慢性肺心病并发多器官衰竭（附70例报告）

１９８６～１９９２年我院共收治急性发作期慢性肺心病１９６例，其中因严重肺部感染发生多器官衰竭（ＭＯＦ）者７０例（３５．７％），平均受损脏器２．５个，死亡２６例，总病死率为３７．１％。其中２和３个脏器受损者的病死率分别为２０．１％和４４．４％，而４和５个脏器受损者则均死亡。血气分析显示ｐＨ和ＰａＯ２值与受损脏器数目呈负相关，而ＰａＣＯ２值与受损脏器数目呈正相关。本文讨论了肺心病因肺部感染并发ＭＯＦ的发病机理，并提出防治的措施。     

肺结核线索调查中X线胸透的代价和效益试评

用热释光剂量计测试了受检者胸透体表照射量，结果表明受检者体表照射量符合对数正态分布，几何均值为０．１９ｍＣ·ｋｇ－１，高于一般体检胸透照射量水平。根据危险度系数，估算出由此造成的辐射诱发恶性肿瘤危险度，男女分别为３．５５×１０－６和４．０５×１０－６，后裔遗传疾患的危险度均为４．０×１０－８，由此估计该次实践造成的人均寿命缩短时间为０．５２ｈ·人－１。利用江苏省结核病的患病率、死亡率、化疗治愈率估算出由此次实践带来的人均寿命延长时间为４５．８ｈ·人－１。     

Pulmonary Function in Survivors of Wilms' Tumor

The respiratory status of 47 patients surviving childhood Wilms' tumor was studied. The group that had receivedflnnk irradiation (which impinges on the lower lung) (n - 17) had a sisnijGantly lower mean percent predicted for forced expiratory volume in one second, residual volume, and total lung capaci(v when compared to those who had received no irradiation (n - 23). Those patients who had received whole-lung irradiation (n - 3) had sisnijicantly lower transfn. foctor for carbon monoxide and gas transfer per unit lung volume whm compared to the nonirradiated group (n - 23). There was no sipiftiant dimue in the prevalence of respiratory symptoms between the three groups. Patients receiving any form of radiotherapy for Wilms' tumor may have abnormulities o f pulmonary function and should have pulmonary function tests performed as part o f their long-tmn follow-up.     

Pulmonary aspiration of gastric contents after a priming dose of vecuronium

A case is presented of a 16-year-old girl with ectodermal dysplasia for whom dental surgery under general anaesthesia was planned. Following a priming dose of vecuronium, and immediately after injection of sodium thiopentone (5 mg·kg⁻¹) pulmonary aspiration of gastric contents occurred. It is hypothesized that, because of the rapid speed of onset of neuromuscular blocking agents on the laryngeal muscles, that partial laryngeal paralysis was present at the time of induction of anaesthesia and that this was responsible in part for the episode of pulmonary aspiration.     

Evaluation of the Usefulness of Open Lung Biopsies

The role of open lung biopsy (OLB) in the diagnosis of the etiology of lung infiltrates in children was analyzed for a 10-year period 1979-1989 in a tertiary referral center. A total of 18 children had 19 lung biopsies to ascertain the cause of lung infiltrates. Thirteen of these children (72 %) were immunocompromised due to treatment of hematological/solid malignancies and bone marrow transplantation. The clinical diagnosis was bilateral lung infiltrates of unknown etiology in 17 of 18 children. Eight of these children were ventilated for respiratory failure. The biopsy was useful in achieving a histological diagnosis in 18 of 19 samples (diagnostic yield 95%) and an etiological diagnosis in 14 of 19 samples (etiological yield 74 %). Therapeutic strategy was altered in 14 of 18 patients based on the biopsy results. Five of 14 patients responded favorably to a change in specific treatment. The lime interval from onset of respiratory illness to biopsy was 2-60 days (mean 16 days). Despite the critical state of these children there were few complications associated with the biopsy and no mortality directly related to the procedure. We recommend that OLE be undertaken sooner rather than later in immunocompromised children with bilateral pulmonary infiltrates of unknown etiology.     

