目的 探讨计划-实施-检查-处理（PDCA）循环法及根本原因分析法在持续正压通气治疗重症肺炎患儿中的应用效果。方法 选取2021年1月—2023年1月医院收治并接受鼻塞式持续正压通气治疗的重症肺炎患儿80例,基于随机数字表法分为两组,每组各40例。对照组接受常规护理,观察组采用PDCA循环法联合根本原因分析法护理干预。比较两组临床症状改善时间、血气指标[动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）]、肺功能指标[第1秒用力呼气容积（FEV₁）、潮气量（VT）]、炎症免疫指标[单核细胞趋化蛋白-1（MCP-1）、可溶性髓系细胞触发受体-1（sTREM-1）、可溶性细胞间黏附分子-1（sICAM-1）]水平变化,比较两组患儿家属满意度情况。结果 观察组患儿咳嗽、气促、哮鸣音、心率恢复及紫绀等症状改善用时均低于对照组,比较差异有统计学意义（P<0.05）。干预前,两组患儿PaO₂、SaO₂、PaCO₂、FEV₁、VT、MCP-1、sTREM-1、sICAM-1水平比较差异均无统计学意义（P>0.05）;干预后,两组患儿上述指标水平均有不同程度变化（P<0.05）,观察组PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）、SaO₂（93.58±3.82% vs 86.30±4.21%）、FEV₁（2.66±0.46 L vs 1.97±0.34 L）、VT（11.92±1.89% vs 9.83±1.10%）水平均高于对照组,观察组PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）、MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）、sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）、sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）水平低于对照组,差异均有统计学意义（P<0.05）。观察组患儿家属满意度整体优于对照组（P<0.05）;观察组总满意率（97.5% vs 77.5%）高于对照组,差异有统计学意义（P<0.05）。结论 PDCA循环法及根本原因分析法应用于接受持续正压通气治疗的重症肺炎患儿,能够有效促进患儿临床症状改善,有利于血气及肺功能恢复,且可降低炎症反应,患儿家属满意度较高。

Objective To explore the application effect of Plan-Do-Check-Action（PDCA）circulation method and root cause analysis method in the treatment of children with severe pneumonia with continuous positive pressure ventilation．Methods From January 2021 to January 2023,80 children with severe pneumonia who were admitted to hospital and received nasal plug continuous positive pressure ventilation treatment were enrolled in this study．Based on the random number table method,they were divided into two groups,with 40 cases in each group．The control group received routine nursing,while the observation group received PDCA circulation method combined with root cause analysis nursing intervention．The improvement time of clinical symptoms,changes in blood gas indicators[arterial partial oxygen pressure（PaO₂）,arterial oxygen saturation（SaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）],lung function indicators [（forced expiratory volume in 1 second,FEV₁）,tidal volume（VT）],and inflammatory immune indicators [monocyte chemotactic protein-1（MCP-1）,soluble myeloid cell trigger receptor-1（sTREM-1）,soluble intercellular adhesion molecule-1（sICAM-1）] levels between the two groups were compared,and the family members’ satisfaction of the two groups was also compared．Results The improvement time for symptoms such as cough,shortness of breath,wheezing,heart rate recovery and cyanosis in the observation group was lower than that in the control group,and the difference was statistically significant（P<0.05）．Before intervention,there was no statistically significant difference in the levels of PaO₂,SaO₂,PaCO₂,FEV₁,VT,MCP-1,sTREM-1 and sICAM-1 between the two groups of children（P>0.05）．After intervention,the levels of the above indicators in both groups of children showed varying degrees of change（P<0.05）．The levels of PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）,SaO₂（93.58±3.82% vs 86.30±4.21%）,FEV₁（2.66±0.46 L vs 1.97±0.34 L）,VT（11.92±1.89% vs 9.83±1.10%）in the observation group were higher than those in the control group．The levels of PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）,MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）,sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）and sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）in the observation group were lower than those of the control group,with statistically significant differences（P<0.05）．The overall satisfaction of the observation group was better than that of the control group（P<0.05）,the total family members’ satisfaction rate of the observation group was higher than that of the control group（97.5% vs 77.5%）,with a statistically significant difference（P<0.05）．Conclusions PDCA circulation method and root cause analysis method applied to children with severe pneumonia who receive continuous positive pressure ventilation treatment,can effectively promote the improvement of clinical symptoms,be conducive to the recovery of blood gas and lung function,and reduce inflammatory reaction,with high family members’ satisfaction．

