【摘要】 目的 觀察經皮導管介入治療急性肺栓塞的療效。 方法 選擇2003年1月-2009年6月收治的急性肺栓塞患者15例，采用經皮導管吸栓術、碎栓術及溶栓術治療。溶栓術用局部灌注加即刻靜脈注射尿激酶，總量100萬U。溶栓后給予低分子肝素7~10 d，口服華法林3~6個月。觀察臨床癥狀、體征改善情況、并發癥、平均肺動脈壓（mPAP）與動脈血氧分壓（PO2）的變化，以及肺動脈開通情況。 結果 12例肺動脈完全開通，3例部分開通，顯效率89%，有效率100%。mPAP從（41.07±6.97） mm Hg降到（21.00±5.66） mm Hg，PO2從（46.26±9.30） mm Hg升到（79.49±8.04） mm Hg，治療前后差異有統計學意義（Plt;0.05）。即刻臨床癥狀明顯改善，mPAP迅速降低11例。隨訪3~6個月，療效持續，未見復發。 結論 介入治療急性肺栓塞療效顯著，安全可行，對搶救危重患者、改善臨床癥狀、維持血流動力學穩定有重要作用。【Abstract】 Objective To observe the clinical curative effect on acute pulmonary embolism(PE)via percutaneous catheter intervention. Methods Fifteen acute PE patients admitted from January 2003 to June 2009 were treated with percutaneous catheter drawing of thrombus, thrombectomy, and thrombolysis. Local infusion and immediate intra-venous injection of urokinase with 100 000 000 U in total were used for thrombolysis. Afterwards, the low molecular weight heparin was given for seven to ten days, and an oral intake of warfarin lasts for three to six months. Observe the clinical symptoms, improvement of physical signs, occurrence of complications, change of mean pulmonary arterial pressure (mPAP) and arterial partial pressure of oxygen (PO2), as well as the patency condition of pulmonary artery. Results Twelve of fifteer patients gained complete patency of pulmonary artery, and the other three patients gained partial patency, with an obvious effectiveness rate of 89% and an effectiveness rate of 100%. mPAP decreased from (41. 07±6. 97) mm Hg to (21. 00±5. 66) mm Hg, and PO2 elevated from (46. 26±9. 30) mm Hg to (79. 49±8. 04) mm Hg, showing a significant difference (Plt;0. 05) before and after the therapy. The immediate clinical symptoms exhibited a significant improvement. The pulmonary artery pressure of 11 patients dropped rapidly. During three to six months’ follow up, the therapeutic effects persisted and no recurrence was found. Conclusion The interventional treatment of acute PE demonstrates remarkable effectiveness, safety and feasibility, which plays an important role in the rescue of critical patients, improvement of clinical symptoms, and maintenance of hemodynamic stability.
Objective To summarize the characteristics of disseminated Penicillium marneffei infection.Methods The clinical, imageological and bacteriological characteristics were summarized by reviewing one case of disseminated Penicillium marneffei infection in an immunocompetent patient diagnosed in our hospital and the related literatures. Results The patient was a 32-year-old Guangdong male, whose main clinical features were fever, cough, and the abscess of pulmonary, tracheomucosa and subcutaneous. Routine blood examination showed leukocytosis. Other laboratory examination revealed multiple lesions of heart, liver, and kidney. Multiple masses histopathology revealed inflammation, but the culture from the purulent exudates were negative and standard antibiotic therapy was useless. Bronchoscope revealed gray nodus on airway mucosa. Under the direction of bacteriologist, final diagnosis of Penicillium marneffei infection was obtained by the fungal culture from the purulent exudates and the deep sputum. Conclusions Penicillium marneffei can infect immunocompetent patients. Disseminated Penicillium marneffei infection should be considered when patients presented with multiple organ lesions and multiple subcutaneous pyogenic masses which can not explained by connective tissue disease or common pyogenic infection, and with epidemiology of southeast life history.