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纤维支气管镜代胸腔镜诊断不明原因胸腔积液28例临床分析

目的探讨纤维支气管镜代胸腔镜检查在诊断胸腔积液中的临床应用价值。 方法以我院2013年5月至2014年8月收治的不明原因胸腔积液患者28例为研究对象, 对其行纤维支气管镜代胸腔镜检查, 获取胸腔积液及病变组织行病理学检查。 结果28例患者中, 2例脓胸患者未行病理检查, 其余26例患者均行病理检查并明确诊断, 确诊率为92.86%。其中, 18例为恶性肿瘤病变, 包括腺癌10例, 鳞癌8例; 8例为肉芽肿样改变, 诊断为结核性胸腔积液, 经正规抗结核治疗胸腔积液消失。27例患者的人工气胸在术后1~3 d内完全吸收拔管, 无术中术后大出血、伤口感染以及胸腔积液新发感染等并发症发生。 结论纤维支气管镜代胸腔镜在检查胸腔积液病因中是一种安全有效、检出率高的检查方法, 值得临床大范围应用与推广。

肺癌手术漏诊支气管腔内病变三例

Kartagener 综合征四例报告并文献复习

目的探讨 Kartagener 综合征的临床特点，提高该病的诊治水平。方法回顾本院呼吸内科收治的 4 例 Kartagener 综合征患者的临床资料，综合复习相关文献后进行分析。结果4 例 Kartagener 综合征中，男 3 例，女 1 例，年龄 24～51 岁。1 例父母为表兄妹近亲结婚。患者均因咳嗽、咳痰，伴或不伴咯血痰、胸闷、气促、喘息、浮肿、发热等症状就诊。1 例在外院确诊 Kartagener 综合征、肺源性心脏病，余 3 例 CT 影像等检查提示存在内脏转位、支气管扩张、鼻窦炎三联征，入院后确诊 Kartagener 综合征。4 例均给抗感染、祛痰、分泌物引流治疗，合并肺源性心脏病者予以无创呼吸机辅助通气、抗心力衰竭等治疗后，病情缓解出院。复习国内外文献，咳嗽、咳痰、咯血、气促是 Kartagener 综合征就诊的主要症状；预防感染、及时控制感染是治疗 Kartagener 综合征的关键。随着对 Kartagener 综合征的基因遗传学研究的深入，有望寻找到有效的办法以早期诊断，有效治疗，甚至减少发病。结论Kartagener 综合征是一种以内脏转位、支气管扩张、鼻窦炎为表现的罕见的先天遗传性疾病。提高临床医生对该病的认识，早期诊断，综合治疗，有效控制慢性气道炎症，是控制疾病进展、改善预后的有效方法。

Bronchial asthma combined clinical analysis of 32 cases of pregnancy

目的:探讨妊娠合并哮喘的临床表现及治疗方法。方法:对32 例妊娠合并支气管哮喘患者的临床资料进行回顾性分析。结果:经过适当的治疗,32例支气管哮喘合并妊娠患者症状缓解,随访至产后1 个月,婴儿和母亲均正常。结论:支气管哮喘合并妊娠时,妊娠早期可选用对胎儿无影响的药物如头孢菌素类抗生素、β2 受体激动剂、糖皮质激素(吸入布地奈德,强的松口服,短期甲强龙静滴),妊娠中晚期还可选用茶碱类药物及全身使用糖皮质激素等药物。

Analysis of the occurrence and influencing factors of fatigue in asthma patients

ObjectiveTo investigate the fatigue of asthma patients, and to analyze its influencing factors, and provide a reference for clinical intervention.MethodsThe convenience sampling method was adopted to select asthma patients who were in clinic of the First Affiliated Hospital of Guangxi Medical University from November 2018 to March 2019. The patients’ lung function were measured. And questionnaires were conducted, including general data questionnaire, Chinese version of Checklist Individual Strength-Fatigue, Asthma Control Test, Chinese version of Self-rating Depression Scale. Relevant data were collected for multiple stepwise linear regression analysis.ResultsFinally, 120 patients were enrolled. The results of multiple stepwise linear regression analysis showed that age, education level, place of residence, time period of frequent asthma symptoms, degree of small airway obstruction, Asthma Control Test score and degree of depression were the influencing factors of fatigue in asthma patients (P≤0.05). Multivariate linear stepwise regression analysis showed that degree of small airway obstruction, degree of depression and time period of frequent asthma symptoms were the main influencing factors of fatigue in asthma patients, which could explain 51.8% of the variance of fatigue (ΔR2=0.518).ConclusionsThe incidence of fatigue in asthma patients is at a relatively high level. Medical staff should pay attention to the symptoms of fatigue in asthma patients. For asthma patients, it is recommended to strengthen standardized diagnosis and treatment, reduce the onset of symptoms at night and eliminate small airway obstruction. Psychological intervention methods are needed to improve patients’ depression, reduce fatigue symptoms, and improve quality of life.

