Search

重型新型冠状病毒肺炎合并糖皮质激素诱导性糖尿病一例及糖皮质激素使用初探

未规范使用舒利迭致霉菌性食管炎一例临床分析

支气管哮喘是一种常见的慢性呼吸道疾病, 其本质是气道的慢性炎症。糖皮质激素是抗炎治疗的首选药物, 尤其是吸入性糖皮质激素( ICS) 加长效β2 受体激动剂( LABA) 联合治疗已被全球哮喘创议( GINA) 作为中重度哮喘的首选治疗方案。沙美特罗替卡松粉吸入剂( 舒利迭) 也已被广泛使用于哮喘患者的临床治疗中, 而且取得了非常良好的临床效果。但长期使用舒利迭, 部分患者会出现咽干、咽痒、声音嘶哑, 甚至口咽部真菌感染等并发症, 出现霉菌性食管炎的病例尚未见报道。

硫酸气雾吸入中毒性肺水肿四例报告并文献复习

目的总结硫酸气雾吸入中毒性肺水肿患者的临床特点、救治方法及转归。 方法对4例硫酸气雾吸入中毒性肺水肿患者的临床表现、胸部CT表现、抢救措施及转归进行回顾性分析。 结果4例硫酸气雾吸入中毒性肺水肿患者中重度中毒2例, 中度中毒2例。患者均有咳嗽、咳痰、胸闷、呼吸困难、咽痛、流涕、结膜充血, 双肺听诊呼吸音粗糙, 其中2例闻及干、湿啰音。心率53~103次/min, 未闻及明显病理性杂音。2例患者动脉血氧分压(PaO2)<60 mm Hg, 氧合指数<200 mm Hg。胸部CT检查示双肺弥漫性磨玻璃影2例, 双肺散在絮状密度增高影及小结节影2例。2例行肺功能检查者中1例肺功能下降, 1例肺功能基本正常。1例患者谷丙转氨酶、谷草转氨酶增高。入院后均给予雾化吸入、支气管舒张剂、氧疗、适当控制液体入量及糖皮质激素等综合治疗, 其中2例重度中毒患者气道分泌物较多, 予以反复拍背、气道雾化及支气管舒张剂。治疗后患者症状均改善, 行PaO2、肝功能、胸部CT、肺功能检查均未见异常后出院。 结论硫酸气雾吸入中毒性肺水肿患者均有咳嗽、咳痰、胸闷、呼吸困难、咽痛、流涕、结膜充血, 双肺呼吸音粗糙。胸部CT检查可有弥漫性磨玻璃影或散在絮状密度增高影及小结节影。中度中毒者肺功能可基本正常。重度中毒者谷丙转氨酶、谷草转氨酶可增高。给予保持呼吸道通畅、合理氧疗、糖皮质激素、雾化吸入等综合治疗措施后预后良好。

Clinical features, short-term prognosis and risk factors of Pseudomonas aeruginosa infection in patients with acute exacerbation of chronic obstructive pulmonary disease

ObjectiveTo study the clinical features, short-term prognosis and risk factors of Pseudomonas Aeruginosa (P.aeruginosa) infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with P.aeruginosa infection were included as case group, AECOPD patients without P.aeruginosa infection were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 2∶1. The differences in basic conditions, complications, clinical manifestations on admission and in-hospital prognosis between the two groups were compared, and the risk factors of P.aeruginosa infection were analyzed. ResultsA total of 14007 inpatients with AECOPD were included in this study, and 338 patients were confirmed to have P.aeruginosa infection during hospitalization, with an incidence rate of 2.41%. The in-hospital prognosis of AECOPD patients with P.aeruginosa infection was worse than that of the control group, which was manifested in higher hospital mortality (4.4% vs. 1.9%, P=0.02) and longer hospital stay [13.0 (9.0, 19.25)d vs. 11.0 (8.0, 15.0)d, P=0.002]. In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, dyspnea in the case group were higher than those in the control group, and the inflammatory indicators (neutrophil ratio, erythrocyte sedimentation rate) and partial pressure of carbon dioxide in arterial blood gas were higher than those in the control group, while the serum albumin was significantly lower than that in the control group (all P<0.05). Multivariate logistic regression analysis showed that Parkinson's disease [odds ratio (OR)=5.14, 95% confidence interval (CI): 1.43 to 18.49, P=0.012], bronchiectasis (OR=4.97, 95%CI: 3.70 to 6.67, P<0.001), invasive mechanical ventilation (OR=2.03, 95%CI: 1.23 to 3.36, P=0.006), serum albumin<35 g/L (OR=1.40, 95%CI: 1.04 to 1.88, P=0.026), partial pressure of carbon dioxide ≥45 mm Hg (OR=1.38, 95%CI: 1.01 to 1.90, P=0.046) were independent risk factors for P.aeruginosa infection in AECOPD patients. ConclusionsP.aeruginosa infection has a relative high morbidity and poor outcome among AECOPD inpatients. Parkinson’s disease, bronchiectasis, invasive mechanical ventilation, serum albumin below 35 g/L, partial pressure of carbon dioxide ≥45 mm Hg are independent risk factors of P.aeruginosa infection in AECOPD inpatients.

Validation of predictive models for short-term mortality and adverse outcomes in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.