目的:评价足量布地奈德溶液雾化治疗重度慢性阻塞性肺疾病急性加重期患者的临床应用价值。方法: 90例30%≤FEV1lt;50%的重度COPD急性加重期患者随机分为3组: 布地奈德组给予布地奈德溶液雾化吸入2mg/次,每8小时1次;甲泼尼龙组给予口服甲泼尼龙片24mg /次,1/日;对照组不使用任何糖皮质激素。疗程10d,观察3组患者治疗后肺功能,动脉血气和呼吸困难评分变化,以及糖皮质激素主要不良反应。结果: 与对照组相比,吸入布地奈德组和口服甲泼尼龙组在FEV1,PaO2,PaCO2和呼吸困难评分改善值方面,有显著差异性(Plt;005);吸入布地奈德组和口服甲泼尼龙组两组各项指标改善程度相似(Pgt;005);吸入布地奈德组和对照组的不良反应少于口服甲泼尼龙组 (Plt;005)。〖HTH〗结论:〖HTSS〗足量布地奈德溶液雾化治疗与口服糖皮质激素疗效相近,全身副作用小,安全性好,是重度COPD急性加重期糖皮质激素的有效选择。
ObjectiveTo evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by gram-negative bacilli. MethodsFrom January 2010 to December 2013,a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group (60 patients) and a control group (60 patients) in Shanghai Fifth People's Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians' decision according to guidelines,the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication,mortality,weaning rate and adverse events were recorded. ResultsAt the end of nebulized treatment,the rate of clinical cure in the nebulized group was significantly higher than that in the control group (75.0% vs. 53.3%,P=0.013). So was the rate of bacterial eradication (75.0% vs. 44.4%,P=0.008). But the crude mortality and weaning rate were similar between two groups (P>0.05). The adverse events in two groups were similar too (P>0.05). When followed-up to the 28th day,the weaning rate in the nebulized group was significantly higher than that in the control group (71.7% vs. 51.7%,P=0.024),but the crude mortality was not different (P>0.05). ConclusionNebulized amikacin as an adjunctive therapy for the treatment of VAP,which do not demonstrate obviously adverse events,can help improve rate of clinical cure and bacterial eradication and long-term weaning rate,but can not reduce patients' crude mortality.
Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.
Objective To investigate the pollution status of ultrasonic atomization fumigation and washing machine of traditional Chinese medicine and the effect of precision disinfection intervention, and to provide scientific basis for strengthening the cleaning and disinfection work of ultrasonic atomization fumigation and washing machine of traditional Chinese medicine. Methods From January to February 2024, samples were collected from the surface of seven ultrasonic atomization fumigation and washing machines of traditional Chinese medicine that could be used normally in the Department of Traditional Chinese Proctology of the First People’s Hospital of Longquanyi District, Chengdu. Samples were collected from four points, namely the nozzle, the front edge of the hip bath cover, the rear edge of the hip bath cover, and the outer edge of the hip bath cover, and at four times, namely before use, after use, after pre-intervention routine disinfection, and after post-intervention precision disinfection (including training of personnel, solidification of disinfection process, and improvement of disinfection supplies), to compare the pollution status and disinfection effect of the object surface at different points and sampling times, and analyze the microbial detection. Results In terms of different times, the qualified rate of specimens was 28.6% before use, which decreased to 14.3% after use; the qualified rate of specimens was 39.3% after pre-intervention routine disinfection, which increased to 92.9% after post-intervention precision disinfection, with a statistically significant difference (χ2=17.923, P<0.001). A total of 158 strains of bacteria were detected from unqualified specimens, including 121 strains of Gram-positive bacteria (accounting for 76.58%) and 37 strains of Gram-negative bacteria (accounting for 23.42%). The detected bacteria were mainly common environmental bacteria. The top three were Kocuria rhizophila, Dermacoccus nishinomurai, and Microbacterium aureum. The main pathogenic bacteria of common nosocomial infections were Staphylococcus epidermidis and Escherichia coli, and no multi-drug resistant strains were detected. Conclusion Targeted cleaning and disinfection measures should be taken to ensure the disinfection effect and reduce the risk of nosocomial infection for special medical instruments such as ultrasonic atomization fumigation and washing machine of traditional Chinese medicine.