目的 探讨清热化痰宣肺汤治疗痰热壅肺型重症肺炎的临床效果。方法 选择2022年3月—2023年6月天津市中西医结合医院收治的158例痰热壅肺型重症肺炎患者进行探讨,采用随机分组法分为研究组和对照组,每组各79例,对照组接受常规对症处理联合抗生素治疗,研究组在对照组基础上给予清热化痰宣肺汤,两组均治疗2周,比较疗效、中医证候积分、肺功能、血气分析结果以及不良反应发生情况。结果 研究组总有效率为94.94%,高于对照组的84.81（P=0.035）;研究组治疗后发热、痰壅以及气促评分分别为（1.12±0.33）分、（1.02±0.28）分及（1.16±0.30）分;对照组治疗后发热、痰壅以及气促评分分别为（1.45±0.36）分、（2.11±0.42）分及（2.06±0.39）分,研究组和对照组各项评分均较治疗前降低（均P<0.05）,研究组低于对照组（P均<0.05）;治疗后研究组PEF、FEV₁、FVC以及MVV分别为（3.48±0.53）L/s、（2.95±0.52）L、（2.98±0.58）L、（88.15±5.25）L/min,治疗后对照组的PEF、FEV₁、FVC以及MVV分别为（4.22±0.53）L/s、（2.41±0.47）L、（2.98±0.58）L、（88.15±5.25）L/min,两组均较治疗前升高（均P<0.05）,且研究组高于对照组（均P<0.05）; 治疗后研究组和对照组PaO₂分别为（9.77±1.12）kPa、（9.33±1.09）kPa,均较治疗前升高（均P<0.05）,研究组高于对照组（P=0.013）,治疗后研究组和对照组的PaCO₂分别为（4.22±0.14）kPa、（5.11±0.16）kPa,均较治疗前下降（均P<0.05）,研究组低于对照组（P<0.001）;研究组出现3例恶心不良反应,对照组未见不良反应发生,组间无显著差异（P>0.05）。结论 清热化痰宣肺汤治疗痰热壅肺型重症肺炎效果理想,可明显改善肺功能及血气指标,且具有较高安全性。

目的 探讨对于重症肺部感染患者采用药物+纤维支气管镜肺泡灌洗吸痰术治疗的效果。方法 选取2021年9月—2023年5月在郑州市第一人民医院ICU中94例肺部感染患者,分为观察组、对照组,对照组进行常规治疗,观察组采用药物+纤维支气管镜肺泡灌洗吸痰术治疗,对比两组患者的疗效、症状的缓解时间、炎性因子、实验室相关指标以及不良反应。结果 治疗后,观察组患者的治疗有效率91.49%高于对照组76.60%（χ²=3.887,P<0.05）,观察组患者的发热、肺部湿啰音、咳嗽以及咳痰等症状的缓解时间分别为（3.09±1.25）（4.17±2.24）（3.95±1.53）（4.05±1.77）d,均低于对照组（5.14±2.43）（7.03±3.23）（6.40±2.62）（6.32±1.81）d（t=5.143、4.988、5.536、6.147,P<0.05）,观察组的 C 反应性蛋白（C-reactive protein,CRP）、白细胞介素-6（Interleukin-6,IL-6）以及Toll样受体4（Toll-like receptor 4,TLR-4）水平分别为（3.64±0.87）mg/L、（54.59±10.65）ng/mL、（7.94±1.57）%,均低于对照组（7.51±1.43）mg/L、（87.66±11.17）ng/mL、（12.11±2.48）%（t=15.850、14.690、9.740,P<0.05）,观察组的气道压力、动脉血二氧化碳分压（partial pressure of carbon dioxide in artery,PaCO₂）水平分别为（6.92±3.60）cmH₂O、（43.19±6.29）mmHg,低于对照组（8.68±2.98）cmH₂O、（55.43±5.95）mmHg,观察组动脉氧分压（Partial arterial oxygen pressure,PaO₂）（86.06±5.31）mmHg、血氧饱和度（oxyhemoglobin saturation,SpO₂）（98.03±6.63）%高于对照组（68.04±5.19）mmHg、（90.22±5.51）%要高（t=2.582、9.692、16.638、6.221,P<0.05）,观察组中的不良反应发生率为2.13%与对照组10.64%比较差异无统计学意义（χ²=2.849,P>0.05）。结论 对处于ICU中的肺部感染患者治疗时,使用药物+纤维支气管镜肺泡灌洗吸痰术能够改善患者症状,降低炎性因子水平。

