Objective To compare the effects of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) whith or without pulmonary surfactant(PS) supplement on water vapour inhalation injury.Methods New Zealand rabbits model of severe acute lung injury with acute respiratory failure caused by steam inhalation was established.Then the animals were treated by CMV，HFOV，CMV+PS or HFOV+PS，respectively while animals in control group did not ventilated and supplemented with PS.Femoral arterial blood samples were obtained at 1，2，3，4 h after treatment for blood gas analysis.4 h after treatment ,the lowest lobe of right lung was weighed for calculating wet-to-dry weight ratio (W/D).Four different parts including dependent areas and non-dependent areas of the middle lobe of right lung were excised for histological observation.Results (A) After ALI established PaO2 in the five groups decreased below 60mmHg (Plt;0.01) but intergroup differences were found.Meanwhile the change of PaCO2 showd no statistical significance(Pgt;0.05).(B) PaO2 in the four treatment groups had increased since one hour after treatmentand sustained at favorite levels during treatment period.PaO2 in the HFOV and HFOV+PS groups were higher than those in CMV and CMV+PS groups,respectively (Plt;0.01，Plt;0.05).PaO2 in the CMV+PS group at 2 h and HFOV+PS group at 2 h and 3 h were significantly higher than those in corresponding non-PS groups at the same timepoints (Plt;0.05).P（A-a）O2 in the HFOV and HFOV+PS groups were lower than those in CMV and CMV+PS groups (Plt;0.05).P（A-a）O2 in the two groups with PS at 2 h，3 h and 4 h t were statistically lower than those in the two corresponding groups without PS (Plt;0.05).The pH and PaCO2 as well as circulatory function in the four groups were not significantly different at different treatment timepoints (Pgt;0.05).(C) Lung W/D was not different between CMV and HFOV groups (Pgt;0.05)，or CMV+PS and HFOV+PS.But lung W/D in the two groups treated with PS showed statistically decrement than that in non-PS groups (Plt;0.05).(D) Histological injury score was lowest in HFOV+PS group and highest in CMV group.Conclusion HFOV combined with exogenous PS supplement can improve arterial oxygenation and alleviate pulmonary edema and injury，which may be a optimal method for the treatment of acute lung injury with acute respiratory failure caused by water vapour inhalation.
Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IPA) in both animal studies and clinical researches. Methods MEDLINE, ISI, EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4. 22 sofeware was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio ( OR) and 95% confidence interval ( CI) . Results Five animal studies with a total of 626 animals were included. The overall survival rate of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was increased ( 38.3% vs. 9.7% , OR=13.93, 95% CI 7.46 ～26.01, Plt;0. 000 01) . Six clinical trials including 1354 patients were considered. Our meta-analysis showed that inhaled AmB could significantly reduce the incidence rate of IPA ( 2.6% vs. 9.2% , OR=0.27, 95% CI 0.16 ～0.46, P lt;0. 000 01) , but had no definite benefit on mortality. Four studies evaluated the potential side effects of nebulized AmB and showed that there were no significant adverse events. Conclusions Empirical inhaled AmB is associated with a lower rate of IPA but no significant
吸入疗法是治疗呼吸系统疾病的常用方法, 包括气雾吸入、经储雾罐气雾吸入、干粉吸入以及雾化吸入等, 而以雾化吸入疗效最确切, 适应证也最广泛。但是, 关于雾化吸入治疗的用药方案以及药物配伍信息却非常有限。近期美国卫生系统药师协会发表的常用雾化吸入药物混合配伍指南[ 1 ] 提出了可供雾化吸入的药物及其配伍的各种推荐意见, 并采用表格形式便于临床医生理解和掌握。成人慢性气道疾病雾化吸入治疗专家组在该指南的基础上, 结合中国呼吸道疾病雾化吸入治疗现状, 制定了雾化吸入药物治疗共识, 同时根据不同的疾病提出雾化治疗推荐方案, 以供临床医师参考。
