 4±0.259 7)ng/mL,(2.680 9±0.255 4)ng/mL)]were significantly higher than those in controls[(2.472 8±0.077 6)ng/mL,(2.426 3±0.307 2)ng/mL](P<0.01,P<0.05).After treatment,the levels of serum sICAM-1 and sVCAM-1 significantly decreased[(2.518 3±0.205 2)ng/mL,(2.523 0±0.279 4)ng/mL](P<0.01,P<0.01)and were not different from those in controls(P>0.05).The levels of sICAM-1 were positively correlated with neutrophil counts(r=0.602,P<0.001)rather than the levels of sVCAM-1(r=0.036,P>0.05).Conclusion The changes of sICAM-1 and sVCAM-1 before and after treatment are predictive to the prognosis in patients with CAP.

2007年2月22日我院收治一例重症肺炎合并成人呼吸窘迫综合征 (ARDS) 患者,后经省CDC检查、国家CDC复查确诊为人感染高致病性H5N1亚型禽流感.

22003 年至今我国确诊人感染高致病性H5N1亚型禽流感30例,经救治成功10例,死亡20例.现将福建省救治成功2例报道如下.

Objective To investigate the incidence of tsutsugamushi disease complicated with acute respiratory failure(ARF).Methods 13 cases of tsutsugamushi disease complicated with acute respiratory failure were gathered from July 1996 to Nov 2007.Results The tsutsugamushi disease complicated with acute respiratory failure is always complicated with multiple organ dysfunction.It has high mortality rate.The severity is direct correlation with misdiagnosis rate.If the diagnosis and treatment are promptly,the prognosis is good and curing rate is high.Conclusion The incidence of tsutsugamushi disease complicated with acute respiratory failure is less,and has high misdiagnosis rate.We should collect the history and signs carefully to make appropriate diagnosis and treatment,to avoid ARF.

[Objective] To investigate the differential diagnosis value of pleural fluid ADA and CEA detection for tuberculous pleuritis(TP) and carcinomatous pleuritis(CP).[Methods] Totally 38 TP and 42 CP cases were selected for differential diagnosis.ADA activity and CEA value were detected by velocity method and immunization method of electro-chemiluminescence respectively,The validity,predictive value and likelihood ratio of TP and CP were evaluated.[Results] ADA positive rate of TP(86.8%) was higher than that of CP(2.4%)(P〈0.01);CEA positive rate of CP(71.4%) was higher than that of TP group(2.6%)(P〈0.01).The sensitivity,specificity,Yoden's index,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of ADA in diagnosing TP were 86.8%,97.6%,0.84,97.1%,89.1%,36.49 and 0.14 respectively;The indexes as mentioned above of CEA in diagnosing CP were 71.4%,97.4%,0.84,96.8%,75.5%,27.16 and 0.29 respectively.[Conclusion] Detection of ADA and CEA in pleural fluid is of considerable clinical significance in differential diagnosis of TP and CP.

光气(COCl2)又名炭酰氯,是化工合成中一种重要原料,也是一种军用毒剂.光气是一种刺激性气体,属剧毒类,其对人体损害的靶器官是肺.光气中毒事件时有报道,但在抢救光气中毒中造成医务人员二次中毒的报道罕见.我们将本院最近抢救光气中毒中医务人员二次中毒的事件报道分析如下,以期从中吸取经验教训。

现将我省2006年1月确诊并经救治痊愈的1例成人重症高致病性H5N1亚型禽流感病例报道如下.

OBJECTIVE:To describe the characteristics of Dieulafoy's disease of the bronchus.METHODS:One patient with Dieulafoy's disease of bronchus was described and relevant literatures were reviewed.RESULTS:Bronchial Dieulafoy's disease is extremely rare, characterized by the erosion of an anomalous artery in the submucosa of bronchus. The etiology of Dieulafoy's disease of bronchus is still unknown, but congenital vascular malformation and airway chronic inflammation or bronchial injury have been postulated. The sudden onset of massive hemoptysis and fatal hemorrhage caused by biopsy injury are common manifestations. Bronchial and pulmonary angiography is a very useful examination before operation, and histopathological diagnosis can be made by the examination of the surgical specimen and the necroscopic specimen. Selective bronchial artery embolization could be proposed as a method for stopping the bleeding, but it may fail and bleeding may recur. At present, lobectomy of the lung is a fundamental approach.CONCLUSIONS:Bronchial Dieulafoy's disease should be included in the differential diagnosis of cryptogenic hemoptysis, and if a cone-shaped endobronchial protrusion is found by bronchoscopic examination, care should be taken for potential danger of a biopsy.

Objective To explore the clinical features and the cause of secondary phosgene poisoning after rescuing the patients with acute phosgene poisoning.Methods According to the diagnostic criteria of occupational acute phosgene poisoning,the differences of clinical manifestation,laboratory results and chest X-ray between secondary poisoning patients and primary patients were compared.Results Among the 25 patients with secondary phosgene poisoning,14(56.0%) had cough,13(52.0%)had throat stimulus,10(40.0%)had chest stuffiness,2(8.0%)had polypnea,1(4.0%) had pain in the eye.There was no significant difference in clinical manifestation between the secondary and primary patients. No positive sign was found after the examination of pulmonary function in the 25 patients,but all of them had abnormal chest X-ray,and typical bronchitis could be found.According to the diagnostic criteria,the 25 patients had slight acute phosgene poisoning,and recovered after treatment for 7 to 10 days.Conclusion To prevent the secondary phosgene poisoning after treating the patients with acute phosgene intoxication,medical workers should enhance protection awareness and take some necessary measures.

普通型间质性肺炎(UIP)发病机制尚不清楚,但越来越多的资料证明炎性细胞因子,氧化应激可能在其发生发展中起着非常重要的作用.我们运用基因芯片技术比较UIP患者与正常人肺组织基因表达的差异,以探讨UIP的发病机制.