Objective To investigate the efficacy of medication combined with bronchoscopic alveolar lavage and sputum aspiration in ICU patients with severe pulmonary infection. Methods Ninety-four patients with pulmonary infection in the ICU of Zhengzhou First People's Hospital from September 2021 to May 2023 were selected and divided into observation group and control group．The control group received routine treatment,and the observation group was treated with medication and bronchoscopic alveolar lavage and sputum aspiration．The efficacy,duration of symptom remission,inflammatory factors,laboratory-related indicators and adverse reactions were compared between the two groups. Results After treatment,the effective rate of 91.49% in observation group was significantly higher than 76.60% in control group（χ²=3．887,P<0.05）．The relief time of fever,pulmonary rale,cough and sputum in observation group was（3.09±1.25）d,（4.17±2.24）d,（3.95±1.53）d,and（4.05±1.77）d,respectively,which were significantly lower than the control group[（5.14±2.43）d,（7.03±3.23）d,（6.40±2.62）d and（6.32±1.81）d]（t=5.143,4.988,5.536,6.147,P<0.05）．The levels of CRP,IL-6 and TLR-4 in the observation group were（3.64±0.87）mg/L,（54.59±10.65）ng/mL and（7.94±1.57）%,respectively．They were significantly lower than（7.51±1.43）mg/L,（87.66±11.17）ng/mL and（12.11±2.48）% in the control group（t=15.850,14.690,9.740,P<0.05）．The airway pressure and PaCO₂ levels of the observation group were（6.92±3.60）cmH₂O and（43.19±6.29）mmHg,respectively,which were significantly lower than those of the control group[（8.68±2.98）cmH₂O and（55.43±5.95）mmHg]．The levels of PaO₂[（86.06±5.31）mmHg] and SpO₂[（98.03±6.63）%] in the observation group were higher than those in the control group[（68.04±5.19）mmHg and（90.22±5.51）%],and there were statistically significant differences（t=2.582,9.692,16.638,6.221,P<0.05）．The adverse reactions of 2.13% in the observation group were lower than 10.64% in the control group,and there was no statistically significant difference（χ²=2.849,P>0.05）. Conclusions In ICU patients with severe lung infection,the treatment of drugs combined with alveolar lavage and fiberoptic bronchoscopic aspiration is better,and can significantly improve the symptoms and inflammatory factor levels of patients．

目的 探讨超声监测导向下早期肠内营养（EEN）在重症脓毒血症（SS）有创通气（IV）患者中的应用效果。方法 选取2021年2月—2023年11月连州市人民医院收入的115例SS-IV患者,依据随机数字表法分为对照组（n=57）、超声监测组（n=58）。所有患者均予重症监护病房（ICU）综合治疗,在此基础上对照组实施临床经验的传统肠内营养（EN）干预,超声监测组实施超声监测导向下EEN干预,均监测至治疗结束。统计两组IV时间、ICU停留时间、EN达标时间、EN不耐受发生率、相关并发症发生率,比较干预前、EN结束时营养状况[白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）]、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果 对照组剔除放弃治疗1例,死亡2例,纳入54例;超声监测组剔除放弃治疗1例,死亡1例,纳入56例。超声监测组EN达标时间[（40.18±8.46）h]、IV时间[（7.12±1.44）d]、ICU停留时间[（9.21±1.63）d]短于对照组[（46.03±10.15）h、（8.02±1.62）d、（10.18±1.54）d]（t=3.288、3.082、3.206,均P<0.05）。EN结束时超声监测组SS-IV患者血清ALB[（32.05±3.13）g/L]、TP[（65.36±3.62）g/L]、PA[（0.24±0.06）g/L]高于对照组[（30.28±2.24）g/L、（63.28±4.24）g/L、（0.21±0.05）g/L]（t=3.400、2.770、2.843,均P<0.05）。EN结束时超声监测组APACHEⅡ评分[（15.85±1.93）分]、SOFA评分[（7.42±1.64）分]低于对照组[（17.02±2.04）分、（8.35±2.03）分]（t=3.091、2.648,均P<0.05）。超声监测组EN不耐受发生率[12.50%（7/56）]低于对照组[29.63%（16/54）],超声监测组相关并发症发生率[8.93%（5/56）]低于对照组[24.07%（13/54）]（χ²=4.878、4.608,均P<0.05）。结论 超声监测导向下EEN干预应用于SS-IV患者,可改善患者病情与营养状况,降低EN不耐受及相关并发症发生风险,缩短恢复时间。

