经支气管镜治疗96 例难治性肺炎临床观察

目的：探讨经支气管镜吸痰、灌洗和注药治疗难治性肺炎的临床疗效和安全性。方法：96 例确诊的难治性肺炎患者被随机分 为观察组和对照组,每组均为48 例。对照组采用针对性和经验性常规治疗;观察组在常规治疗基础上行经支气管镜局部吸痰、灌 洗和注药。比较两组治疗情况、通气功能和血气指标变化、疗效及不良反应情况等。结果：观察组住院时间和病灶好转时间仅为 (12.45± 3.25)d 和(19.32± 3.86)d 均显著低于对照组住院和病灶好转时间(P<0.05),而住院费用仅为(30721.00± 1004.00)元,显著 少于对照组(P<0.05);治疗后体温、CRP、WBC、RR 和HR 水平分别下降到(36.74± 0.40)℃、(34.9± 3.0) mg/L、(9.49± 1.20) × 109/L 、(21± 5) 次/min 和(84± 8) 次/min,显著低于治疗前和对照组治疗后水平(P<0.05);总有效率为83.33%显著高于对照组52.08% (P<0.05),细菌培养阳性率85.42％,显著高于细菌培养阳性率29.17％(P<0.05);术后无严重并发症。结论：在常规治疗基础上经纤 维支气管镜局部吸痰、灌洗和注药治疗难治性肺炎,能改善患者肺通气功能,提高临床治疗效果,缩短病程。     

纤维支气管镜在肺不张诊断与治疗中的意义

目的:探讨纤维支气管镜(纤支镜)在肺不张的诊断及治疗中的意义.方法:对经X线、CT诊断为肺不张的67例患者行纤支镜检查和治疗.结果:纤支镜病因诊断符合率为98.5%.其中肺癌38例(56.7%),炎症19例(28.4%),结核9例(13.4%),异物阻塞1例(1.5%).病变部位以右上叶16例最多(23.9%),接着依次为右肺下叶(19.4%),右肺中叶(17.9%).对肺不张患者经纤支镜吸痰、灌洗、局部给药、取出异物等治疗后,患者症状均有不同程度的改善,且炎症、结核、异物所致的肺不张肺叶均有不同程度复张,呼吸功能改善.结论:纤支镜对肺不张的诊断及治疗具有重要意义,且经纤支镜辅助治疗可促进肺复张.     

Negative Pressure Artificial Respiration: Use in Treatment of Respiratory Failure of the Newborn

Ninety-one infants with respiratory failure secondary to primary pulmonary disease and with a birth weight of 1000 g. or over have been managed in a negative-pressure respirator (Air-Shields) over a three-year period. Of these the failure in 87 was due to respiratory distress syndrome (RDS) and in four it resulted from massive meconium aspiration. Respiratory failure was indicated initially by arterial blood gas tensions (while breathing 100% O₂) of Po₂ <40 mm. Hg, pH <7.10 and Pco₂ >75 mm. Hg in the initial 47 cases; these levels were subsequently raised to Po₂ < 50 mm. Hg, pH <7.20 and Pco₂ >70 mm. Hg for the remainder. Fifty-four (59.3%) of the infants survived the use of the respirator and 47 of these (51.6%) were subsequently discharged alive and well. Mean time in hours to normalization of blood gas values while on the respirator were as follows: for Po₂, 10.5; for pH, 11.6; and for Pco₂, 22.6. These values indicate that the respirator is more efficient in promoting oxygenation (raising Po₂) than ventilation (lowering Pco₂). They also suggest that the observed acidosis is in large part secondary to the hypoxia rather than the result of co₂ retention. For the survivors the average time of total respirator dependency before commencement of weaning was 53.7 hours. All the infants were managed without the use of endotracheal tubes although the use of the respirator and/or administration of 100% oxygen were either continuous or intermittent for periods of up to two weeks. There have been no instances of so-called respirator lung disease in the survivors or in those who died, which suggests that the use of high oxygen concentration by itself is not the major factor in the pathogenesis of this complication.     

Negative Pressure Artificial Respiration: Use in Treatment of Respiratory Distress Syndrome of the Newborn

Forty-five newborn infants in respiratory failure with respiratory distress syndrome were treated with intermittent negative pressure ventilation (INPV). There was a survival rate of 38% (17/45).All infants were initially treated without nasotracheal intubation. However, 24 of these developed a Paco₂ greater than 70 mm. Hg and were subsequently intubated. Intubation was followed by a decrease in the degree of hypercarbia in each instance and simultaneous increase in Pao₂.Complications encountered during ventilation were: emphysema (one patient), aspiration pneumonia (two patients), septicemia (two patients), misplaced nasotracheal tube (one patient).Follow-up of the 17 surviving patients for periods of four to 36 months disclosed two patients with post-intubation hoarseness. One infant initially had spastic quadriplegia with EEG abnormalities, both of which cleared by 5 months of age. In the remaining 14 infants, the results of physical, neurological and psychological examinations have remained within normal limits.     

Metal Reduction at Low pH by a Desulfosporosinus species: Implications for the Biological Treatment of Acidic Mine Drainage

We isolated an acid-tolerant sulfate-reducing bacterium, GBSRB4.2, from coal mine-derived acidic mine drainage (AMD)-derived sediments. Sequence analysis of partial 16S rRNA gene of GBSRB4.2 revealed that it was affiliated with the genus Desulfosporosinus. GBSRB4.2 reduced sulfate, Fe(III) (hydr)oxide, Mn(IV) oxide, and U(VI) in acidic solutions (pH 4.2). Sulfate, Fe(III), and Mn(IV) but not U(VI) bioreduction led to an increase in the pH of acidic solutions and concurrent hydrolysis and precipitation of dissolved Al³⁺. Reduction of Fe(III), Mn(IV), and U(VI) in sulfate-free solutions revealed that these metals are enzymatically reduced by GBSRB4.2. GBSRB4.2 reduced U(VI) in groundwater from a radionuclide-contaminated aquifer more rapidly at pH 4.4 than at pH 7.1, possibly due to the formation of poorly bioreducible Ca-U(VI)-CO₃ complexes in the pH 7.1 groundwater.