目的 对比纤维支气管镜肺灌洗治疗和常规治疗重症肺部感染患者的临床疗效。方法 将2015年5月—2017年4月间在我院接受治疗的92例重症肺部感染患者作为研究对象,按照随机数字表分为实验组(n=46)和对照组(n=46),其中对照组采用常规对症治疗,实验组加以实施纤维支气管镜肺灌洗治,治疗后,纤支镜气道灌洗检测两组患者的血气分析指标变化,采用ELISA测定血清炎症因子含量,及放射免疫法测定血清应激激素含量。结果 经比较,实验组患者治疗后的PaO₂、SaO₂、PaCO₂高于对照组患者(P<0.05);实验组患者的血清炎症因子hs-CRP、IL-6、IL-8水平低于对照组患者(P<0.05);此外,实验组患者的Ang-II、NE、Cor含量低于对照组患者(P<0.05)。结论 纤支镜气道灌洗可有助于改善重症肺部感染患者的肺通气功能,降低全身炎症应激程度,促进疾病康复。

Objective To compare the clinical efficacy of bronchoalveolar lavage and conventional treatment in patients with severe pulmonary infection. Methods 92 patients with severe pulmonary infection treated in our hospital from May 2015 to April 2017 were selected as research objects. They were randomly divided into experimental group (n=46) and control group (n=46). The control group was treated with conventional symptomatic treatment, The experimental group implemented bronchoscopy lung lavage treatment. After treatment, blood gas bronchoscopic airway lavage in two groups were detected with analysis indexes. Serum inflammatory factors were determined by ELISA, and the serum levels of stress hormones were determined by radioimmunoassay. Results After the treatment, the PaO₂, SaO₂ and PaCO₂ in the experimental group were higher than those in the controlgroup(P<0.05). The levels of serum inflammatory factors hs-CRP, IL-6、IL-8 in the experimental group were lower than those in the control group (P<0.05); in addition, the levels of Ang-II, NE and Cor in the experimental group were lower than those in the control group(P<0.05). Conclusion Bronchoscopy airway lavage may help to improve the pulmonary ventilation function of patients with severe pulmonary infection, reduce the degree of systemic inflammatory stress, and promote disease recovery.

目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

目的 研究EGFR基因突变与系列肿瘤标志物在160例原发性肺癌患者及51例肺部良性占位病变患者中的表达状况,为肺部占位病变的诊断、鉴别诊断和治疗提供参考依据。方法 160例肺癌患者取新鲜病理组织标本,采用扩增阻滞突变系统荧光PCR(ARMS-PCR)技术检测EGER基因突变;160例肺癌患者和51例良性占位病变患者取外周静脉血用化学发光法检测系列肿瘤标志物,用χ²检验统计分析数据。结果 160例肺癌病例中,EGFR基因野生型比率为47.56%(78/164),EGFR基因突变型比率为52.44%(86/164),突变型中21L858R点突变占23.17%(38/164),19Del缺失突变占22.56%(37/164)。肺癌组中系列肿瘤标志物较良性占位组具显著高表达,P＜0.01。差异有统计学意义。结论 肺癌致病与EGFR基因突变、肿瘤标志物高表达有显著正相关,通过肿瘤标志物和EGFR基因突变检测,结合影像学检查,将有助于肺部占位病变诊断和鉴别诊断,并为治疗手段选择提供参考依据。

Objective To research EGFR gene mutation and series of tumor markers expression in 160 patients with primary lung cancer and 51 patients with lung benign placeholder lesions, provide some references for the diagnosis, differential diagnosis and treatment in lung placeholder lesions. Methods We took fresh pathological tissue specimens from 160 cases of patients with lung cancer, Then used ARMS PCR technique to detect EGER gene mutations. We took the peripheral venous blood in 160 patients with lung cancer and 51 patients with lung benign placeholder lesions, with chemiluminescence method to detect series of tumor markers,and used thechi-square test to statistic and analysis data. Results In 160 cases of lung cancer patients,The EGFR gene wild type rate was 47.56%(78/164).The EGFR gene mutation type rate was 52.44%(86/164).In EGFR gene mutation type,The proportion of 21L858R mutation was 23.17%(38/164),19del mutation was 22.56%(37/164). Series of tumor markers had significantly higher expression in lung cancer group than in benign placeholder lesions group. P＜0.01.The difference was statistically significant. Conclusion Lung cancer pathogenesis and EGFR gene mutations, tumor markers high expression was significantly positive correlation. Through a series of tumor markers and EGFR mutation testing, combined with imaging examination, it will contribute to the diagnosis and differential diagnosis in lung placeholder lesions, and provide the basis for treatment.