Objective To investigate the effect of ultrasound monitoring guided early enteral nutrition（EEN）in patients with severe sepsis（SS）and invasive mechanical ventilation（IV）．Methods A total of 115 SS-IV patients admitted to Lianzhou People's Hospital from February 2021 to November 2023 were randomly divided into control group（n=57）and ultrasound monitoring group（n=58）．All patients were given comprehensive treatment in intensive care unit（ICU）．On this basis,traditional enteral nutrition（EN）intervention with clinical experience was implemented in control group,and EEN intervention guided by ultrasonic monitoring was implemented in ultrasound monitoring group．All patients were monitored until the end of treatment．IV time,ICU stay time,EN compliance time,incidence of EN intolerance,and incidence of related complications were analyzed in the 2 groups．Nutritional status [albumin（ALB）,total protein（TP）,prealbumin（PA）],sequential organ failure assessment（SOFA）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）were compared before intervention and at the end of EN．Results In control group,1 cases gave up,2 cases died,and 54 cases were included．In ultrasound monitoring group,1 case gave up,1 case died,and 56 cases were included．The EN compliance time [（40.18±8.46）h],IV time [（7.12±1.44）d] and ICU stay time [（9.21±1.63）d] of ultrasound monitoring group were shorter than those of control group [（46.03±10.15）h,（8.02±1.62）d,（10.18±1.54）d]（t=3.288,3.082,3.206,all P<0.05）．At the end of EN,serum ALB[（32.05±3.13）g/L],TP[（65.36±3.62）g/L],PA[（0.24±0.06）g/L] of SS-IV patients in ultrasound monitoring group were higher than those in control group [（30.28±2.24）g/L,（63.28±4.24）g/L,（0.21±0.05）g/L]（t=3.400,2.770,2.843,all P<0.05）．At the end of EN,APACHEⅡ scores [（15.85±1.93）points] and SOFA scores [（7.42±1.64）points] of ultrasound monitoring group were lower than those of control group [（17.02±2.04）points and（8.35±2.03）points]（t=3.091,2.648,all P<0.05）．The incidence of EN intolerance in ultrasound monitoring group [12.50%（7/56）] was lower than that in control group [29.63%（16/54）],and the incidence of related complications in ultrasound monitoring group [8.93%（5/56）] was lower than that in control group [24.07%（13/54）]（χ²=4.878,4.608,all P<0.05）．Conclusions EEN intervention guided by ultrasonic monitoring in SS-IV patients can improve the nutritional status of patients,reduce the risk of EN intolerance and related complications,shorten the recovery time,and reduce the progression of patients' disease．

目的 探索视频喉镜下经食道超声(TEE)探头插入在急诊重症患者中的应用。方法 全麻下行非心脏手术的急诊重症患者60名,美国麻醉医师协会分级Ⅱ-Ⅳ级,采用随机数字法分成A组(n=30)和B组(n=30)2组。A组采用盲法插入TEE探头,B组采用视频喉镜辅助插入TEE探头。比较2组探头一次插入成功率、插入所需时间、插入时血流动力学变化、插入时不良反应的情况。结果 B组一次插入成功率(82.8%)高于A组(58.6%),差异有统计学意义(P<0.05)。B组第一次尝试成功插入所需时间长于A组,(24.6±3.1) s vs (15.5±3.0) s, 差异有统计学意义(P<0.05)。成功插入探头所需的总时间2组无差异,差异无统计学意义(P>0.05)。咽喉部损伤B组少于A组(3.4% vs 27.6%),差异有统计学意义(P<0.05)。探头插入时2组患者平均动脉压、心率无明显差异,差异无统计学意义(P>0.05)。结论 视频喉镜可以改善经食道超声探头插入的条件,提高插入成功率,减少相应并发症,可安全用于急诊重症患者的TEE探头插入。