支气管Dieulafoy 病致大咯血一例

病历摘要 患者男性, 62 岁。因“咯血3 d, 加重1 h”于2010 年3 月23 日凌晨急诊入院。患者于入院3 d 前无诱因出现咯血, 初咯血量较少, 入院前1 h 突然出现大咯血, 鲜红色, 约150 mL; 伴头晕、心悸, 无畏寒、发热, 无胸痛和呼吸困难。既往有两次大咯血病史, 未明确诊断; 否认肺结核和支气管扩张病史。

大型“C”臂实时引导下经电子支气管镜小导管脓腔冲洗治疗肺脓肿的临床观察

目的探讨大型"C"臂实时引导下经电子支气管镜小导管脓腔冲洗治疗肺脓肿的疗效。 方法将12例肺脓肿患者随机分为治疗组和对照组, 每组各6例。对照组患者予以止咳、化痰、抗感染及体位引流等常规治疗。治疗组患者在上述治疗的基础上加用大型"C"臂实时引导下经电子支气管镜小导管脓腔冲洗治疗。两组患者的疗程均为3周。 结果对照组患者的总有效率为68.8%;治疗组患者的总有效率为100.0%, 两组总有效率比较差异有统计学意义(P＜0.05)。治疗组患者的住院时间、抗生素应用时间及血降钙素原恢复正常时间均较对照组明显缩短(P＜0.05)。治疗组电子支气管镜治疗过程中未出现严重并发症。 结论大型"C"臂实时引导下经电子支气管镜小导管脓腔冲洗治疗肺脓肿具有疗效确切、治愈率高、疗程短的特点。

良性气道狭窄病因分析及治疗方式总结

目的 探讨良性气道狭窄病因分析及治疗方式。方法 收集2006 年1 月至2010 年5月期间四川大学华西医院经胸部CT、纤维支气管镜或手术、病原学、病理学确诊为良性气道狭窄的住院患者100 例。对患者的病史特点、胸部影像学检查、纤支镜镜下表现、手术所见、病原微生物、病理结果及治疗方式进行统计分析。结果 在良性气道狭窄患者中, 支气管结核60 例( 60% ) , 气管切开术后15 例( 15% ) , 创伤后6 例( 6% ) , 气管插管后3 例( 3% ) , 支气管吻合术后3 例( 3% ) , 甲状腺肿3 例( 3% ) , 复发性多软骨炎2 例( 2% ) , 良性肿瘤4 例( 4%) , 其他原因4 例( 4%) 。结论 良性气道狭窄的病因常见原因是结核性, 起病较隐匿, 临床医生应注意排查肺结核患者有无气道狭窄。纤支镜下的介入治疗为治疗良性气道狭窄的主要方法。

支气管结石的诊治分析

支气管结石为临床少见疾病。作者收集杭州市余杭区妇幼保健院和中国有色金属公司金川公司职工医院1986 ～2010 年诊治的6 例患者, 均进行胸片、螺旋CT 及支气管镜检查, 最后经支气管镜摘除结石、咯出结石或者手术取出结石证实。对其病因、诊治经过进行分析, 以提高早期诊断率, 减少误诊。

Cardiovascular events after acute exacerbation of bronchiectasis

Objective To investigate the cardiovascular events (CVE) and survival status of patients with bronchiectasis (BE) during follow-up after acute exacerbation. Methods Prospective cohort study was used. Clinical data of 134 BE patients with acute exacerbation who were hospitalized from July 2016 to September 2020 were collected. The patients were followed up after discharge by phone or respiratory clinic every 3 months until November 2022. CVE or death was the endpoint event. Result During the follow-up period, 41 patients developed CVE, while 93 patients did not. Fifty-one patients died during the follow-up period, with a mortality rate of 38.06%. Among them, 41 cases of CVE resulted in 21 deaths, with a mortality rate of 51.22%; 30 cases died in 93 non-CVE patients, with a mortality rate of 32.26%. Logistic regression results showed significant influencing factors for CVE in BE patients were age, hypertension, chronic obstructive pulmonary disease (COPD), and moderate to severe illness. The significant influencing factors for the death of BE patients were age, COPD, moderate and severe illness, and CVE events. The significant influencing factors for the death of CVE patients were age and receiving CVE treatment. The area under ROC curve (AUC) and 95%CI was 0.858 (0.729 - 0.970) for the warning model for CVE in BE patients. The AUC (95%CI) was 0.867 (0.800 - 0.927) for the warning model for death in BE patients. The AUC (95%CI) was 0.811 (0.640 - 0.976) for the warning model for death of CVE patients. Conclusions Population factors and comorbidities are risk factors for CVE in BE patients after acute exacerbation. The appearance of CVE worsens the long-term prognosis of BE patients. The corresponding warning models have high warning effectiveness with AUC>0.8.