经皮肺活检及支气管肺泡灌洗对周围性肺疾病诊断的临床价值

目的：探讨经皮肺活检及支气管肺泡灌洗(BAL)对周围性肺疾病诊断的价值。方法：对以结节或块状阴影为主的52例病人行经皮肺活检；对以弥漫性周围性肺疾病为主的33例病人行BAL检查；对采用两种不同方法的检查结果进行阳性率分析。结果：52例经皮肺活检对肺周围性病变诊断敏感性为88％，特异性100％。33例行BAL检查对结核及恶性弥漫性肺周围性病变诊断敏感性为75％～80％，特异性100％。结论：BAL检查及经皮肺活检对肺周围块状阴影或弥漫性病变的确诊有很高价值。     

Longitudinal decline in pulmonary function in atopic cough and cough variant asthma

OBJECTIVE: Cough variant asthma and atopic cough are different clinical manifestations of eosinophilic airway inflammation presenting with isolated chronic non-productive cough. The aim of this study was to examine the longitudinal change in pulmonary function in cough variant asthma and atopic cough. METHODS: Longitudinal change in FEV1 was prospectively examined in 20 patients with cough variant asthma, 14 patients with atopic cough and 271 asymptomatic healthy subjects. All were lifetime non-smokers. Of the 20 cough variant asthma patients, 13 were taking long-term inhaled corticosteroid therapy (ICS) (beclomethasone dipropionate 615 +/- 58 micro g/day) and the other seven were not. Spirometry was taken at first visit, after cough was almost completely relieved on therapy, and at least once every year for 5 or more years afterwards. RESULTS: The slope of longitudinal change in FEV1 was not significantly different among cough variant asthma patients (- 0.029 +/- 0.007/year), atopic cough patients (- 0.021 +/- 0.022/year) and asymptomatic subjects (- 0.028 +/- 0.002 L/year). In patients with cough variant asthma, the slope in patients not taking inhaled corticosteroids (ICS) was 0.032 +/- 0.007 L/year, which was not significantly different from that in patients taking ICS (- 0.027 +/- 0.010 L/year). CONCLUSION: Pulmonary function decline is not greater in cough variant asthma than atopic cough and the normal population, and long-term ICS has no effect on the decline in cough variant asthma.     

应用最大似然法鉴别诊断周围型肺癌、肺错构瘤和结核球的初步研究

目的:探讨应用最大似然法鉴别周围性肺癌、肺错构瘤及结核球3种孤立性肺结节(SPN)的诊断价值。方法:对150例经临床和手术病理证实的SPN(周围性肺癌、肺错构瘤、结核球各50例)的HRCT影像学征象进行分类统计分析,运用最大似然判别法,将其各种征象转化为记分值,以数值的大小来判定肺结节所属的类型。结果:最大似然法对周围型肺癌、肺错构瘤及结核球的诊断正确率分别为86%、92%及90%,平均诊断正确率为89.3%,高于常规阅片法的82%,但两组间差异无统计学意义(χ2=2.434,P>0.05)。最能提示为肺癌的征象依次为空泡征、分叶征、支气管充气征和血管集束征;最能提示为肺错构瘤的征象依次为脂肪、边缘清楚及钙化;最能提示为结核球的征象依次为空洞、卫星灶、钙化及胸膜凹陷征。结论:最大似然法对常见SPN的鉴别诊断正确率有所提高,是一种辅助影像学诊断的有价值的方法。     

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.     

Anti-avian antibodies and rheumatoid factor in pigeon hypersensitivity pneumonitis

BACKGROUND: Although several immunological abnormalities may be present in pigeon hypersensitivity pneumonitis (HP), few specific hallmarks have been described. OBJECTIVE: To determine whether the presence of rheumatoid factor (RF) could be useful to discriminate pigeon HP from asymptomatic breeders (AB) and other interstitial lung diseases. METHODS: Fifty-three patients with pigeon HP, 47 AB, 31 idiopathic pulmonary fibrosis (IPF) patients and a rheumatoid arthritis (RA) group were studied. IgM RF was determined through enzyme-linked immunosorbent assay (ELISA) and western blot using human IgG and IgG Fc fragment as antigens. IgG and IgA anti-avian antibodies (AA) against pigeon serum antigen were also measured. The use of F(ab')2 fraction of peroxidase-labelled anti-human immunoglobulins prevented endogenous interferences. Possible cross-binding of RF with avian antigens and the reactivity against human IgG by AA were studied. RESULTS: RF tests were frequently positive in HP (52.8%) in comparison to AB (4.2%) and IPF (12.9%; P = 2.6 x 10-10 and 4.1 x 10-5). Therefore, the presence of RF in pigeon HP showed a sensitivity of 52% and was highly specific considering the results of AB and IPF (95 and 87%, respectively). The RA group revealed positive RF but negative AA tests. RF activity was confirmed through western blot using purified IgG Fc fragment. Overlapping levels of IgG and IgA AA were found in HP and AB. The frequency of AA was low in IPF. The cross-reaction of RF with avian antigens was excluded, and no reactivity against human IgG by AA was detected. Other endogenous interferences were ruled out. CONCLUSION: No single immunological test may definitively distinguish pigeon HP from AB and other interstitial lung disorders; however, positive RF, together with high AA levels, seems to be useful in differentiating the diagnosis.