Objective To explore the application of transesophageal echocardiography (TEE) probe insertion under video laryngoscopy in acute severe patients. Methods Sixty acute severe patients, ASA grade II-IV, underwent non-cardiac surgery under general anesthesia were divided into two groups (A and B) evenly by random number method.TEE probe was blindly inserted into the group A patients, and in group B, a video laryngoscope was used to assist the insertion.The first insertion success rate, the time required for insertion, the changes of hemodynamics during insertion, and the adverse reactions incidence during insertion of the two groups were compared. Results The first insertion success rate of the group B (82.8%) was significantly higher than that of the group A (58.6%), the difference was statistically significant (P<0.05). The time required for the first successful insertion of the group B was significantly longer than that of the group A, (24.6±3.1) s vs (15.5±3.0) s, and the difference was statistically significant (P<0.05). The total time required to insert the probe was not significantly different between the two groups (P> 0.05). Throat injury in the group B was significantly less than that in the group A (3.4% vs 27.6%), the difference was statistically significant (P<0.05). The hemodynamics (MAP and HR) of the two groups during insertion were not significantly different (P>0.05). Conclusions Video laryngoscope can improve the conditions of transesophageal ultrasound probe insertion, increase the success rate of insertion, and reduce the corresponding complications.It can be safely used for TEE probe insertion in acute severe patients in an emergency.

目的 探讨良肢位训练联合风险预控急救应用于重症脑卒中的效果。方法 采用回顾性分析,纳入我院2020年3月—2021年3月期间收治的41例重症脑卒中患者为对照组,救治方式为常规救治联合良肢位训练。同时纳入我院2021年4月—2022年4月期间收治的41例重症脑卒中患者为观察组,救治方式为良肢位训练联合风险预控急救。对比2组抢救情况、抢救效果、运动功能。结果 观察组院外吸氧率（46.34%）、院外插管率（34.15%）均高于对照组（17.07%、9.76%）,转入专科治疗时间、发病至入院时间均短于对照组（P<0.05）;干预3 d后,观察组格拉斯哥昏迷量表分值高于对照组,APACHEⅡ评分分值低于对照组（P<0.05）;观察组Fugl-Meyer运动评估、Berg平衡量表分值均高于对照组,NIHSS量表分值低于对照组（P<0.05）。结论 良肢位训练联合风险预控急救应用于重症脑卒中可有效改善抢救情况、提升抢救效果,从而增强运动功能。

Objective To explore the effect of normal extremity position training combined with risk pre-control emergency treatment in severe stroke．Methods Forty-one severe stroke patients from March 2020 to March 2021 included in the control group were retrospective studied,and the treatment method was conventional treatment combined with normal extremity position training．At the same time,41 severe stroke patients from April 2021 to April 2022 were included in the observation group,which the treatment method was the risk pre-control and emergency treatment．The rescue situation,rescue effect and sports function of the two groups were compared．Results Incidences of oxygen inhalation（46.34%）and intubation（34.15%）outside the hospital in observation group were higher than that in control group（17.07%,9.76%）;specialist treatment,onset to admission time were longer in control group（P<0.05）．Glasgow coma scale score in observation group was higher than that in control group,while APACHE Ⅱ score was lower in observation group（P<0.05）,Fugl-Meyer assessment and Berg Balance Scale score were higher,and NIHSS score was lower than control group（P<0.05）．Conclusions Combination of normal extremity position training and risk pre-control emergency treatment in severe stroke treatment can effectively improve the rescue effect,thus enhance the motor function．

目的 调查非重症监护室护士对住院卧床老年患者肺康复的知信行现状,探讨其影响因素。方法 采用自行设计的卧床老年患者肺康复知信行现状调查问卷,对广州市第一人民医院的555 名非重症监护室护理人员进行调查。结果 共回收有效问卷513份。调查对象肺康复知信行总分为（76.01±12.27）分,知识维度、态度维度、行为维度得分分别为（14.09±3.25）、（21.89±3.38）、（40.03±9.87）分。多元回归分析显示,主要影响护士对住院老年卧床患者实施肺康复知信行的因素为护龄、是否参加过肺康复相关培训及科室是否已开展肺康复（P<0.05）。结论 非重症监护室护士对卧床老年患者肺康复的态度积极,行为良好,但知识有待提升。建议开展卧床老年人相关肺康复培训,激励护士主动学习肺康复新理念的积极性和主动性,强化理论联系临床实践,从而提高临床护理质量。

