Pneumoconiosis is an interstitial lung disease with pulmonary fibrosis as the main pathological change. Patients with pneumoconiosis can increase immunity, delay disease progression, reduce symptoms, and improve lung function through respiratory rehabilitation. With the development of the domestic medical stratification, grading, and referral system between various specialties and the promotion of “internet +” model, remote home respiratory rehabilitation has become an inevitable trend in the full-cycle management of chronic respiratory diseases. By searching Chinese and English literatures, this article summarizes the safety, efficacy and research progress of remote home respiratory rehabilitation for pneumoconiosis. The purpose is to provide ideas for patients with pneumoconiosis to receive home-based remote rehabilitation management.
Objective To evaluate the clinical efficacy and safety of domestic cefepime in the treatment of acute bacterial lower respiratory tract infection. Methods A randomized, single-blind, controlled clinical trial was performed. The positive control was imported cefepime. The dosages of cefepime were 1g for moderate infection and 2g for severe infection, twice a day intravenously. The duration of the treatment was 7-10 days. Results Thirty-one patients were enrolled in the trial, of whom 30 were evaluable (15 in the triagroup and 15 in the control group). No significant differences were observed between the trial group and the control group with respect to the cure rate (40% vs. 27%), the effective rate (80% vs. 87%), the bacterial clearance rate (92% vs. 100%), and the incidence of adverse drug reactions (12.5% vs. 13%) (Pgt;0.05). Conclusion Domestic cefepime injection is effective and safe in the treatment of acute bacterial lower respiratory tract infection.
【Abstract】 Objective To analyze the risk factors for ventilator-associated pneumonia ( VAP) in respiratory intensive care unit ( RICU) , as well as the impact on mortality. Methods A retrospective cohort study was conducted in 105 patients who had received mechanical ventilation in RICUbetweenMay 2008 andJanuary 2010. The duration of intubation, vital signs, primary disease of respiratory failure and complications,blood biochemistry, blood routine tests, arterial blood gas analysis, APACHEⅡ score,medications, nutritional status, bronchoalveolar lavage ( BAL) , protected specimen brush ( PSB) quantitative culture, chest X-rayexamination were recorded and analyzed. Results The incidence rate of VAP was 32. 4% . Mortality in the VAP patients were significantly higher than those without VAP( 58. 8% vs. 28. 2% , P = 0. 007) . The duration of intubation, hypotension induced by intubation, cerebrovascular disease, and hypoalbuminemiawererisk factors for VAP in RICU. Conclusions Mortality of the patients with VAP increased obviously. The risk factors for VAP in RICU were the duration of intubation, hypotension after intubation, cerebrovascular disease, and hypoalbuminemia.
Objective To investigate the viral etiology of acute lower respiratory tract infection in adult inpatients. Methods 192 adult inpatients suffering from community-acquired pneumonia, acute bronchitis, or acute exacerbation of chronic obstructive pulmonary disease, admitted from October 2007 to October 2008, were enrolled in the study. Swabs from the nasopharynxes were collected. Multiple polymerase chain reaction was employed to identify the 7 common species of respiratory virus ( including 11subspecies) . Serumspecific IgM against several viruses were detected by indirect immunofluorescence. 106 healthy volunteers were enrolled as control. Results Only 4 cases were found to be infected with virus in 106 healthy volunteers. Viruses were identified in 80 ( 41. 6% ) cases of 192 inpatients and 99 ( 51. 5% )viral strains were detected. The most common viruses identified in the inpatients were influenza virus A ( FluA) , rhinovirus ( RhV) , and parainfluenza virus 1 ( PIV1) . The ratio of the 3 virus strains to the all strains identified was 81. 8% ( 81/99) . Serumspecific IgM was positive in 61 ( 31. 7% ) inpatients and 73 ( 38. 0% ) viral strains were detected. The most common viruses identified in the inpatients were FluA, PIV1,and respiratory syncytial virus ( RSV) . When summing up the data from the swabs and serum, 91 ( 47. 3% )cases had viral infection in 192 inpatients and 110 ( 57. 2% ) viral strains were detected. Conclusion The rate of viral infection is relatively high in the adult inpatients with acute lower respiratory tract infection, and the most common species are FluA, RhV, and PIV1.
