目的 分析呼吸科重症监护病房（RICU）中呼吸机相关性肺炎（VAP）病原菌的来源、分布特点及耐药情况, 为在RICU中更好地控制VAP提供科学依据。 方法 回顾性分析2005年1月－2011年12月期间，医院RICU收治的行机械通气时间＞48 h，住院时间＞7 d的136例VAP患者病原菌分布情况和耐药性等临床资料。 结果 RICU中VAP的发生率为42.8%（136/318），病死率为47.8%（65/136）。共分离出病原菌507株，其中G−菌占74.8%（379/507），铜绿假单胞菌居首位，其次为鲍曼不动杆菌和肺炎克雷伯菌；G+球菌占10.3%（52/507），以金黄色葡萄球菌为主；真菌占14.9%（76/507），以白色念珠菌为主。G−杆菌对常用抗菌药物表现出较高的耐药率，其中对青霉素类、头孢菌素类抗菌药物高度耐药，而对碳青霉烯类耐药率相对较低；耐甲氧西林的金黄色葡萄球菌对多种常见抗菌药物高度耐药，但对万古霉素敏感。 结论 RICU的VAP病原菌以G−菌为主，耐药情况比较严重，铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为RICU中的主要致病菌。
ObjectiveTo observe the impact of obstructive sleep apnea-hyponea syndrome (OSAHS) on the severity of pulmonary thromboembolism (PTE) and its treatment strategies. MethodsPTE patients hospitalized in our department between January 2006 and December 2012 were screened for this study, including 16 patients with OSAHS and 20 patients without OSAHS, and the difference in clinical characteristics such as arterial blood gas, apnea-hypopnea index, lowest pulse oxygen saturation (LSpO2) and treatment methods were analyzed and compared between the two groups. ResultsAs compared to PTE patients without OSAHS, the age of patients was lower[(53.4±12.1), (64.5±9.8) years; P=0.005], while body mass index[(29.3±2.2), (26.1±3.3) kg/m2, P=0.002] and smoking index (150±24, 101±18; P<0.001) were higher in PTE patients with OSAHS. Additionally, significantly lower LSpO2[(71.7±8.3), (79.4±7.1) mm Hg (1 mm Hg=0.133 kPa); P=0.005] and more lung segments (8±3, 5±2; P=0.001) were involved in PTE patients with OSAHS. In this cohort, all patients received anticoagulation and/or thrombolysis treatment, but the rate of continuous positive airway pressure (CPAP) ventilation application was significantly higher in PTE patients with OSAHS. ConclusionPTE patients with OSAHS have relatively lower age but serious condition, and both anticoagulation and CPAP should be used in the clinical treatment.
Objective To explore the pathological diagnostic value of optical coherence tomography (OCT) in lung cancer. Methods This study selected patients who underwent general anesthesia and electronic bronchoscope biopsy at the Respiratory Endoscopy Center of Sichuan Provincial People’s Hospital from January 1, 2023, to December 1, 2023. White-light bronchoscopy (WLB), auto-fluorescence bronchoscopy (AFB), and OCT examinations were performed in all patients. Lesions were assessed for benign or malignant characteristics based on AFB and OCT before biopsy. The final pathological results were determined according to pathology report. Results A total of 124 patients were included in the study. The accuracy of OCT in differentiating the nature of lesions was 93.55%, significantly higher than AFB (accuracy 83.06%). The accuracy, sensitivity, and specificity of OCT were all higher than AFB. For squamous carcinoma, adenocarcinoma, and small cell lung cancer, the accuracy rates of OCT imaging characteristics were 91.94%, 94.35%, and 94.35%, respectively. Conclusion OCT can improve the accuracy of pre-bronchoscopic tissue pathology biopsy in determining the nature of lesions and provide rapid pathological typing basis, potentially further promoting the development of non-invasive histological biopsy.