Objective To investigate the knowledge,attitude and practice of non-intensive care unit（ICU）nurses about pulmonary rehabilitation of hospitalized bedridden elderly patients,and to explore the influencing factors．Methods A self-designed questionnaire on the status of knowledge,attitude and practice about pulmonary rehabilitation of bedridden elderly patients was used to investigate 555 non-ICU nurses in our hospital．Results A total of 513 valid questionnaires were collected．The total score of pulmonary rehabilitation was（76.01±12.27）,and the scores of knowledge,attitude and practice were（14.09±3.25）,（21.89±3.38）and（40.03±9.87）,respectively．Multiple regression analysis showed that the main factors affecting nurses' knowledge,attitude and practice in implementing pulmonary rehabilitation for hospitalized elderly bedridden patients were nursing age,whether they had participated in training related to pulmonary rehabilitation and whether pulmonary rehabilitation had been carried out in the unit（P<0.05）．Conclusions Non-ICU nurses have positive attitudes and good practice toward pulmonary rehabilitation for bedridden elderly patients,but their knowledge needs to be improved．It is recommended that training on pulmonary rehabilitation for the bedridden elderly be carried out to motivate nurses to learn new concepts of pulmonary rehabilitation,strengthen the link between theory and clinical practice,and improve the quality of clinical care．

目的 对本院老年重症肺炎患者的临床资料进行回顾性分析,为老年重症肺炎多药耐药菌感染的临床诊疗提供参考。方法 回顾性分析本院医院76例老年重症肺炎患者的病例信息,将患者随机分为研究组和对照组,每组38例,研究组患者在对照组基础上(头孢哌酮／舒巴坦)联合胸腺肽α1治疗。研究2组患者的痰液致病菌分布及其临床特点,通过对比2组患者治疗前后免疫功能指标T淋巴细胞CD4⁺及炎症因子超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)水平变化,对头孢哌酮/舒巴坦联合胸腺肽α1治疗老年重症肺炎的临床效果进行分析。结果 76例老年重症肺炎患者中,共检出143株病原菌,以不动杆菌属为主的革兰氏阴性菌(89株)为主要致病菌株,占比64.3%,革兰氏阳性菌(54株)以葡萄球菌属为主,占比35.7%;排名前3位的主要致病菌为:铜绿假单胞菌(33.6%)、金黄色葡萄球菌(22.4%)和大肠埃希菌(14.7%)。痰液分离出的致病菌出现了普遍的严重耐药性,主要以多药耐药铜绿假单胞菌为主。2组治疗前 T 淋巴细胞CD4⁺、hs-CRP、IL-6、TNF-α水平对比无差异(P＞0.05),治疗后观察组CD4⁺水平更高,而 CRP、TNF-α、IL-6水平更低,与对照组有差异(P＜0.05)。结论 老年重症肺炎多药耐药菌重症肺炎检出病原菌主要以铜绿假单胞菌为主,治疗上联合使用胸腺肽α1,能够有效改善患者的免疫抑制状态、减轻老年患者机体炎症反应,对于提高老年患者临床治疗效果及改善患者预后有着重要的临床意义,值得广泛推广。

目的 探讨结核病相关重症患者的诊治特点,提高此类疾病的诊治水平。方法 回顾性分析2020年7月—8月我科收住的4例临床表现类似的结核病相关重症患者的临床资料。结果 4例患者均诊断为活动性结核病或结核潜伏感染,均为合并1个或多个器官功能衰竭的重症患者,均表现为发热、血小板减少、肝肾损伤,经予以个体化的积极抢救治疗,均获得满意疗效。结论 结核病相关重症患者往往病情复杂危重,可能临床特点相似,但实际病因不同,因而治疗重点各异,需临床医生认真剖析病情,找到关键病因,以尽量挽救患者生命。