目的 回顾分析慢性阻塞性肺疾病急性加重期并或不并肺部结核感染在感染及营养方面指标的差异性,明确结核感染对AECOPD的影响。方法 选取2013年7月—2015年6月因急性发作入住我院的COPD患者105例,根据GOLD 2011对COPD的诊断标准及卫生部2008年制定的肺结核诊断标准将其分为无结核组、稳定期组、好转期组及进展期四组。分别在入院时测定患者白细胞计数、中性粒细胞比率、总淋巴细胞计数、淋巴细胞比值、红细胞沉降率、血红蛋白浓度、血清白蛋白及C反应蛋白及体重指数。结果 各组感染指标比较,WBC、CRP两指标差异不显著(P>0.05),而无结核组相较于其他三组,NEUT%更高(F=4.004,P=0.010)、LY%及ESR更低(F/P分别为3.668/0.015和20.197/0.000);各组营养指标比较,合并有肺结核的三组,其Hb、ALB及BMI均比无结核组低,达到统计学差异(P<0.05),而TLC在各组间无差异(F=0.858,P=0.466)。结论 合并有结核感染的AECOPD患者更容易出血贫血(Hb降低)、低蛋白血症(ALB降低)、低体重(BMI降低)、中性粒细胞含量偏低(NEUT%降低)而血沉(ESR)、淋巴细胞比率(LY%)升高的情况,对出现此类情况的AECOPD患者应进行结核感染相关检查。

目的 探讨不同用药方案治疗慢性阻塞性肺病所致肺部感染的药物经济学。方法 本次医学研究选择我院2012年1月—2014年1月收治的200例慢性阻塞性肺病所致肺部感染患者为观察对象,随机将其分为A组、B组、C组和D组,A组观察对象接受盐酸莫西沙星治疗,B组观察对象接受硫酸依替米星治疗,C组观察对象接受头孢哌酮钠治疗,D组观察对象接受他唑巴坦钠/哌拉西林钠治疗,回顾分析四组观察对象药物经济学。结果 四组观察对象药物敏感度对比差异有统计学意义(P<0.05),而临床治疗效果和不良反应发生率对比则差异无统计学意义(P>0.05)。结论 慢性阻塞性肺病所致肺部感染患者接受C方案治疗,具有理想的临床效果和较高的药物经济学效率。

       目的   探讨支气管镜灌洗用于儿童重症肺部感染合并肺实变的治疗效果及对CT特征、肺功能的影响。方法   选取2022年5月—2024年5月铜仁市人民医院收治的100例重症肺部感染合并肺实变患儿开展前瞻性研究，应用随机数表法分为对照组和观察组，每组各50例。对照组患儿采取常规治疗，观察组则采取常规治疗加支气管镜灌洗治疗。对比其临床疗效，治疗前后炎症因子、CT特征及肺功能变化。结果   观察组治疗总有效率高于对照组（P＜0.05）；治疗后观察组患儿白细胞计数（10.36±2.52）×10⁹ /L、白细胞介素-6（20.57±5.05）ng/L、C反应蛋白（13.12±2.64）mg/L、降钙素原（101.62±12.16）pg/L均低于对照组白细胞计数（13.25±3.32）×10⁹ /L、白细胞介素-6（31.69±4.11）ng/L、C反应蛋白（16.16±4.44）mg/L、降钙素原（113.46±18.11）pg/L（P＜0.05）；治疗后两组患儿胸腔积液、支气管壁增厚、空气支气管征、肺部实变、磨玻璃影等相关CT影像特征占比下降，且观察组低于对照组（P＜0.05）；治疗后两组患儿呼气流量峰值水平均升高，观察组（90.67±18.45）L/s高于对照组（81.27±17.69）L/s，用力肺活量水平均更高，观察组（3.33±0.68）L高于对照组（2.68±0.25）L（P＜0.05）。结论   针对儿童重症肺部感染合并肺实变，在常规治疗基础上增加支气管镜灌洗可提升临床疗效，减轻机体炎症反应，改善胸部CT各种表现及肺功能。

        Objective  To explore the therapeutic effects of bronchoalveolar lavage in children with  severe pulmonary infection complicated by lung consolidation and its impact on CT features and pulmonary function．Methods A prospective study was conducted on 100 children with severe pulmonary infection complicated with pulmonary consolidation in a hospital from May 2022 to May 2024．They were randomly divided into observation group and control group using a random number table method，50 cases in each group．The control group of children received routine treatment，and the observation group received conventional treatment plus bronchoalvelar lavage．Clinical efficacy，inflammatory factors，CT features，and alterations in pulmonary function before and after therapy were compared．Results  The total effective rate of the observation group was higher than that of the control group（P＜0.05）．After treatment，the white blood cell count（10.36±2.52）×10⁹ /L，interleukin-6（20.57±5.05）ng/L，C-reactive protein（13.12±2.64）mg/L，and procalcitonin（101.62±12.16）pg/L in the observation group were all lower than those in the control group（13.25±3.32）×10⁹ /L，interleukin-6（31.69±4.11）ng/L，C-reactive protein（16.16±4.44）mg/L，and procalcitonin（113.46±18.11）pg/L（P＜0.05）．After treatment，the proportion of CT imaging features such as pleural effusion，bronchial wall thickening，air bronchogram sign，lung consolidation，ground glass opacities，decreased in both groups of children，and the observation group was lower than the control group（P＜0.05）．After treatment，the peak levels of expiratory flow in both groups of children increased，with the observation group（90.67±18.45）L/s higher than the control group（81.27±17.69）L/s．The forced vital capacity levels were also higher，with the observation group（3.33±0.68）L higher than the control group（2.68±0.25）L（P＜0.05）．Conclusions  Adding bronchoalvelar lavage to routine treatment for children with severe pulmonary infection complicated with pulmonary consolidation can improve their clinical efficacy，alleviate inflammatory reactions，and improve various chest CT manifestations and lung function．

