发热伴阵发性呼吸困难——感染继发肺栓塞4例临床治疗观察并文献复习

为总结感染继发肺栓塞的临床特点和处理,回顾性分析4例感染继发肺栓塞患者的诊治经过。结果4例患者在强力有效抗感染治疗基础上溶栓并序贯抗凝治疗后均获得康复。提示有明确肺梗塞病灶及明显低氧血症存在的感染继发肺栓塞患者,在充分抗感染治疗基础上进行抗凝治疗的同时,必要时可以慎重溶栓治疗。     

对慢性阻塞性肺疾病防治的若干思考

结合我国目前COPD防治的现实情况,从建立COPD防治的教育和管理综合模式、社区及基层医院普及COPD防治的途径、吸入剂的终身服用及利弊的权衡等角度,探讨了COPD防治的一些见解及认识。     

Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

Abstract

Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine the relationship between general anxiety and dyspnea on exertion in patients with COPD.

Ninety patients with stable COPD participated; 44 men, mean age 61 (standard deviation (SD) 10.4), and mean forced expiratory volume in 1 second (%pred.) 40.5 (SD 16.9). All participants performed pulmonary function tests and an incremental cycle ergometry. The Modified Borg Scale was used to measure the level of dyspnea on exertion. Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale. Data were analyzed using Spearman's correlations and multivariate regression. Dyspnea on exertion was correlated with general anxiety (r=.31), age (r=–.30), and exercise capacity (r=.27). Regression analysis showed that general anxiety was associated with dyspnea on exertion, adjusted for sex, age, baseline dyspnea, and exercise capacity. Consequently, it is reasoned that results of exercise training and activities in daily living may be influenced negatively by anxiety-worsened dyspnea. Attention should be given to anxiety management in patients with COPD to optimize exercise training.     

支气管结核介入诊治的认识和思考

支气管结核（EBTB）的介入诊断和治疗有了长足的进展,但也面临着诸多的问题,有必要加深认识和思考。EBTB的支气管镜下分型目前分为五型,即炎症浸润型（Ⅰ型）、溃疡坏死型（Ⅱ型）、肉芽增殖型（Ⅲ型）、疤痕狭窄型（Ⅳ型）、管壁软化型（Ⅴ型）,建议在原来EBTB“五型”的基础上将结核性支气管瘘从第Ⅱ型中分离出来成为单独的一型即Ⅵ型。在支气管结核的治疗中,应根据不同的类型,采用包括高频电刀、冷冻、氩气刀、激光、支架置入、球囊扩张以及黏膜下穿刺注射抗结核药物等综合介入技术进行治疗。     

常见肺栓塞评分方法及临床应用

肺栓塞评分方法是国际上肺栓塞诊断策略的重要基础。本文简要介绍国际上常用肺栓塞评分方法,即Wells法、Geneva法、Geneva改良法、Pisa法和Claudia法,并评价和比较这些方法在临床上的应用,建议建立并规范使用适合我国国情的肺栓塞评分方法。     

从西地那非的研发过程探讨医学研究的规律

西地那非研制成功20余年,用于治疗男性勃起功能障碍（erectile disorder,ED）。而近几年来,越来越多的证据表明西地那非可以明显降低各种原因所导致的肺动脉高压（pulmonary arterial hypertension,PAH）。西地那非对肺动脉高压的治疗作用,再次引起了人们对西地那非进行深入研究的兴趣。西地那非的研究历程给人们带来很多有益的启示。     

2006年沈阳市胸科医院肺结核住院患者痰抗酸杆菌涂片结果分析

回顾性分析了2006年3月至2006年12月沈阳市胸科医院确诊为肺结核3644例住院患者的临床资料。评价我院痰涂阳性的住院患者的性别比率及临床意义。共有痰涂阳性住院病例207例,痰涂阳性病人男女性别比例为3．31：1。痰菌涂阳病例对性别的比值比为1．67（95％的可信限为1．20～2．33）,男性和女性痰菌阳性结果比较差异有统计学意义（Χ^2=9．48,P〈0．01）。提示我院痰涂阳性住院患者存在有明显的性别差异。     

结核病的再燃和控制新策略

由于忽视结核病控制工作、耐药菌株的出现、流动人口的增加以及艾滋病的流行导致了结核病在全球范围内再燃,中国是全球22个结核病高负担国家之一.世界卫生组织提出了控制结核病流行的有效新策略-DOTS.政府承诺、综合医院积极配合、归口管理、健康教育、加强培训等是确保DOTS实施的有效措施.     

Active tuberculosis detection by pouched rats in 2014: More than 2,000 new patients found in two countries

Tuberculosis (TB) is a major problem in poor countries because sensitive diagnostic tools are unavailable. In 2014, our pouched rats evaluated sputum from 21,600 Tanzanians and 9,048 Mozambicans whose sputum had previously been evaluated by microscopy, the standard diagnostic for TB. Evaluation by the rats revealed 1,412 new patients with active TB in Tanzania and 645 new patients in Mozambique, increases of 39% and 53%, respectively, when compared to detections by microscopy alone. These results provide further support for the applied use of scent‐detecting rats.     

肺结核痰涂片阴性的试验性治疗应用探讨

本文通过对涂阴肺结核及试验性治疗相关概念的分析探讨,结合临床实际,认为试验性治疗不仅有利于涂阴肺结核的早期诊断和及时治疗,也是减少误诊、漏诊的主要措施。