ObjectiveTo evaluate the clinical effects of nebulized lidocaine anesthesia and anesthesia with lidocaine and midazolam in patients with preoperative bronchoscopy. MethodsTotally, 136 inpatients between May 2002 and June 2013 with preoperative bronchoscopy were included in the study. The patients were randomly assigned to experimental group and control group with 68 patients in each. For patients in the experimental group, 8 mL of 2% lidocaine was administered through inhalation anesthesia, followed by 2-3 mg bolus of midazolam, and subsequently 0.5 mg of midazolam was administered every 2 minutes depending on patients' awareness. Patients in the control group accepted lidocaine alone for anesthesia. The clinical efficacy and adverse effects of both the two ways of anesthesia were observed. ResultsThe time of sustained and effective anesthesia was (24.5±2.8) minutes in the experimental group, as compared with (16.8±2.1) minutes in the control group (P<0.01). The average amount of consumption of lidocaine was (12.4±1.3) mL in the experimental group, as compared with (16.8±1.5) mL in the control group (P<0.01). The heart rate at 5 min after operation was (81.5±19.5) beats/min in the experimental group, as compared with (94.6±34.6) beats/min in the control group (P<0.01). The mean pulse oxygen saturation at 5 min after operation was (93.5±3.6)% in the experimental group, as compared with (88.2±13.3)% in the control group (P<0.01). ConclusionCombined application of lidocaine and midazolam before bronchoscopy is simple and feasible for anesthesia, which has higher success rate, lesser side effects and other reactions such as body movement and coughing.
ObjectiveTo summarize the experiences of artificial airway management for inhalation injury patients undergoing tracheotomy. MethodsA retrospective analysis was made on the clinical data of 16 patients with inhalation injury who accepted artificial airway implantation after tracheotomy from January 2012 to October 2014. Certain measures were taken for the patients such as timely sputum suction in a correct way, effective airway moist, timely airway lavage, strict aseptic operation, reasonable position management, dynamic observation and health education. ResultsFifteen patients were cured, and one died. Among the cured patients, there were one case of catheter change due to blocked sputum, and one case of catheter outward portion sliding depth adjusting. ConclusionStrengthening artificial airway management after tracheotomy is the key to keep airway unobstructed, to prevent complications, and to guarantee the safety and a speedy recovery of patients.
ObjectiveTo improve the diagnosis and treatment of pulmonary alveolar proteinosis (PAP). MethodsThe clinical data of 34 PAP cases diagnosed between May 2008 and June 2015 in Hunan Prevention and Treatment Center for Occupational Diseases were retrospectively analyzed. ResultsThere were 34(52.9%)patients with a history of dust exposure. Cough and progressive dyspnea were common clinical symptoms. The incidence rate of hypoxemia and lung function damage was 87.9% and 90.9%,respectively. High resolution CT clearly demonstrated the characteristic map-like changing and paving-stone sign. Arterial blood oxygen partial pressure increased from (62.5±12.9)mm Hg to (73.0±12.2)mm Hg,and DLCO%pred increased from (50.1±14.9)% to (64.6±14.4)% after large-volume whole lung lavage. The recurrence rate was 38.2%. ConclusionThe etiology of PAP is unknown,dust exposure may be associated with secondary PAP. The effect of whole lung lavage is remarkable but the recurrence rate is high. It is needed to study further on etiological treatment of PAP.