Objective To compare three approaches of lipopolysaccharides ( LPS) administration for inducing acute lung injury ( ALI) in mice. Methods LPS ( 5 mg/kg) was intratracheally aerosol administered ( ITA group) , intratracheally instilled ( ITI group) , or intraperitoneally injected ( IPI group) to induce ALI in BLAB/ c mice. Evans Blue instead of LPS was intratracheally administered to observe the liquid distribution in the lungs. Two hours after LPS administration, the mice were sacrificed and the lungs were removed to determine wet-to-dry lung weight ratio ( W/D) , and the histological changes were evaluated by HE staining. Phosphorylation level of IκB-αand NF-κB p65 in lung tissue were investigated by Western blot. Transcription intensity of TNF-α and IL-1β mRNA in lung tissue were detected by real-time quantitative PCR. Results Evans Blue distributed more uniformly in the ITA group than the ITI group. The lung W/D ratio and histological changes score in three LPS administration groups were all significantly higher than the normal control group ( P lt;0. 01) , with the ITA group being the highest. The phosphorylation levels of IκB-αand NF-κB p65 were significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt; 0. 05) . Transcription intensity of TNF-αand IL-1βmRNA was significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt;0. 05) . Conclusion Being non-invasive and convenient,intratracheal LPS aerosol inhalation is an optimal method to induce ALI in mice because it induces more extensive and uniformly distributed injuries in lung.
ObjectiveTo evaluate the efficacy of aerosolized aminoglycoside antibiotics in patients with ventilator-associated pneumonia (VAP) by meta-analysis.MethodsWe searched PubMed, Embase, China National Knowledge Infrastructure, VIP and Wanfang Data for the Chinese and English literature on aerosolized aminoglycoside antibiotics for VAP until May, 2018. After data extraction and quality evaluation, RevMan 5.2 software was performed for meta-analysis.ResultsA total of 9 randomized controlled trials and a total of 543 patients were included in this study. Compared with patients treated with non-atomized inhaled aminoglycoside antibiotics, meta-analysis showed that aerosol inhalation of amikacin significantly improved the clinical cure rate of patients with VAP ［odds ratio (OR)=2.37, 95% confidence interval (CI) (1.50, 3.75), P=0.000 2］, nebulized tobramycin ［OR=2.30, 95%CI (0.92, 5.78), P=0.08］ and two or more antibiotics ［OR=2.00, 95%CI (0.62, 6.46), P=0.25］ had no significant effect on the clinical cure rate of patients with VAP; aerosolized aminoglycoside antibiotics had no significant effect on mortality of patients ［OR=1.17, 95%CI (0.66, 2.07), P=0.59］ and tracheal spasm rate ［OR=2.39, 95%CI (0.94, 6.11), P=0.07］ and renal dysfunction rate ［OR=0.62, 95%CI (0.32, 1.21), P=0.16］ in patients with VAP.ConclusionInhalation of amikacin can significantly improve the clinical cure rate of patients with VAP, but it can not reduce the mortality rate of patients; the safety of aerosolized aminoglycoside antibiotics is good, and the risk of tracheal spasm and renal function damage in patients with VAP is not increased.
【摘要】目的探讨喉癌手术后患者对两种不同雾化方式的耐受性,为选择最佳雾化方式提供参考。方法将49例喉癌手术后患者随机分为观察组(25例)和对照组(24例),观察组采用氧气雾化吸入,对照组采用空气压缩泵雾化吸入。分别记录两组患者雾化吸入前及吸入15 min时脉搏血氧饱和度(SpO2)及心率;雾化过程中患者有无心慌、气紧等不适以及雾化后痰液的性质及量。采用SPSS 13.0软件进行统计分析。结果两组患者雾化吸入15 min时的SpO2差异有统计学意义(Plt;001),观察组高于对照组;而两组患者雾化吸入前SpO2、心率、不适主诉及雾化后痰液的性质差异均无统计学意义(Pgt;005)。结论氧气雾化吸入可以提高喉癌手术后患者雾化过程中的SpO2,使患者感觉更加舒适。【Abstract】Objective To investigate postoperative patients with laryngeal carcinoma atomization of two different forms of tolerance, in order to choose the best means of atomization. Methods Fifty postoperative patients with laryngeal carcinoma were divided into observation group using oxygen inhalation and control group using the air compression pump inhalation. Two groups of patients were recorded the value of SpO2 and heart rate before 15 minutes after the inhalation,as well as the discomforts such as flustered,gas tight during the atomization process and the nature and olume of sputum. Results The results of two groups of patients at the time of 15 minutes inhalation SpO2 statistically significant difference (Plt;001), the observation group than in the control group average SpO2 high; and two groups of patients with preinhalation SpO2 average, average heart rate, Discomfort chief complaint and the nature of sputum after aerosol compared no significant difference (Pgt;005). Conclusion Oxygen inhalation in patients with laryngeal cancer can improve the atomization process SpO2 value, so that patients feel more comfortable.