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find Keyword "支气管扩张症" 21 results
  • Bacterial analysis of community acquired lower respiratory tract infection in hospitalized patients with underlying chronic respiratory tract diseases

    Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data,sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected,with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease,gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens,with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%,mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection,86.2% were caused by gram negative bacteria,the top three being,in descending order,Pseudomonas aeruginosa (27.5%),Haemophilus parainfluenzae (13.7%),and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590,95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652,95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679,95%CI 1.108~6.476).For enterobacters infections,including Klebsiella pneumoniae,Enterobacter cloacae and Escherichia coli,the risk factors were antibiotic usage within 1 month (OR=4.236,95%CI 1.982~9.057),having renal diseases (OR=4.305,95%CI 1.090~17.008) and diabetes mellitus (OR=2.836,95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases,severity of diseases and drug usage history of patients.

    Release date:2016-08-30 11:35 Export PDF Favorites Scan
  • 吸入激素在支气管扩张症中的应用

    支气管扩张症(简称支扩)是以进行性和不可逆性气道破坏和扩张为特征的慢性气道炎症性疾病[1],大多表现为长期咳嗽、咳脓性痰,反复急性发作,肺功能受损,后者主要表现为阻塞性通气功能障碍,气道反应性增高,晚期患者常常出现劳力性呼吸困难,严重影响患者生活质量[2,3] 。大部分支扩患者第1秒用力呼气容积(FEV )每年下降大约50mL [4] 。在我国支扩的发病率为0.3‰~0.5‰。2005年美国成人支扩发病率约为52.3/100 000。发病率随年龄而增加,在所有年龄阶段女性发病率均较男性高,预计在美国有18岁以上的支扩患者110 000例,每年医疗费用约6.3亿美元[5]。

    Release date:2016-08-30 11:35 Export PDF Favorites Scan
  • 大环内酯类抗生素在支气管扩张症中的应用

    Release date:2016-08-30 11:35 Export PDF Favorites Scan
  • 雾化吸入抗生素在支气管扩张症中的应用

    支气管扩张症(简称支扩)是一种慢性肺部疾病,特征性地表现为支气管异常、持久的扩张和破坏,临床处理困难。虽然支扩的病因多种多样,但细菌性感染和持续性炎症是其典型病变,且反复发生,导致病情不断恶化。临床表现主要为发热、咯脓性痰,并常伴有胸痛和咯血。在支扩患者的痰中最常分离培养出的细菌是流感嗜血杆菌、肺炎链球菌、金黄色葡萄球菌和铜绿假单胞菌,其中铜绿假单胞菌是病程晚期最常见也是最难处理的感染病原体,往往难以清除,并与病情的加重和恶化密切相关,与其他病原体感染相比可导致更快的肺功能和生活质量的下降[1]。

    Release date:2016-08-30 11:35 Export PDF Favorites Scan
  • 支气管扩张症的抗生素治疗

    支气管扩张症(简称支扩)是指由多种原因引起支气管壁肌肉和弹力支撑组织的破坏而引起的中等大小支气管的不正常扩张,是一种肺组织结构破坏性疾病,表现为反复呼吸道感染,大量脓痰,可出现咯血。支扩有许多相关因素及病因,总体来说,其发生可归结于以下两个因素:① 感染的持续刺激;②气道阻塞、支气管引流功能损害和防御功能的缺陷。两种因素可以同时存在,互为因果。支扩的病程一般呈进行性发展,其机制可用Cole[1] 在1984年提出的恶性循环(vicious circle)假说来解释,该假说认为感染或定植的细菌触发气道上皮的炎症反应,释放炎症介质和酶,持续的慢性炎症反应引起支气管壁和肺组织的损伤,破坏气道纤毛上皮的清洁功能,进一步加重感染和细菌定植,形成一个周而复始的恶性循环。因此,抗生素几乎是现阶段治疗支扩的主要药物之一。

    Release date:2016-08-30 11:35 Export PDF Favorites Scan
  • Efficacy of Long-term Inhaled Salmeterol/Fluticasone Combined with Low-dose Oral Erythromycin in Patients with Bronchiectasis

    Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.

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  • Complete Video-assisted Thoracoscopic Surgery Lobectomy for the Treatment of Bronchiectasis