ObjectiveTo analyze the influencing factors of ventilator-associated pneumonia (VAP) in comprehensive intensive care units (ICUs) in a certain district of Shanghai, and to provide evidence for developing targeted measures to prevent and reduce the occurrence of VAP.MethodsThe target surveillance data of 1 567 inpatients with mechanical ventilation over 48 hours in comprehensive ICUs of 5 hospitals in the district from January 2015 to December 2017 were retrospectively analyzed to determine whether VAP occurred. The data were analyzed with SPSS 21.0 software to describe the occurrence of VAP in patients and to screen the influencing factors of VAP.ResultsThere were 133 cases of VAP in the 1 567 patients, with the incidence of 8.49% and the daily incidence of 6.01‰; the incidence of VAP decreased year by year from 2015 to 2017 (χ2trend=11.111, P=0.001). The mortality rate was 12.78% in VAP patients while was 7.25% in non-VAP patients; the difference was significant (χ2=5.223, P=0.022). A total of 203 pathogenic bacteria were detected in patients with VAP, mainly Gram-negative bacteria (153 strains, accounting for 75.37%). The most common pathogen was Pseudomonas aeruginosa. The single factor analysis showed that gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, the length of ICU stay, and the length of mechanical ventilation were the influencing factors of VAP (χ2=9.572, 5.237, 34.759, 48.558, 44.960, P<0.05). Multiple logistic regression analysis found that women [odds ratio (OR)=1.608, 95% confidence interval (CI) (1.104, 2.340), P=0.013], APACHE Ⅱ score >15 [OR=4.704, 95%CI (2.655, 8.335), P<0.001], the length of ICU stay >14 days [OR=2.012, 95%CI (1.188, 3.407), P=0.009], and the length of mechanical ventilation >7 days [OR=2.646, 95%CI (1.439, 4.863), P=0.002] were independent risk factors of VAP.ConclusionsNosocomial infection caused by mechanical ventilation in this area has a downward trend, and the mortality rate of patients with VAP is higher. For the patients treated with mechanical ventilation in ICU, we should actively treat the primary disease, shorten the length of ICU stay and the length of mechanical ventilation, and strictly control the indication of withdrawal, thereby reduce the occurrence of VAP.
Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient
目的:利用低剂量多层螺旋CT儿童序列及多平面重组(MPR)技术探索儿童鼻咽部气道大小及形态。资料及方法:回顾性性分析2005.05～2008.08来我院检查鼻及鼻咽部儿童的CT扫描图像,选择符合条件的3～14岁患儿73例,根据儿童鼻咽部腺样体生理特点分两组,一组3～7岁,二组8～14岁,分析儿童鼻咽部A值、N值及A/N值,总结鼻咽腔形态学特点。结果:3～14岁(两组)儿童正常鼻咽部气道失状位均呈镰刀形,周围脂肪间隙清晰,后缘光整连续;一组及二组A值均数分别为9.23±4.85 mm、9.56±4.74 mm;N值均数分别为19.23±3.5 mm、21.5±4.9 mm;两组A值及N值均数间没有统计学差异;A/N值范围一组为0.2～0.58,二组0.21～0.6。结论:3～14岁健康儿童鼻咽腔失状位呈弓向上的镰刀形,边缘光整,周围脂肪间隙清晰,A/N≤0.6。
【摘要】 目的 探讨加强护理干预措施对呼吸机相关性肺炎发病率的影响。 方法 将2007年1月-2008年12月收住在重症监护病房行有创机械通气治疗的96例患者，随机分为对照组和治疗组，每组48例，比较不同护理干预对呼吸机相关性肺炎的影响。 结果 对照组VAP发生率52%（25/48），治疗组VAP发生率23%（11/48），两组比较有统计学意义（χ2=8.711，P=0.003）。 结论 针对VAP感染的环节加强气管导管气囊的管理、吸痰、口腔护理等干预措施可以有效降低VAP的发生率。【Abstract】 Objective To investigate the impact of nursing intervention on ventilation-associated pneumonia. Methods A total of 96 patients from January 2007 to December 2008 who had undergone invasive mechanical ventilation in ICU were randomly divided into a trial group and a control group with 48 patients in each. The impact of the different nursing intervention on ventilator-associated pneumonia were compared. Results The incidence of ventilator associated pneumonia (VAP) was 52% (25/48) in the control group, and 23% (11/48) in the trial group;the difference between the two groups was statistically significant (χ2=8.711，P=0.003). Conclusion The nursing intervention in VAP infection chain, such as the management of tracheal suction catheter balloon, aspiration of sputum, and oral care interventions, can reduce the incidence of VAP effectively.