Objective To observe the effect of fresh orange peel flavor inhalation on the improvement of gastrointestinal reactions such as nausea and vomiting in tumor patients during chemotherapy. Methods Ninety-one inpatients undergoing chemotherapy with PF and TP regimens between May 2012 and September 2013 were included in this study. The patients were randomly divided into orange group (n=45) and control group (n=46). Patients in the control group received conventional care, while those in the orange group were treated with fresh orange peel flavor inhalation during chemotherapy. We observed the effect of orange peel flavor inhalation on such gastrointestinal reactions as nausea and vomiting in tumor patients during chemotherapy. Results All the patients completed each cycle of chemotherapy. At the fifth day during chemotherapy, compared with the control group, the incidence rates of grade Ⅲ-Ⅳ gastrointestinal reactions (nausea and vomiting) in the orange group were significantly lower (P=0.023). At the fourth day, when gastrointestinal reactions were the most significant, the food intake of patients in the orange group was significantly higher than that in the control group (P=0.012). During chemotherapy, the addition rate of antiemetic drugs in the orange group was significantly lower than that in the control group (P=0.038). In the orange group, 80.0% of the patients had good self-feeling after orange peel flavor inhalation. Conclusions The study results have shown that fresh orange peel flavor inhalation can effectively improve the gastrointestinal reactions (such as nausea and vomiting), appetite, and degree of comfort in tumor patients during chemotherapy, and reduce the use of antiemetic drugs. This study is of great significance to guide the future research on how to reduce the discomfort of on-chemotherapy patients and provide more comfortable care.
Objective To evaluate therapeutic efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) inhalation in patients with recurrent pulmonarv alveolar proteinosis (PAP). Methods Three cases of recurrent PAP were treated by GM-CSF inhalation after whole lung lavage. The clinical data of the pulmonary function and SpO 2, the clinical symptoms and pulmonary lesions were compared before and after treatment. Results The pulmonary function and manifestations were improved obviously after GM-CSF inhalation. Also the ground-glass opacity was improved in high-resolution CT. The pulmonary function and SpO 2 increased obviously after received GM-CSF inhalation. There were no any adverse reactions in 3 cases. Conclusion GM-CSF inhalation therapy is effective and safe in recurrent PAP, but the long-term effect remains to be seen.
Objective To evaluate the effects of inhalation combined intravenous antibiotics for the treatment of ventilator-associated pneumonia. Methods A computerized search was performed through Cochrane library, Joanna Briggs Institute Library, PubMed, MEDLINE, CINAHL, CBM, CNKI and Wangfang medical network about inhalation combined intravenous antibiotics therapy in ventilator-associated pneumonia in the literatures. The data extracting and quality assessment were performed by three researchers. The meta-analysis was performed by RevMan 5.3 software. Results Thirteen studies was included for analysis. The results showed that the cure rate was higher in the experimental group compared with the control group with significant difference (RR=1.16, 95%CI 1.07 to 1.56,P=0.000 5). There were no significant differences in the mortality (RR=1.04, 95%CI 0.82 to 1.32,P=0.74) or the incidence of kidney damage (RR=0.79, 95%CI 0.51 to 1.22,P=0.29). The difference in pathogenic bacteria removal was statistically significant (RR=1.38, 95%CI 1.09 to 1.74,P=0.007). The negative conversion rate of respiratory secretions was higher in the experimental group. Conclusion Inhalation combined intravenous antibiotics can improve the cure rate of patients with ventilator-associated pneumonia, clear pathogenic bacteria effectively, and is worthy of recommendation for clinical use.
ObjectiveTo describe the imaging and clinical features of vaccinia virus induced pneumonia by long-term follow-up.MethodsThe clinical data, imaging features and long-term follow-up of 5 patients with vaccinia virus pneumonia admitted to Wuxi People's Hospital Affiliated to Nanjing Medical University were analyzed.ResultsAll the 5 patients were male, aged between 21 and 54 years. The latent period of the disease was 2 to 5 days. All the patients had fever and pneumonia, while 3 of them had herpes. Two patients with severe pneumonia showed extensive patchy and nodular shadows in both lungs. Chest CT findings of the other three patients showed scattered small nodules in both lungs. All patients were followed up by telephone every half a year for 3 years. The prognosis of all patients was good. The patients reported in the English literature were clinically clustered, with fever, vomiting and rash as the main symptoms.ConclusionsVaccinia virus may cause different clinical symptoms through different transmission routes, and its infectivity is strong. Biological protection should be strengthened in laboratory and working environment.