    Abstract: Objective To compare clinical outcomes of complete video-assisted thoracoscopic surgery (cVATS) lobectomy with routine thoracotomy lobectomy for the treatment of bronchiectasis, and evaluate the feasibility, safety and specific considerations of cVATS lobectomy for the treatment of bronchiectasis. Methods We retrospectively analyzed the clinical data of 115 patients who underwent lobectomy for the treatment of bronchiectasis in Beijing Chaoyang Hospital from May 2009 to January 2012. According to the way of operation, these patients were divided into two groups (cVATS group and thoracotomy group). In the thoracotomy group, there were 62 patients (28 males and 34 females with an age of 46.2±11.9 years) who underwent routine thoracotomy lobectomy. In the cVATS group, there were 53 patients (19 males and 34 females with an age of 45.7±12.2 years) who underwent cVATS lobectomy. Operation time, intra-operative blood loss, postoperative thoracic drainage, complications and hospitalization, and cost of hospitalization were compared between the two groups. Results There was no perioperative death in all patients. There was no statistical difference in operation time between the two groups. Intra-operative blood loss of thoracotomy group patients was significantly higher than that of cVATS group patients (228.8±121.7 ml vs. 157.1±123.8 ml, t=2.592, P=0.011). Postoperative thoracic drainage (866.7±439.5 ml vs. 1 805.3±466.7 ml, t=9.003,P=0.000), duration of chest tube drainage (6.6±3.3 d vs. 9.8±4.6 d,t=3.339,P=0.001), and postoperative hospitalization (7.5±2.2 d vs. 11.2±5.4 d, t=3.424,P=0.001) of cVATS group were significantly lower than those of thoracotomy group. The cost of hospitalization of cVATS group was significantly higher than that of thoracotomy group (38 543.6±11 051.8 yuan vs. 30 523.4±10 028.5 yuan,t=3.423, P=0.001). There was no statistical difference in postoperative complications between the two groups (P>0.05). Forty-five patients in cVATS group were followed up for 2 to 14 months. Among them, 42 patients completely had no sputum or haemoptysis and 3 patients still intermittently had some sputum. Conclusion cVATS lobectomy is safe and feasible for the treatment of bronchiectasis. Compared with routine thoracotomy lobectomy, cVATS lobectomy does not increase surgical risk, but can significantly reduce operation injury and length of hospital stay. During cVATS, the lung residual should be handled cautiously especially for patients with nonanatomic pulmonary resection, and the non-single-order operation is recommended.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 肺段支气管剔除治疗支气管扩张症的疗效

    目的 观察肺段支气管剔除治疗支气管扩张症的疗效与安全性。 方法 回顾性分析武警甘肃总队医院2004年12月至2007年12月均经支气管碘油造影、胸部X线片及胸部CT检查确诊的支气管扩张症30例患者的临床资料,其中男21例,女9例;年龄31.9 (16~41)岁。其中囊性扩张6例,柱状扩张9例,混合性扩张15例;双侧病变8例,单侧病变22例。全组患者均行肺段支气管剔除术,观察其疗效。 结果 共剔除肺段支气管64支,手术时间为50~180 min。术中失血量380 (300~600) ml,手术当天胸腔引流量350~550 ml,无手术死亡。术后第3~5 d拔除胸腔引流管。术后胸部X线片示肺膨胀良好,无残腔。术后1例出现肺不张,经纤维支气管镜吸痰后肺复张。住院时间2~3周。随访6个月,患者症状消失,复查血气分析检查均正常,胸部X线片示肺膨胀良好,未发现残腔、积液。无1例复发,病理诊断均为支气管扩张症。 结论 掌握好手术条件,采用肺段支气管剔除术代替肺段切除术治疗支气管扩张症可行,手术方法简单,出血少,减少了术后并发症,克服了以往手术术式的不足,值得临床推广。

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • 支气管扩张症138例

    目的 总结支气管扩张症外科治疗的临床诊断和治疗经验. 方法 回顾性分析1985~ 1999年手术治疗138例支气管扩张症患者的诊断和治疗情况. 结果 全组无1例手术死亡,94例单叶或双叶支气管扩张患者症状消失;13例双侧或广泛支气管扩张患者,症状均改善. 结论 把握好手术适应证和肺的切除范围,可降低手术死亡率和并发症发生率,提高治疗效果.肺切除术对治疗单叶或双叶支气管扩张疗效十分显著,尽可能完全切除病灶是获得最佳治疗效果的前提.

    Release date:2016-08-30 06:34 Export PDF Favorites Scan
  • 无创正压机械通气治疗支气管扩张症合并呼吸衰竭的回顾性分析

    目的观察支气管扩张症合并呼吸衰竭患者应用无创正压机械通气(NPPV)治疗前后各项生理指标的变化,评价其疗效。 方法选择2010年1月至2011年12月华北油田公司总医院收治的应用无创正压机械通气治疗的支气管扩张症合并呼吸衰竭患者36例,比较治疗前后患者的心率、呼吸频率(RR)、pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、辅助呼吸肌评分、呼吸困难分级、第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积/用力肺活量比值(FEV1/FVC)、插管率和病死率。 结果经无创正压机械通气治疗后,患者的心率、RR、PaCO2、辅助呼吸肌评分和呼吸困难分级均明显下降,pH值、PaO2、PaO2/FiO2、FEV1%pred、FEV1/FVC均明显上升,与治疗前比较差异具有统计学意义(P<0.05)。2例患者因病情恶化行有创机械通气治疗,插管率5.56%,其中1例患者死亡。 结论合理选择应用NPPV可以改善支气管扩张症合并呼吸衰竭患者的肺通气功能。

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