自发性气胸200例分析

目的通过对多种自发性气胸的临床表现采用不同的治疗方法,达到治愈。方法对我院2003年至2007年收治200例气胸患者的临床资料进行回顾性分析。结果保守治疗25例,胸腔闭式引流175例,气胸长期不愈合10例,应用胸腔镜治疗,1例死亡。结论自发性气胸为常见多发病,有多种原因引起,针对不同情况选取不同治疗,胸腔闭式引流目前为首选、可靠、简单的治疗方法。     

青年原发性自发性气胸的临床治疗方法及疗效分析

目的探讨青年原发性自发性气胸的治疗方法及疗效。方法回顾性分析我院2010年1月—2012年3月收治的40例青年自发性气胸患者的临床特点、治疗方法、治疗结果及相关因素。结果本组40例患者除4例内科治疗无效转外院外科治疗外其他36例均治愈,其中内科保守治疗治愈9例,经胸腔穿刺闭式引流治愈18例,经胸腔穿刺抽气治愈9例。结论青年原发性自发性气胸在无严重并发症的情况下,根据患者的临床表现选择不同的治疗方法,预后尚可。     

治疗自发性气胸硬化剂的选择

目的探讨自发性气胸胸腔内注入两种不同“硬化剂”病人临床表现的疗效。方法对2001年6月,本科收治自发性气胸病人38例采用胸腔闭式引流加胸腔内注入“滑石粉”及“卡介苗素”比较。结果发现两种方法的治愈率、治愈时间无显著性差异;而护理时发现在注入药物三天内病人的临床表现——胸痛、发热、舒适改变方面存在着显著差异。结论自发性气胸病人治疗上不选用“滑石粉”为硬化剂,而采用反应小的生物制剂“卡介苗素”。     

老年自发性气胸临床特点分析

目的探讨老年自发性气胸的临床表现特点。方法选择我院近15年收治的60岁以上老年自发性气胸51例,观察其临床表现、病因、诱因、气胸类型与部位及肺压缩面积、合并症、误诊情况及其治疗,并与79例青壮年自发性气胸作对照,探讨老年自发性气胸发生的临床特点。结果老年组气胸的病因、诱因、临床表现、气胸类型与部位及肺压缩面积、合并症、误诊情况及其治疗与对照组有明显不同。结论老年自发性气胸具有自身的特点,及时诊断和治疗,防止误诊,具有重要临床意义。     

自发性气胸160例治疗体会

目的探讨自发性气胸临床特点及最佳治疗方法的选择。方法回顾性分析我院呼吸内科2002～2006年160例自发性气胸的临床特点，治疗方法及预后。结果40例肺容积压缩〈20％，经保守治疗32例，5～20d气胸完全吸收30例；120例肺容积压缩〉20％，其中细硅胶管胸腔闭式引流治愈86例，切口粗管闭式引流治愈26例，外科手术治愈5例，死亡3例。结论根据气胸临床特点分别采用保守治疗、胸腔闭式引流、外科手术可使绝大部分气胸治愈。     

慢性阻塞性肺气肿合并自发性气胸诊治分析

目的浅析慢性阻塞性肺气肿合并自发性气胸的临床诊断。方法回顾性分析我院27例慢性阻塞性肺气肿合并自发性气胸患者的病历资料,分析原发性基础疾病,临床特征、诊断与鉴别诊断及治疗。结果本组患者治愈15例,起效10例,无效2例。发生慢性阻塞性肺气肿合并自发性气胸的基础疾病复杂,大多数患者缓慢起病并发症多,治疗困难。结论慢性阻塞性肺气肿合并自发性气胸在临床表现上比较复杂,容易漏诊、误诊,需要及时救治,详细检查,正确诊断,提高治愈率。     

82例自发性气胸的治疗体会

目的了解自发性气胸治疗方法的选择及治疗。方法对2004年以来自发性气胸的临床诊治资料进行回顾性分析。结果82例自发性气胸患者突发胸痛、气急80例。14例肺容积被压缩〈30％，其中保守治疗6例，穿刺排气8例，在1周内全部治愈；68例肺压缩〉30％，均经胸腔闭式引流排气，平均住院时间9d，治愈率97．1％，并发皮下气肿3例。其中有6例复发性气胸经胸膜粘连治疗治愈5例，2例自发性血气胸经手术治疗未再复发。结论根据肺压缩程度分别采用保守、留置针穿刺或胸腔闭式引流排气法，可完全治愈自发性气胸，并发症少。胸膜粘连或手术可有效复发性气胸。     

胸腔镜在治疗自发性气胸中应用体会

目的总结电视胸腔镜手术（VATS）治疗自发性气胸（SP）的治疗经验。方法分析56例自发性气胸采用VATS治疗的资料,其合并血胸急诊手术3例,辅助胸腔镜小切口10例。结果患者全部治愈,术后平均住院12天、平均留置胸腔引流管4天,随访1月～3年,55例无术侧气胸复发,1例发生术侧气胸复发,经保守治疗治愈。结论 VATS肺大疱切除术是治疗自发性气胸常用术式,其疗效确切,创伤小,康复快,并发症少,外观满意。     

