【摘要】 目的 探討左氧氟沙星聯合阿奇霉素治療老年難治性呼吸道感染的療效及安全性。 方法 選擇2005年2月-2010年9月收治的高齡難治性呼吸道細菌感染患者68例，隨機分為治療組和對照組。治療組34例，給予左氧氟沙星聯合阿奇霉素；對照組34例，給予左氧氟沙星，兩組總療程皆為15 d。觀察兩組患者的臨床療效、細菌清除率和不良反應。 結果 治療組的總有效率為64.71%，對照組總有效率為32.35%，兩組差異有統計學意義（Plt;0.05） 。治療組細菌清除率為76.19%，對照組細菌清除率為36.36%，兩組差異有統計學意義（Plt;0.05） 。治療組和對照組的不良反應發生率分別為5.88%和8.82%，差異無統計學意義（Pgt;0.05）。結論 左氧氟沙星聯合阿奇霉素治療老年難治性呼吸道感染療效高， 能有效清除細菌， 不良反應較少， 值得臨床推廣應用。【Abstract】 Objective To evaluate the efficacy and safety of levofloxacin combined with azithromycin on refractory respiratory infections in elder patients. Methods A total of 68 elder patients with refractory respiratory infections in our hospital from February 2005 to September 2010 were randomly divided into two groups: treatment group (n=34) and control group (n=34). The patients in treatment group were treated with levofloxacin combined with azithromycin; while the patients in the control group were treated with levofloxacin alone. The total treatment periods of both groups were 15 days. The therapeutic efficacy, eradication rate of pathogens and the rate of aelverse reactions were observed. Results The therapeutic effect rate was 64.71% in the treatment group and 32.35% in the control group, and the difference between the two groups was statistically significant (Plt;0.05). The eradication rate of pathogens was 76.19% in the treatment group and 36.36% in the control group, and the difference was significant (Plt;0.05). The rate of the adverse reaction was 5.88% in the treatment group and 8.82% in the control group, and there were no significant differences between the two groups (Pgt;0.05). Conclusion Levofloxacin combined with Azithromycin is effective on refractory respiratory tract infection in elder patients, which can effectively remove the bacteria with few adverse reaction.
Objective To evaluate the clinical efficacy and safety of domestic cefepime in the treatment of acute bacterial lower respiratory tract infection. Methods A randomized, single-blind, controlled clinical trial was performed. The positive control was imported cefepime. The dosages of cefepime were 1g for moderate infection and 2g for severe infection, twice a day intravenously. The duration of the treatment was 7-10 days. Results Thirty-one patients were enrolled in the trial, of whom 30 were evaluable (15 in the triagroup and 15 in the control group). No significant differences were observed between the trial group and the control group with respect to the cure rate (40% vs. 27%), the effective rate (80% vs. 87%), the bacterial clearance rate (92% vs. 100%), and the incidence of adverse drug reactions (12.5% vs. 13%) (Pgt;0.05). Conclusion Domestic cefepime injection is effective and safe in the treatment of acute bacterial lower respiratory tract infection.
ObjectiveTo systematically review the protective effect of serum maternal respiratory syncytial virus (RSV) antibodies on infants with RSV infection. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect observational studies on the correlation between serum maternal RSV antibodies and infants with RSV infection from inception to July 18, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, qualitative analysis was performed. ResultsA total of 19 studies were included, and 60% of those studies suggested that a higher level of maternal antibodies could prevent RSV infection. However, the remaining 40% of them showed that there was no significant difference in the level of RSV maternal antibodies between the infected group and the non-infected group. Further more, in the studies of the correlation between maternal antibody level and disease severity after RSV infection, 55% of those showed that maternal antibody level was negatively correlated with disease severity. ConclusionThe protective effect of serum maternal RSV antibodies on infants reported in different studies varies. Whether it can prevent RSV infection and affect the severity of RSV infected children still needs to be explored.
