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微创胸膜腔置管注入尿激酶治疗结核性胸腔积液

【摘要】 目的 探讨微创胸膜腔置入中心静脉导管(简称导管)注入尿激酶治疗结核性包裹性胸腔积液(简称积液)的临床价值。方法 2008年6月-2009年8月在正规抗结核治疗基础上,选取确诊积液患者72例,按数字随机法分为治疗组和对照组,治疗组36例经超声引导导管置入胸膜腔并注入生理盐水50 mL加尿激酶10万 U,对照组36例多次穿刺抽液,比较两组疗效及积液引流量、胸膜厚度、积液吸收时间等。结果 治疗组28例显效,5例好转,3例无效;对照组10例显效,13例好转,13例无效,两组疗效差异具有统计学意义(Plt;0.05)。治疗组与对照组平均积液引流量分别为1 421 mL和756 mL,胸膜厚度分别为(1.9±0.4) mm和(3.7±1.2) mm,积液吸收时间分别为(13.3±1.2)d和(17.3±1.6)d,两组间比较差异均有统计学意义(Plt;0.05)。结论 超声引导导管置入胸膜腔并注入尿激酶治疗结核性包裹性胸腔积液疗效显著,可增加引流量,减轻胸膜肥厚,改善肺功能,减少穿刺机会。

49例结核性毁损肺的外科治疗

目的 总结结核性毁损肺手术治疗的经验。 方法 回顾分析我院近12年来手术治疗49例结核性毁损肺的临床资料，其中行右肺上叶切除术11例，右全肺切除术9例，左肺上叶切除术3例，左全肺切除术25例，左上余肺切除术1例。全组未作胸廓成形术。术中出血量200～4 000ml，输血31例，输血量300～3 600ml。手术时间1.8～8.0h。 结果 无手术死亡，18例痰抗酸杆菌涂片阳性患者全部转阴。随访2个月～11年10个月。术后并发支气管胸膜瘘3例，血胸4例，胸腔积液3例，乳糜胸1例，均采用相应的治疗而治。 结论 手术治疗结核性毁损肺，应做好防范手术风险和预防术后并发症的充分准备。

Clinical Study of 68 Tuberculous Meningitis Patients

目的:分析结核性脑膜炎的临床及治疗中影响预后的因素。方法:回顾分析10 年来我院收治的68 例结核性脑膜炎患者的临床及实验室资料。结果:59 例患者痊愈,5 例患者遗留肢体后遗症,4 例患者死亡。结论:治疗结核性脑膜炎过程中积极区分引起低钠血症的原因及鉴别药物热与类赫氏反应并给以合理治疗和对中重度和治疗效果不佳的结核性脑膜炎适时的鞘内注药可改善患者的预后。患者的体质同预后有关。

可来福接头在结核性脑膜炎患者输注甘露醇中的应用及效果

目的探讨可来福（无针输液）接头在结核性脑膜炎患者输注甘露醇中的应用及效果。 方法将2012年7月－2014年1月输注甘露醇治疗的112例结核性脑膜炎患者采用抽签法随机分为试验组和对照组，每组各56例。两组患者输液时均采用中国洁瑞公司生产的24G安全留置针，试验组使用可来福接头，对照组采用普通肝素帽接9号头皮针，对比两组在输入甘露醇时留置针输液速度、回血、堵管、静脉炎、输液管脱落等情况。 结果试验组与对照组的输液时间分别为（9.52±1.32）、（13.02±2.08）min，试验组发生回血、堵管、静脉炎、输液管脱落的患者例数分别为6、5、4、0例，对照组分别为22、17、15、10例，组间差异均有统计学意义（P＜0.01)。 结论结核性脑膜炎患者在输注甘露醇时宜选用可来福接头。

Clinical Analysis of 126 Patients with Tuberculous Meningoencephalitis

Objective To investigate the clinical features of tuberculous meningoencephalitis.Methods The clinical characteristics and laboratory results of 126 cases who were diagnosed as tuberculous meningoencephalitis fromJanuary 2000 to April 2009 were analyzed retrospectively. Results The clinical manifestations of tuberculous meningoencephalitis included fever, headache, vomitting, hemiparalysis,paraplegia, mental anomaly, hypopsia, deafness, diplopia, muscular spasms, coma, and incomplete oculomotor palsy, etc. Vomitting which was characteristic symptom of tuberculous meningoencephalitis was found in 25 cases( 19. 8% ) . The diagnosis was confirmed more than eightweeks after the onset of the disease in 31 cases ( 24. 6% ) . The inhospital mortality rate of tuberculous meningoencephalitis was 14. 3% ( 18 /126) . The inhospital mortality rate of re-treatment patients was 42. 9% ( 6 /14) . In 41 patients with poor prognosis ( death or therapy failure) , 68. 3% ( 28/41) cases were complicated with military tuberculosis, which was higher than the overall occurrence of 41. 3% ( 52/126) . Conclusions Strict diagnostic criteria and atypicalsymptoms lead to delayed diagnosis, delayed treatment, and high mortality in patients with tuberculous meningoencephalitis, particularly in patients with military tuberculosis and re-treatment patients. There is still no effective treatment which have a significant impact on the prognosis.