        目的   探究支气管镜联合雾化吸入药物对肺炎支原体肺炎患儿症状持续时间及肺部影像学好转情况。方法   选取94例肺炎支原体肺炎患儿为研究对象，以随机数字表法分为A组、B组，各47例，分别实施布地奈德雾化吸入治疗、支气管镜肺泡灌洗联合布地奈德雾化吸入治疗，比较两组症状持续时间、治疗后肺部影像改善情况、炎症指标水平及不良反应发生率。结果  B组体温恢复时间（2.73±0.51）d、咳嗽消失时间（5.98±1.24）d、住院时间（10.96±3.36）d，A组分别为（3.14±0.83）（7.06±2.33）（13.27±3.18）d，B组较A组短（t=2.885、2.809、3.423，均P＜0.05）；治疗后B组40.43%阴影完全消失、34.04%阴影显著缩小、23.40%阴影有所缩小、2.13%阴影改善不明显，A组分别为21.28%、36.17%、25.53%、17.02%，B组肺部阴影改善情况优于A组（Z=8.311，P＜0.05）；治疗前B组白细胞计数（WBC）、超敏C-反应蛋白（hs-CRP）、降钙素原（PCT）水平与A组相近（P＞0.05）；治疗后B组WBC（7.71±1.94）×109 /L、hs-CRP（4.96±1.44）mg/L、PCT（84.32±21.40）pg/mL，A组分别为（9.05±2.48）×109 /L、（6.17±1.85）mg/L、（105.46±34.02）pg/mL，B组水平较A组低（t=2.918、3.538、3.606，均P＜0.05）；B组不良反应发生率为8.52%，A组为4.26%，B与A组相近（χ ² =0.178，P＞0.05）。结论   对肺炎支原体肺炎患儿实施支气管镜联合雾化吸入药物治疗，可缩短康复时间，促进肺部阴影消退，降低其炎症指标水平，且未增加不良反应发生率。

     Objective  To investigate the effect of bronchoscopy combined with nebulized inhalation of medication on the duration of symptoms and pulmonary imaging conversion in children with Mycoplasma pneumoniae pneumonia（MPP）．Methods  A total of 94 children with MPP were selected as the research subjects and randomly divided into Group A and Group B using a random number table，with 47 cases in each group．They were treated with budesonide nebulization inhalation therapy and bronchoalveolar lavage combined with budesonide nebulization inhalation therapy，respectively．The duration of symptoms，improvement of lung imaging before and after treatment，levels of inflammatory indicators，and incidence of adverse  reactions were compared between the two groups．The results showed that the temperature recovery time was（2.73±0.51）days，cough disappearance time was（5.98±1.24）days，and hospitalization time was（10.96±3.36）days in Group B，（3.14±0.83）days，（7.06±2.33）days，and（13.27±3.18）days in Group A，respectively．Durpation in Group B was shorter than Group A（t=2.885，2.809，3.423，all P＜0.05）． After treatment，40.43% of the shadows in Group B completely disappeared，34.04% of the shadows significantly reduced，23.40% of the shadows reduced，and 2.13% of the shadows showed no significant improvement，better than 21.28%，36.17%，25.53%，and 17.02% in Group A（Z=8.311，P＜0.05）． Before treatment，the white blood cell count（WBC），high-sensitivity C-reactive protein（hs CRP），and procalcitonin（PCT）levels in group B were similar to those in Group A（P＞0.05）．After treatment，the WBC（7.71±1.94）×109 /L，hs CRP（4.96±1.44）mg/L，and PCT（84.32±21.40）pg/mL in Group B were lower than those in Group A（9.05±2.48）×109 /L，（6.17±1.85）mg/L，and（105.46±34.02）pg/mL，respectively（t=2.918，3.538，3.606，all P＜0.05）．The incidence of adverse reactions in Group B was 8.52%，while in Group A it was 4.26%．The incidence of adverse reactions in group B was similar to that in group A（χ ² =0.178，P＞0.05）．Conclusions  Bronchoscopy combined with nebulized inhalation therapy for children with MPP can shorten the recovery time，promote the disappearance of lung shadows，reduce their inflammatory index levels，and without increasing the incidence of adverse reactions．