Objective To evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 ( sTREM-1 ) in endotracheal aspirate and plasma of patients with ventilator-associated pneumonia ( VAP) . Methods The consentration of sTREM-1 in plasma and endotracheal aspirate, and serum high-sensitivity C-reactive protein ( hs-CRP) were measured by enzyme-linked immunosorbent assay ( ELISA) in 68 patients with VAP ( VAP group) , 50 patients underwent ventilation without VAP ( non-VAP group) , and 50 healthy individuals ( control group) . The sensitivity and specificity of each parameter were calculated. Results In the patients with VAP, sTREM-1 in plasma and endotracheal aspirate before treatment were significantly higher than that in the non-VAP group [ ( 143.62 ±46.82) pg/mL vs. ( 68.56 ±16.24) pg/mL, ( 352.86 ±92.57) pg/mL vs. ( 126.21 ±42.28) pg/mL, Plt;0.05] ; sTREM-1 in plasma and endotracheal aspirate on the 3rd and the 7th day during treatment were significantly decreased ( Plt;0. 05) . By ROC analysis, the cut-off value of sTREM-1 in endotracheal aspirate were 193.64 pg/mL, with sensitivity and specificity of 93.84% and 89.51% respectively. The areas under ROC curve of sTREM-1 in endotracheal aspirate were 0.912. Clinical diagnostic value of sTREM-1 in endotracheal aspirate was better than plasma sTREM-1 and serum hs-CRP ( areas under ROC curve were 0. 768 and 0. 704 respectively) . Conclusions sTREM-1 may be helpful for evaluating the therapeutic effect in patients with VAP. The diagnostic value of sTREM-1 in endotracheal aspirate may be superior to plasma sTREM-1 and serum hs-CRP.
目的探讨单操作孔胸腔镜在纵隔肿瘤治疗中的临床应用价值。 方法回顾性分析我科2012年至3月至2014年3月我院胸外科采用单操作孔胸腔镜切除纵隔肿瘤18例的临床资料，男11例、女7例，年龄45.5（30～55）岁。胸腺瘤12例，胸腺瘤合并重症肌无力3例，胸腺囊肿4例，畸胎瘤2例。 结果所有患者均在胸腔镜下或胸腔镜辅助下完成，其中16例采用单操作孔胸腔镜下操作，其中有1例因术中出血，延长操作孔切口，完成止血，另有1例因肿瘤直径约8 cm，合并胸膜腔部分粘连，增加一副操作孔完成。术中操作时间80（40～120）min，术中出血量100（50～300）ml，术后胸腔引流管留置时间3（2～5）d，住院时间6（4～8）d，均未出现严重并发症。术后随访18例患者1个月至2年，均未见肿瘤复发，其中合并重症肌无力的3例患者，术后肌无力均消失。 结论单操作孔胸腔镜治疗前纵隔肿瘤是安全有效且可行的。