结核性肠梗阻伴重度营养不良患者的围术期治疗策略：附5例报道

目的探讨结核性肠梗阻伴重度营养不良患者围术期治疗策略。方法回顾性分析2022年12月至2023年8月期间在甘肃省中医院普通外科治疗的5例结核性肠梗阻患者的诊断、治疗过程及预后。结果5例患者在入院时均明确诊断为结核性肠梗阻，均伴重度营养不良及体能异常，在中位38 d的预康复后手术治疗，以粘连松解及肠排列术为基础（其中4例行回肠造口术），中位总手术时间为8 h。5例患者中只有1例术后发生肠瘘（为未行肠造口患者），经对症治疗后痊愈出院。中位总住院时间62 d，中位术后住院时间43 d；术后中位随访16个月，3例患者于1年时顺利回纳造口，随访期间未发生肠梗阻；5例患者于1年后体能异常者均恢复正常。结论预康复、肠造口及肠梗阻导管在结核性肠梗阻伴重度营养不良患者围术期治疗中至关重要，可明显提高治愈率及减少术后并发症发生。

不典型耐药结核性脑膜炎一例

Value of Adenosine Deaminase (ADA) for the Diagnosis of Tuberculous Serous Cavity Fluidify: Evidence-based Evaluation

Objective　To investigate the value of adenosine deaminase (ADA) for the diagnosis of tuberculous serous cavity fluidify. Methods　The literatures on the application of ADA for the diagnosis of tuberculous serous cavity fluidify in the database including PUBMED and CNKI were reviewed. Results　Studies including randomized controlled trial or meta-analysis have performed to determine the level of ADA in the effusion of tuberculous serous cavity fluidify. These studies have sufficiently proved that ADA is a specific and sensitive method for the diagnosis of extrapulmonary tuberculosis. Most of the studies have determined the optimal cut-off value of ADA in the effusion of tuberculous serous cavity fluidify. Conclusion　Measurement of ADA in the effusion of tuberculous serous cavity fluidify is widely used as a fast, convenient, safe and effective adjunctive diagnostic method of tubeculosis in clinic.

Characteristic Analysis and Nursing Measures of Pregnant Women Suffering from Tuberculous Meningitis

【摘要】　目的　分析总结妊娠合并结核性脑膜炎患者的相关特征及护理经验。　方法　对2010年1-12月收治的8例妊娠合并结核性脑膜炎患者的相关资料进行回顾性分析，并就疾病特点所采取的有效护理措施进行表述。　结果　6例患者好转出院继续治疗（均于出院后1周内终止妊娠），1例经抢救后转院行引产手术，1例因经济原因自动出院。　结论　应大力普及妊娠期结核性脑膜炎相关知识，重视首发症状及腰椎穿刺检查结果，做到早发现，早诊断，早治疗，并采取相应的护理措施，减少并发症和致死率。【Abstract】　Objective　To summarize the characteristics of pregnant women with tuberculous meningitis and the nursing measures for these patients.　Methods　The clinical data of 8 pregnant patients with tuberculous meningitis diagnosed between January 2010 and December 2010 were retrospectively analyzed. The characteristics of race, admitting diagnosis, basis diseases, premiers symptoms, and course of disease were analyzed, and the nursing measures were summarized.　Results　Six patients recovered and left the hospital (all had terminationed pregnancy after discharge within one week), one was transferred to another hospital for induction of labor after emergency rescue, one left the hospital for economical reason.　Conclusions　The propagation of the knowledge of tuberculous meningitis is very important. We should pay more attention to its early symptoms, corning′s puncture examination and give suitable nursing care as soon as possible.

Multi Spiral Computed Tomography Differential Diagnosis of Tuberculous Peritonitis and Carcinomatous Peritonitis

目的　探讨结核性腹膜炎（TBP）及癌性腹膜炎（CP）的螺旋CT表现，提高其诊断及鉴别诊断水平。 方法　回顾分析2009年9月－2010年9月经手术病理、穿刺活检或综合手段证实的22例TBP和45例CP患者的CT影像资料，采用χ2检验比较各种CT征象在两种病变中的发生率，结合病理、临床结果进行分析。 结果　TBP组及CP组患者大量腹水所占比例差异有统计学意义（36.4%、75.6%，χ2=9.703，P=0.002）；两组壁腹膜、肠系膜增厚构成比差异有统计学意义，TBP组以壁层腹膜均匀增厚、肠系膜污迹样改变为主，CP组壁层腹膜以结节、块样增厚为主；两组大网膜厚度差异有统计学意义。 结论　以壁层腹膜改变为基础，综合大网膜、肠系膜及腹水改变CT征象对两种病变的诊断及鉴别诊断具有重要意义。