目的：探討胸膜活檢對胸腔積液病因診斷的價值。方法:對268例胸腔積液患者行經胸壁胸膜活檢術。結果:268例患者共行胸膜活檢289次，二次及以上活檢者19例，獲取胸膜組織244例，穿刺成功率91%，經病理檢查有18例為正常胸膜組織，陽性診斷者為226例，陽性率92.6%（226/244），其病理診斷為結核104例（46%）、腫瘤54例（23.9%）、慢性炎癥68例（30.1%）；發生并發癥者19（6.6%），全部為氣胸，肺壓縮均小于30%，未做特殊處理數日后自行吸收。結論:從本組資料可以看出，經胸壁胸膜活檢術對于胸腔積液的病因診斷具有非常好的效果，相比胸水涂片或病理檢查具有更高的陽性率。因此經胸壁胸膜活檢術由于它的簡單、安全、高效等特點，目前在胸腔積液病因診斷方面仍是一項重要的手段。
【摘要】 目的 探討莫西沙星對急性肺膿腫治療的臨床療效及安全性分析。方法 選擇2008年6月—2009年6月收治的36例急性肺膿腫患者,隨機分為莫西沙星組和對照組,分別給予靜脈滴注莫西沙星和頭孢哌酮舒巴坦聯合替硝唑治療。比較兩組療效及安全性。結果 莫西沙星組和對照組總有效率分別為90.63%、93.75%;細菌敏感性分別為73.3%、86.7%;細菌清除率分別為83.7%、92.4%;不良反應總發率分別為16.7%、11.1%。兩組比較無統計學差異(Pgt;005)。結論 經驗性莫西沙星治療急性肺膿腫的療效及安全性與頭孢哌酮舒巴坦聯合替硝唑相似。但莫西沙星治療費用低且利于口服序貫治療而更具有優勢,可推薦作為經驗性或首選用藥。
Objective To evaluate the relationship between COPD and atherosclerosis, and analyze the risk factors of atherosclerosis among COPD patients. Methods A total of 40 COPD patients and 43 normal subjects were enrolled in the study. Carotid intima-media thickness (IMT) and plaques were detected in both groups. Blood samples were collected to measure the concentration of high sensitive C-reactive protein (hs-CRP) , fibrinogen (Fbg) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , while smoking index was recorded. Multiple regression analysis was performed to evaluate the correlative factors of IMT among COPD patients. According to whether luminal stenosis appeared, the COPD patients were allocated into group A ( without luminal stenosis) and group B ( with luminal stenosis) . Age, gender, hs-CRP, Fbg, TC, TG, HDL-C, LDL-C, and smoking index of the two groups were compared respectively. Results Hs-CRP, Fbg, thickness of IMT, plaques detection rate, and smoking index in the COPD group were significantly higher than those in the control group ( Plt;0.05) . TC, HDL-C, LDL-C in the COPD group were significantly lower than those in the control group ( Plt;0. 05) .Multiple regression analysis of IMT correlative factors among COPD patients showed that age, hs-CRP, Fbg, TC, TG, LDL-C, HDL-C, and smoking index were in linear relationship with IMT thickening. Age, hs-CRP, TC, and smoking index were positively correlated with IMT ( Plt;0.05) . Hs-CRP and smoking index in the group A were lower than those in the group B ( Plt;0. 05) .While TC, TG, LDL-C, and HDL-C in the group A were higher than those in the group B ( Plt;0.05) . Conclusions Age, smoking index, hs-CRP, and TC are risk factors for thickening of carotid artery IMT in COPD patients. Furthermore, smoking index, hs-CRP, TC, TG, LDL-C, and HDL-C are related to the severity of IMT thickening. The ultrasound detection of carotid artery IMT can be a valuble tool to screen atherosclerosis in patients with COPD.
Objective To explore the relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and low-risk pulmonary embolism (PE). Methods In a multicenter retrospective study on clinical characteristics, COPD patients with proven acute PE between October 2005 and February 2017 were enrolled. The patients in risk classes III-V on the basis of the PESI score were excluded. The patients with COPD and low-risk PE were divided into two groups of those with thrombocytosis and without thrombocytosis after extracting platelet count on admission. The clinical characteristics and prognosis of the two groups were compared. Multivariate logistic regression was performed to reveal an association between thrombocytosis and all-cause in-hospital mortality after confounding variables were adjusted. Results A total of 874 consecutive patients with COPD and PE at low risk were enrolled in which 191 (21.9%) with thrombocytosis. Compared with those without thrombocytosis, the thrombocytopenic group had significantly lower body mass index [(20.9±3.3) kg/m2 vs. (25.1±3.8) kg/m2, P=0.01], lower levels of forced expiratory volume in one second (FEV1) [(0.9±0.4) L vs. (1.3±0.3) L, P=0.001] and lower partial pressure of oxygen in the arterial blood (PaO2) [(7.8±1.2) kPa vs. (9.7±2.3) kPa, P=0.003]. The COPD patients with thrombocytosis had a higher proportion of cardiovascular complications as well as higher level of systolic pulmonary arterial pressure (sPAP) [(46.5±20.6) mm Hg vs. (34.1±12.6) mm Hg, P=0.001]. Multivariate logistic regression analysis after adjustment for confounders revealed that thrombocytosis was associated with all-cause mortality in hospitalized patients with COPD and low-risk PE (adjusted OR=1.53, 95%CI 1.03–2.29), and oral antiplatelet treatment was a protective factor (adjusted OR=0.71, 95%CI 0.31–0.84). Conclusions Thrombocytosis is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. Antiplatelet therapy may play a protective role in the high-risk cohort.