Objective To explore the characteristics of diagnosis and treatment of severe tuberculosis-related patients and improve diagnosis and treatment of such diseases. Methods Retrospectively analyzed the clinical data of 4 severe tuberculosis-related patients with similar clinical symptoms admitted to our department from July to August, 2020. Results All 4 patients were diagnosed as active tuberculosis or latent tuberculosis infection, with one or several organs failure, fever, thrombocytopenia, liver and renal injury. They were given individualized positive rescue treatment, and achieved satisfying outcomes. Conclusions Severe tuberculosis-related patients often have complex and critical conditions, and may have similar clinical characteristics, but the actual causes are different, so the treatment focuses are different. Clinicians need to carefully analyze the condition, find out the key causes, and try to save the lives of patients.

目的 对儿童重症肺炎支气管肺泡灌洗液(BALF)进行病原学分析及疾病预后的分析。方法 本研究选取2019年3月—2020年12月在我院儿科住院并进行肺泡灌洗治疗的40例重症肺炎患儿作为研究对象。通过对这些患儿在感染急性期肺泡灌洗液中的细菌、真菌、肺炎支原体等进行病原学检查以及T 淋巴细胞亚群的检测,了解台山地区儿童重症肺炎病原体情况及耐药性、T淋巴细胞亚群与疾病严重程度、预后评估的关系。结果 BALF病原学检测结果分析中,肺炎支原体27例,肺炎支原体+肺炎链球菌5例,肺炎支原体+中间葡萄球菌2例,肺炎支原体+铅黄肠球菌1例,肺炎支原体+嗜麦芽假单胞菌2例,病原菌阴性3例;本组病例血清T细胞亚群检测结果显示:大部分病例CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺水平有不同程度的下降。其中CD3⁺水平下降的有6例,CD4⁺水平下降的有16例,CD8+水平下降的有17例,CD4⁺、CD8⁺水平同时下降的有14例,CD3⁺、CD4⁺、CD8⁺水平同时下降的有4例;BALF细胞总数(3673.1±377.9)×10⁶ /L,巨噬细胞比例(23.6±17.6)%,淋巴细胞(22.1±16.2)%,中性粒细胞(46.5±24.8)%。结论 病原学分析儿童重症肺炎BALF的主要病原菌为肺炎支原体,血清T细胞亚群检测大多表现为CD4⁺、CD8⁺水平下降。

Objective To analyze the etiology of bronchoalveolar lavage fluid and prognosis of children with severe pneumonia. Methods In this study, 40 children with severe pneumonia who were hospitalized in the pediatrics department of our hospital and underwent alveolar lavage treatment from March 2019 to December 2020 were selected as the research objects. Through the detection of pathogens such as bacteria, fungi, Mycoplasma pneumoniae and T lymphocyte subsets of these children in the acute phase of infection, we can understand the pathogens and drug resistance of children with severe pneumonia in Taishan area and the relationship among drug resistance, T lymphocyte subsets and disease severity and prognosis assessment. Results In the analysis of the BALF pathogenic test results, there were 27 cases with Mycoplasma pneumoniae, 5 cases with Mycoplasma pneumoniae+Streptococcus pneumoniae, 2 cases with Mycoplasma pneumoniae+Staphylococcus intermedius, 1 case with Mycoplasma pneumoniae+Enterococcus casseliflavus, 2 cases with Mycoplasma pneumoniae+Pseudomonas maltophilia and 3 cases were pathogenic bacteria negative. The test results of serum T cell subsets of these cases showed that most of the cases had different degrees of decline in the levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺. Among them, CD3⁺ levels decreased in 6 cases, CD4⁺ levels decreased in 16 cases, CD8⁺ levels decreased in 17 cases, CD4⁺ and CD8⁺ levels decreased in 14 cases, and CD3⁺, CD4⁺, and CD8⁺ levels decreased in 4 cases; total cell number of BALF was (3 673.1±377.9)×10⁶/L, the proportion of macrophages was (23.6±17.6)%, lymphocytes had (22.1±16.2)%, and neutrophils had (46.5±24.8)%. Conclusions Pathogenic analysis showed that the main pathogen of BALF in children with severe pneumonia is Mycoplasma pneumoniae, and the detection of serum T cell subsets mostly showed a decrease in CD4⁺ and CD8⁺ levels.