【摘要】 目的 系统评价司帕沙星对比氧氟沙星治疗耐多药肺结核的有效性和安全性。 方法 计算机检索Cochrane图书馆临床对照试验资料库（2010年第2期）和PubMed（1978年-2010年10月）、EMBASE（1974年-2010年10月）、中国学术期刊网络出版总库（1978年-2010年10月）、维普（1989年-2010年10月）、中国生物医学文献数据库（1978年-2010年10月）；手工检索其他相关杂志。检索语种为中文和英文。纳入司帕沙星对比氧氟沙星治疗耐多药肺结核的随机对照试验。按Cochrane系统评价的方法评价纳入研究质量，用RevMan 5.0软件对数据进行Meta分析。 结果 共纳入8篇研究，Meta分析结果显示司帕沙星组与氧氟沙星组相比，痰菌转阴率、病灶显著吸收率、空洞闭合率均高于对照组，差异具有统计学意义（Plt;0.05）。 结论 现有的证据表明，司帕沙星与其他抗结核药物联用治疗难治、耐多药肺结核的疗效优于氧氟沙星的联用方案，但由于纳入的文献数量有限，质量参差不齐，存在潜在的发表偏倚。【Abstract】 Objective To assess the clinical efficacy and safety of sparfloxacin versus ofloxacin in treatment of multi-drug resistant pulmonary tuberculosis (MDR-TB). Methods Literatures were retrieved from PubMed (1978-October, 2010), EMBASE (1974-October 2010), Cochrane library (2nd volume, 2010), China Academic Journal Network Publishing Database (1978-October, 2010), VIP (1989-October, 2010) and CBM (1978 to October, 2010) by computer, and searched some other relevant journals manually. Chinese and English were both used in the search. Randomized controlled trials (RCTs) on sparfloxacin versus ofloxacin in treating pulmonary tuberculosis were included in this study. Meta-analysis was conducted by RevMan 5.0 software. Results The meta-analysis of 8 included RCTs showed that the sputum negative conversion rate, focus absorption rate, cavity closure rate in the sparfloxacin group were significantly higher than the ofloxacin group (P＜0.05). Conclusions The analysis indicates that combined treatment with sparfloxacin has a better effect in treating MDR-TB than with ofloxacin. However, the reliability of this review may be affected by the number and quality of studies included. Large-scale randomized controlled trials of high quality are needed to confirm the conclusions above.
ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
目的 探讨联合康复新液治疗复治菌阳肺结核的临床效果。 方法 选取2011年1月－12月复治菌阳肺结核患者120例，随机分为对照组57例，观察组63例。两组患者均采取异烟肼、利福平、吡嗪酰胺、乙胺丁醇、链霉素联合治疗；观察组在此基础上再联用康复新液予以辅助治疗。治疗期间随访患者临床症状、痰菌阴转、病灶吸收情况，并就两组患者治疗效果进行评价。 结果 治疗2、3、6、8个月时观察组患者痰菌转阴率分别为46.03%、73.02%、90.48%和95.23%，明显高于对照组（26.32%、49.12%、66.66%、84.21%）；治疗6个月后胸部CT检查示观察组患者空洞闭合率为73.58%；对照组患者空洞闭合率为52.08%，两组比较差异有统计学意义（χ2=5.016，P=0.025）；治疗过程中的不良反应发生率观察组为19.04%，对照组为19.30%，两组比较差异无统计学意义（χ2=0.001，P=0.972）。 结论 对复治菌阳肺结核联合康复新液进行治疗是一种安全而有效的治疗方法。
ObjectiveTo observe the impact of perioperative nursing intervention on pulmonary tuberculosis patients undergoing lung resection. MethodThirty-six pulmonary tuberculosis patients going to undergo lung resection hospitalized between January and December 2013 were randomly divided into intervention group and control group with 18 in each. Patients in the intervention group received routine perioperative care plus nursing intervention including preoperative, environmental, dieting and pain intervention. Then, complications, hospitalization time and costs, as well as patients' satisfaction with the nursing work were compared between the two groups. ResultsAfter nursing intervention, complications, hospitalization time, hospital costs of patients in the intervention group were significantly less than the control group (P<0.05), and patients' satisfaction was significantly higher (P<0.05). ConclusionsPerioperative nursing intervention on lung resection treatment and rehabilitation of patients play an active and effective role, which can reduce complications, shorten hospitalization time, reduce hospital costs and improve patients' satisfaction.
ObjectiveTo be aware of the current situation of nurses' protective consciousness on pulmonary tuberculosis in one of the top hospitals, and to discuss its influencing factors, in order to provide references for better improving nurses' tuberculosis protection consciousness. MethodsBy using random sampling method, we selected the nurses who met the requirements to participate in the questionnaire investigation, between March and May 2014. According to the results, we evaluated their protective awareness on tuberculosis and its influencing factors. ResultsWe delivered 320 questionairs and took back 316. Nurses with different age, length of nursing work, professional rank, job title, educational background, and tuberculosis prevention knowledge training status had significantly different scores (P < 0.05). The multiple linear regression analysis was carried out with total scores of tuberculosis prevention knowledge as dependent variable, and age, professional rank, length of nursing work, educational background and tuberculosis prevention knowledge training as independent variable. The results showed that age, educational background, and tuberculosis prevention knowledge training were influencing factors of tuberculosis prevention knowledge scores (P < 0.05). ConclusionPulmonary tuberculosis prevention knowledge in nurses remains to be further promoted, and we should especially strengthen the prevention knowledge training for nurses with short working experience and low-degree education.
Objectives To evaluate the effect and safety of mycobacterium vaccae in the treatment of recurrent treated pulmonary tuberculosis. Methods We searched PubMed (1997 to 2006), VIP (1997 to 2006), Wanfang database (1997 to 2006), The Cochrane Central Register of Controlled Trials (Issue 4, 2006) and the National Research Register (1996 to 2006). Randomized controlled trials comparing the mycobacterium vaccae immunotherapy group and the control group were included. Two reviewers independently performed data extraction and quality assessment. Data were analyzed using RevMan 4.2.2 software by The Cochrane Collaboration. Results Eleven high quality trials were included. Meta-analyses showed that mycobacterium vaccae immunotherapy plus chemotherapy resulted in higher sputum negative conversion rate (RR=1.36, 95%CI 1.21 to 1.54), higher lesion absorption rate (RR=1.39, 95%CI 1.13 to 1.72), and lower lesion non-absorption rate (RR=0.46, 95%CI 0.36 to 0.60), compared with the control group. These differences were all statistically significant. No serious adverse events were reported. Conclusion As an adjunct to chemotherapy, mycobacterium vaccae is helpful for patients with recurrent treated pulmonary tuberculosis in terms of improving cell-medicated immunity, sputum negative conversion and X-ray manifestation. More high quality studies are needed for further analysis.
ObjectiveTo investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.MethodsWe retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two[1], groups.ConclusionCompared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.