目的:探討循證護理在氣管切開術患者呼吸道管理中應用的效果及措施。方法:將104例患者隨機分為觀察組和對照組各52例。觀察組重點從“氣道濕化、肺部物理療法、吸痰、氣道感染的預防、口咽部護理”幾個方面進行循證,獲取最佳證據,指導臨床護理,對照組按傳統護理法。結果:觀察組患者并發癥的發生率、死亡率顯著低于對照組,患者及家屬對護理工作的滿意率明顯提高。結論:運用循證護理能減少患者并發癥的發生,降低病死率,提高生存質量。
Objective To construct a multi-dimensional risk assessment system and scale for the prevention and control risk of respiratory infectious diseases in general hospitals, and make evaluation and early warning. Methods Through the collection of relevant literature on the prevention and control of respiratory infectious diseases during the period from January 1st, 2020 to December 31st, 2022, the articles related to the risk assessment of respiratory infectious diseases such as severe acute respiratory syndrome, COVID-19 and influenza A (H1N1) were screened, and the Delphi method was used to evaluate the articles and establish an indicator system. The normalized weight and combined weight of each item were calculated by analytic hierarchy process. The technique for order preference by similarity to the ideal solution method was used to calculate the risk composite index of 38 clinical departments in a tertiary general hospital in Jiangxi Province in December 2022. Results A total of 16 experts were included, including 4 with senior titles, 8 with associate senior titles, and 4 with intermediate titles. After two rounds of Delphi consult, a total of 4 first-level indicators, 11 second-level indicators, and 38 third-level indicators of risk assessment for the prevention and control of respiratory infectious diseases were determined. The reliability and validity of the scale were good. The top three items with the largest combined weights in the scale were spread by aerosol, spread by respiratory droplet, and commonly used instruments (inspection instruments and monitoring equipment). After a comprehensive analysis on the 38 departments, the top 10 departments in the risk index were the departments of medical imaging, pediatrics, ultrasound, cardiac and vascular surgery, infection, emergency, respiratory and critical care, general medicine, otolaryngology and neck surgery, stomatology, and obstetrics. Conclusions This study constructed the risk assessment scale of respiratory infectious diseases in general hospitals, and the scale has good reliability and validity. The use of this scale for risk assessment of general hospitals can provide a theoretical basis for the risk characteristics of prevention and control of respiratory infectious diseases in general hospitals.
至2002年6月,有關上呼吸道感染治療的臨床證據如下:①止痛劑/抗炎藥用于緩解癥狀:1個系統評價發現與安慰劑比較止痛劑或抗炎藥在1～5 d時顯著減輕咽喉炎癥狀;1個RCT發現在服用抗生素的急性鼻竇炎患者,激素鼻噴劑較安慰劑明顯改善癥狀,持續21 d.②抗生素用于預防β溶血鏈球菌咽炎的少見并發癥:1個系統評價發現抗生素可預防β溶血鏈球菌咽炎的非化膿性并發癥,但在工業化國家該并發癥少見.③抗生素能縮短流感嗜血桿菌、卡他莫拉菌或肺炎鏈球菌感染的康復時間,在少部分患者中其上呼吸道感染由流感嗜血桿菌,卡他莫拉菌或肺炎鏈球菌引起.1個RCT發現抗生素較安慰劑明顯增加這些患者在5 d時的康復.但目前尚無簡捷的方法將此亞組患者從眾多鼻咽培養陰性的患者中甄別出來.④抗生素縮短急性支氣管炎、咽喉炎和鼻竇炎的康復時間:系統評價發現抗生素能輕度改善癥狀.與安慰劑比較,使用抗生素常出現副作用(惡心、嘔吐、頭痛、皮疹、陰道炎).⑤抗生素在感冒患者中的作用:2個系統評價發現,在患感冒6～14 d時使用抗生素在治愈率或全身改善方面與安慰劑沒有差異.⑥抗組胺藥用于流涕和噴嚏:1個系統評價發現,使用抗組胺藥2 d后流涕和噴嚏明顯減輕,但臨床獲益較小.⑦β受體激動劑縮短成人支氣管高反應性、喘息或氣流受限患者咳嗽的持續時間:1個系統評價發現,與安慰劑或紅霉素比較,在7 d時β受體激動劑可減輕成人咳嗽癥狀,但亞組分析表明此種獲益僅限于伴有支氣管高反應性、喘息或氣流受限者.β受體激動劑明顯增加手抖、震顫和神經過敏的發生比例.兒童中進行的2個小樣本RCTs發現在7 d時咳嗽癥狀在β受體激動劑和安慰劑間沒有顯著差異.但是,這些RCTs規模太小,故不能檢出臨床上重要的差異.⑧減充血劑用于充血癥狀的長期緩解:1個系統評價發現,無證據支持數天中反復使用減充血劑.1個病例對照研究發現,有微弱證據支持去甲麻黃堿可能增加出血性中風的風險.⑨減充血劑用于充血癥狀的短期緩解:1個系統評價發現,與安慰劑比較單劑減充血劑顯著減輕鼻充血,持續3～10h.⑩紫錐花屬用于預防:1個系統評價發現與不干預比較,紫錐花屬顯著減少一次感染發作的人數,但與安慰劑比較,無有效證據支持紫錐花屬的作用.(11)紫錐花屬制劑:2個系統評價發現有限證據支持紫錐花屬的某些制劑在改善癥狀方面優于安慰劑,但我們未發現有效證據支持任何特定產品的療效.(12)蒸汽吸入:1個系統評價發現,無證據支持蒸汽吸入的作用.(13)維生素C:1個系統評價發現與安慰劑比較維生素C可輕度縮短感冒癥狀持續時間,但該作用較小且可能是發表偏倚.(14)鋅(鼻內鋅膠或錠劑):2個RCTs發現,與安慰劑比較鼻內鋅膠縮短感冒癥狀的平均持續時間,但僅有1個RCT發現差異有顯著性.2個系統評價發現,與安慰劑比較葡萄糖酸鋅或醋酸鹽鋅錠劑在7d時減輕癥狀的持續.