中心静脉导管治疗自发性气胸26例

目的探讨j书单腔中心静脉导管微创置入胸腔治疗自发性气胸的临床效果。方法对26例自发性气胸病人，均先用单腔中心静脉导管微创置入胸腔，置管后单纯抽气12例，接水封瓶持续负压引流排气14例。结果26例自发性气胸治愈20例，好转4例，无效2例，治愈好转率92．3％，仪3例出现并发症。结论采用单腔中心静脉导管微创置入胸腔治疗自发性气胸，疗效显著，并发症少，值得存临床推广应用。     

一次性无菌留置引流导管闭式引流或负压吸引治疗气胸110例分析

目的应用一次性无菌留置引流导管闭式引流治疗自发性气胸。方法对我科自2007年～2010年应用一次性无菌留置引流导管闭式引流或加用负压吸引治疗的110例自发性气胸进行分析。结果单纯闭式引流治愈77例,加用负压吸引后治愈25例,共治愈102例。无效8例。结论一次性无菌留置引流导管闭式引流或加用负压吸引治疗自发性气胸方法简单、有效、并发症少、患者耐受性好,值得进一步推广。     

Effectiveness of the treatment of spontaneous pneumothorax complicating tuberculosis and other lung diseases]

The paper deals with the data of the clinical follow up observation and treatment of 186 patients with various clinical forms of tuberculosis and nonspecific pulmonary diseases complicated by spontaneous pneumothorax (SP). Treatment was composed of etiotropic, antibacterial, general invigorating and symptomatic measures and correction of the protein and volemic disorders. Local treatment was started with puncture of the pleural cavity. Drainage was applied after 2-3 punctures failed to bring lung expansion. Other measures included persistent aspiration, regular washing of the pleural cavity and administration of antibiotics. Punctures resulted in cure of 8.5% and drainage of 43.1% of the patients. Ineffective drainage was considered as an indication to radical interventions. In the presence of lung inflammation or pleural empyema operations were performed when these conditions underwent regress or stabilization. Treatment effectiveness constituted 63.4%, improvement 17.1%, conditions without changes 5.4% and mortality 8.1% of the cases. In benign SP all patients were cured; in development of pneumothorax and pleural empyema treatment effectiveness was 63.9% and mortality 9.4%. SP cure in pulmonary tuberculosis was 56.7%, mortality 12.4%; in nonspecific pathology the values were 89.2 and 6.8%, respectively.     

Treatment of uncomplicated Plasmodium falciparum malaria in Myanmar: a clinical decision analysis

This study was undertaken to compare cost-effectiveness of three drug regimes for treatment of uncomplicated falciparum malaria in Myanmar. The alternative regimens in this study were chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and mefloquine (MFQ) along with their therapeutic efficacy in Myanmar. The study was performed by modeling a clinical decision tree based on a hypothetical 1,000 adult uncomplicated falciparum malaria cases. Key variables were (i) three drug regimes: CQ, SP and MFQ, (ii) three categories of therapeutic efficacy of each drug: adequate clinical response (ACR), early treatment failure (ETF) and late treatment failure (LTF) according to the 1996 WHO protocol, and (iii) compliance with each drug. In structuring the model, necessary assumptions were made. The cost effectiveness was measured as cost per case cured and cost per case prevented death related to the provided drug, from the provider's perspective. According to the present price and therapeutic efficacy, SP is the most cost effective drug for a case cured in all three categories of efficacy (US$ 0.12 per case cured in ACR, US$ 0.38 per case cured in ETF and US$ 0.54 per case cured in LTF). For a case prevented death, CQ is most cost effective in all three categories (US$ 0.58 per case prevented death in the ACR, US$ 2.14 per case prevented death in the ETF and US$ 2.51 per case prevented death in the LTF). The lowest cost effective regimen is MFQ for both indicators of effectiveness at the present price and therapeutic efficacy. A sensitivity analysis was performed for sensitive values.     

Polymorphisms in Plasmodium falciparum dhfr and dhps genes and age related in vivo sulfadoxine-pyrimethamine resistance in malaria-infected patients from Nigeria

Mutations in Plasmodium falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes have been used as means to predict treatment failure to sulfadoxine-pyrimethamine (SP) and for monitoring/surveillance of resistance to the drug in many areas where malaria is endemic. However, patients responses to treatment are significantly dependent on factors like host immunity profile of treated patients. In order to investigate the relationship between molecular markers of SP resistance, host immunity and clinical outcome, the association between pre-treatment dhfr and dhps genotypes, age and treatment outcomes was evaluated in 109 children treated with SP for acute uncomplicated malaria in Ibadan, Nigeria. Seventy-three percent of the children were cured with the drug, while 27% failed treatment after 28 days of follow-up. All children infected with parasites harboring less than two dhfr/dhps mutations were cured with SP. The dhfr triple (Asn-108/Ile-51/Arg-59) mutants or the dhps double mutants (Gly-437/Glu-540) were independently associated with SP treatment failure in children aged less than 5 years, but not in older children. The dhfr and dhps quintuple mutant (dhfr triple mutant+dhps double mutant) was the genotype most strongly associated with SP treatment failure (OR=24.72, 95%CI=8.24-74.15) in both younger and older children.     