Objective To investigate the clinical features of lower respiratory tract infection caused by hypermastigote. Methods The clinical manifestations, chest imaging characteristics, fiber bronchoscopic and etiological test results were analyzed in 16 patients with hypermastigote infection in lower respiratory tract. Results In 16 patients with hypermastigote infection in lower respiratory tract, fever were present in all the cases, cough in 15 cases, night sweat in 12 cases, wheezing in 3 cases, and eosinophilia in 3 cases.Alive hypermastigotes were found in respiratory tract secretion in all the 16 cases. Bacterial culture of respiratory tract secretion yielded positive results in 8 of 16 cases. Chest imaging showed infiltrations in several lobes and segments or a large opacity with fuzzy patches. Bronchoscopy showed an acute inflammation in the respiratory tract lumen. Prognosis was good with the therapy of Metronidazole. Conclusions Detection of hypermastigote infection in lower respiratory tract have a definite clinical significance in Shenzhen area. Mixed infection is common in hypermastigote infection of lower respiratory tract.
Objective To understand the changing patterns and characteristics of the number of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before, during, and in the post-epidemic period of the COVID-19 pandemic and the Association between acute respiratory infections and hospitalization of patients with AECOPD. Methods A retrospective analysis was conducted to count the patients hospitalized for AECOPD in the Department of Respiratory Medicine of the Third Affiliated Hospital of Chongqing Medical University from July 2017 to June 2024. The pattern of change in the number of AECOPD hospitalizations and the associations with patients with respiratory tract infections in outpatient emergency departments were analyzed. Results During the COVID-19 epidemic, the number of hospitalizations of patients with AECOPD did not increase compared with the pre-epidemic period. Instead, it significantly decreased, especially in the winter and spring peaks (P<0.05). The only exception was a peak AECOPD hospitalization in the summer of 2022. COPD inpatient mortality and non-medical discharge rates tended to increase during the epidemic compared with the pre-epidemic period. Analysis of the curve of change in the number of patients with respiratory infections in our outpatient emergency departments during the same period revealed a downward trend in the number of patients with respiratory infections during the epidemic and an explosive increase in the number of patients with respiratory infections in the post epidemic period, whose average monthly number was more than twice as high as that during the epidemic. Correlation analysis of the number of patients with respiratory infections between AECOPD hospitalizations and outpatient emergency departments showed that there was a good correlation between the two in the pre-epidemic and post-epidemic periods, and the correlation between the two in the post-epidemic period was more significant in particular (r=0.84-0.91, P<0.001).In contrast, there was no significant correlation in 2021 and 2022 during the epidemic (r=0.24 and 0.50, P>0.05 ). The most common respiratory infection pathogens among AECOPD hospitalized patients during the post-epidemic period were influenza virus, COVID-19 virus, and human rhinovirus, respectively. Conclusions The pandemic period of COVID-19 infection did not show an increase in the number of AECOPD hospitalizations but rather a trend towards fewer hospitalizations. Respiratory infections were strongly associated with the number of AECOPD hospitalizations in the pre- and post-pandemic periods, while the correlation between the two was poorer during the pandemic period. Influenza virus was the most important respiratory infection pathogen for AECOPD during the post-epidemic period.
ObjectiveTo explore the expressions of nerve growth factor (NGF) and leukemia inhibitory factor (LIF) in both asthmatic mice and respiratory syncytial virus(RSV)-infected mice,explore if there is a same neurogenic mechanism between ashtma and RSV infection,in order to find a new treatment target for asthma. MethodsOne hundred healthy Balb/c inbred mice were randomly divided into a control group,a RSV group,an asthma group,an asthma with RSV group,and a dexamethasone group. The lung tissue pathology was observed by hematoxylin-eosin staining(HE). The quantitative analysis of NGF mRNA and LIF mRNA of lung tissue was detected by RT-PCR. The expression of NGF protein and LIF protein was detected by immunohistochemical method. ResultsUnder light mocroscope,there were alveolar septum widening,alveolar epithelium swelling,and interstitial edema in the RSV group. There were widen alveolar septum,narrowed bronchial lumen,thicken bronchial wall and a large number of inflammatory cells infiltration around the small blood vessels,alveolar and bronchioles both in the asthma group and the asthma with RSV group,with the latter being more serious. Compared with the RSV group,the inflammation was relieved significantly in the dexamethason group. There were mRNA and protein expressions of NGF and LIF in all groups, which were highest in the asthma with RSV group,then the RSV group and the asthma group,and lowest in the dexamethasone group. ConclusionsThe expressions of LIF and NGF in the lung of mice after RSV infection and futher increase when combined with asthma. Dexamethason can inhibit the expression of NGF and LIF to some extent.