19例脑型血吸虫病临床诊断与治疗

目的 探讨脑型血吸虫病的诊断及治疗。方法回顾性分析2006～2009年我院收治的19例脑型血吸虫病人的临床资料。结果 18例诊断为慢性脑型血吸虫病,1例诊断为急性脑型血吸虫病。全部病例均行内科治疗,8例治愈,5例临床治愈,6例好转。结论 脑型血吸虫病以慢性多见, 内科治疗药物采用吡喹酮效果理想。     

The efficacy of sulfadoxine-pyrimethamine alone and in combination with chloroquine for malaria treatment in rural Eastern Sudan: the interrelation between resistance, age and gametocytogenesis

OBJECTIVE: To compare the efficacy of sulfadoxine-pyremethamine (SP)+chloroquine (CQ) combination treatment against falciparum malaria with SP treatment alone. METHOD: In-vivo study of 254 patients with uncomplicated Plasmodium falciparum malaria in rural eastern Sudan, where the population is semi-immune. RESULTS: Sulfadoxine-pyremethamine treatment alone cured 68.3% (41/60) and SP+CQ cured 63.4% (123/194). Early and late treatment failures occurred in both treatment groups. Host age (as a marker for immunity) and parasite gametocytogenesis (as a marker for transmissibility) were significantly associated with SP resistance. Patients who were cured were significantly older (median age 21 years) than patients whose treatment failed (median age 12 years). Gametocyte production was significantly higher in patients with treatment failure (0.72 vs 0.45) and associated with younger age. Gametocyte counts were comparable between both groups until day 7 of follow up; thereafter, they were significantly higher in patients with treatment failure. However, the longevity of gametocytes was comparable in both treatment groups. CONCLUSION: Chloroquine did not improve the parasite response to SP. Age was strongly associated with clearance of SP-resistant parasites. The fast rise of SP resistance may partially be due to selection of SP resistant parasites and expansion of the resistant population through the gametocytogenic effect of SP.     

慢性脑低灌注的病理生理学和药物治疗

慢性脑低灌注时,脑组织发生一系列病理生理学改变,临床主要表现为进行性认知功能减退,是血管性痴呆、Alzheimer病和Binswanger病等多种疾病发展过程中的一个共同的病理学过程。目前对慢性脑低灌注的临床治疗方法和手段极其有限。因此,研究其发病机制以及预防和治疗措施显得尤为重要。     

药物性肝病临床探讨

目的探讨31例药物性肝病患者的病因和临床特点，以提高临床医师对该病的认识和掌握。方法采用回顾性分析对31例药物性肝病住院患者的用药史、临床表现、肝功能检查、病原学标志以及治疗转归作出综合判断，部分患者结合肝活检组织学检查可使诊断更为明确。结果引起肝病的相关药物中．抗菌素类药占22．6％(7／31)，中药占19．3(6／31)，抗结核类药占12．9％(4／31)，抗肿瘤类药占9．6％(3／31)，解热镇痛类药9．6％(3／31)，抗甲状腺类药6．4％(2／31)、其他药物占6．4％(2／31)，另有4例(12．9％)用药不详。临床分型：急性药物性肝病26例，慢性药物性肝病5例。临床表现根据药物不同作用机制而有所不同，住院患者主要表现为黄疸和转氨酶升高。经停药并给予保肝解毒治疗，30例预后良好，有1例用抗结核药物患者致肝硬化。结论临床医师应重视药物性肝病的预防、诊断和治疗。     

Infective endocarditis with multiple mycotic aneurysms mimicking vasculitis: A case report

The manifestation of infective endocarditis often resembles vasculitis. Approximately one in five infective endocarditis cases are referred initially to a nephrologist because of abnormal renal function or abnormal urinalysis; therefore, infection should be ruled out before diagnosing vasculitis.A case involving a patient with infective endocarditis who presented with migrating skin lesions, renal infarction and multiple pseudoaneurysms is reported. Echocardiography revealed mitral valve vegetation and viridans streptococci were identified in peripheral blood cultures. Although mitral valve annuloplasty and an aneurysm ligation operation were performed with proper antibiotic treatment, the remaining mycotic aneurysm progressed and caused neurological complications. The patient was cured completely after reoperation.     

主动脉夹层诊治分析

目的 探讨主动脉夹层的临床表现特点、早期诊断及治疗方案.方法 对我院收治的65例主动脉夹层患者的临床资料进行回顾性分析,研究其临床特点、影像学诊断、治疗方式及效果.结果 65例中经内科保守治疗19例,介入治疗12例,外科手术治疗34例,62例均好转出院,3例死亡.结论 主动脉夹层是发病急,病情进展迅速,临床表现多样、误诊率及死亡率极高的心血管疾病.然而,合理的早期诊断与积极的治疗可以进一步减少并发症,降低急性期死亡率,大大提高患者的生存率.