Comparison of acute pneumonia caused by SARS-CoV-2 and other respiratory viruses in children:a retrospective multi-center cohort study during COVID-19 outbreak

Background:Until January 18,2021,coronavirus disease-2019(COVID-19)has infected more than 93 million individuals and has caused a certain degree of panic.Viral pneumonia caused by common viruses such as respiratory syncytial virus,rhinovirus,human metapneumovirus,human bocavirus,and parainfluenza viruses have been more common in children.However,the incidence of COVID-19 in children was significantly lower than that in adults.The purpose of this study was to describe the clinical manifestations,treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak.Methods:Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study.A total of 64 children with COVID-19 were defined as the COVID-19 cohort,of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort.Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort.The epidemiologic,clinical,and laboratory findings were compared by Kolmogorov-Smirnov test,t-test,Mann-Whitney U test and Contingency table method.Drug usage,immunotherapy,blood transfusion,and need for oxygen support were collected as the treatment indexes.Mortality,intensive care needs and symptomatic duration were collected as the outcome indicators.Results:Compared with the viral pneumonia cohort,children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19(53/64 vs.23/284),were of older median age(6.3 years vs.3.2 years),and had a higher proportion of ground-glass opacity(GGO)on computed tomography(18/40 vs.0/38,P<0.001).Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases(1/40 vs.38/284,P=0.048),and lower cases with high fever(3/40 vs.167/284,P<0.001),requiring intensive care(1/40 vs.32/284,P<0.047)and with shorter symptomatic duration(median 5d vs.8d,P<0.001).The proportion of cases with evaluated inflammatory indicators,biochemical indicators related to organ or tissue damage,D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort(P<0.05).No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs(lopinavir-ritonavir,ribavirin,and arbidol)as compared with duration in 39 children without antiviral therapy(median 10d vs.9d,P=0.885).Conclusions:The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia.Lopinavir-ritonavir,ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19.During the COVID-19 outbreak,attention also must be given to children with infection by other pathogens infection.

Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance.Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls.Results The numbers of CD3 +, CD4 +, and CD8 + lymphocytes all significantly decreased in acute phase of patients with SARS [(722±533)/μl, (438 ±353)/μl, (307±217)/μl)] compared with those in normal controls [ (1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0. 01) ], which was different from what we observed in patients with AIDS who had decreased CD4 + [ (296±298)/μl] but increased CD8 + [ (818 ±566)/μl counts. The counts of CD3+, CD4+, and CD8 + lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4 + counts less than 200/μl. As the patients' condition improved, CD3 +, CD4 +, and CD8 + counts gradually returned to normal ranges.Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.

Dynamic changes in blood cytokine levels as clinical indicators in severe acute respiratory syndrome

Objective To investigate the dynamic changes observed in serum levels of interleukins (ILs), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1 ) in severe acute respiratory syndrome (SARS) patients.Methods Sixty-one cases of SARS with positive antibodies to SARS coronavirus (SARS-CoV) were classified into the following categories: initial stage (3-7 days), peak stage (8-14 days), and remission and recovery stage (15 -27 days). Forty-four healthy individuals were used as controls. Serum levels of ILs, TNF-a and TGF-p, were measured in all subjects. Serum antibodies to SARS-CoV were detected only in SARS cases.Results The mean concentration of serum IL - 6 in SARS patients did not differ from that in the control group in initial and peak stages, but became significantly higher in remission and recovery stage compared with the control group, initial and peak stages ( P<0. 01). The mean concentration of serum IL-8 in SARS patients did not differ from that of the control group in initial stage, but was significantly higher than control group in peak stage and remission and recovery stage ( P < 0. 05). And it was more significantly higher in remission and recovery stage than in peak stage ( P<0. 01). The mean concentrations of IL-16 and TNF-αin SARS patients were higher than those of the control group for every length of the clinical courses investigated, and were especially high in remission and recovery stage (P<0. 01). SARS patients experienced higher concentration of serum IL-13 compared with the controls in initial stage ( P < 0. 01), but returned to normal levels in peak stage and in remission and recovery stage. The mean concentration of serum IL-18 in SARS patients was significantly lower than that of the control group during all clinical courses ( P < 0. 05). The mean concentration of serum TGF-β1, in SARS patients was higher than that of the control group during all clinical courses. Although TGF-bbbbb1 in serum decreased in remission and recovery stage in SARS patients, the average was still higher than that of the control group (P<0. 01). Conclusions Most proinflammatory cytokines and TGF-β1, were elevated during the early phase of SARS, which may be associated with lung infiltration and proliferation. Concurrently, the mean concentration of serum IL-13 decreased gradually, and the mean concentration of serum IL-18 level in SARS patients was lower than that of the control group during all the courses of SARS, suggesting that the immune state of the patients with SARS was obviously abnormal. Observing the dynamic changes in blood cytokine levels can provide a scientific basis to assess pathogenesis and efficacy of clinical treatment of SARS.

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease.Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology.Results The patients in the study consisted of 42 males and 36 females, aged 20 -75 yrs (mean age 37. 5±11. 6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15. 3%) with WBCs <4. 0 x109/L, 49 cases (62. 8%) ranging between (4. 0-10. 0) ×10~9/L and 17 cases (21. 8%) over 10. 0×10~9/L. The average was(7. 58 ?. 96) x 109/L, with 0. 75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died.Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.

Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 - 20, 2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3) the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8%) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24. 4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological features. Early recognition, prompt isolation, and appropriate therapy are the key to combate this infection.

COVID-19 Patient with Multifocal Pneumonia and Respiratory Difficulty Resolved Quickly: Possible Antiviral and Anti-Inflammatory Benefits of Quercinex (Nebulized Quercetin-NAC) as Adjuvant

Background: SARS-CoV-2 (COVID-19) is a viral pandemic with no current vaccine or effective treatment. Hydroxychloroquine and azithromycin are not without cardiovascular risk or complications, and these treatments can fail to aid in full recovery from COVID-19. As new treatments become approved for the pandemic, an inexpensive, non-toxic, and safe adjunctive therapy is needed. Case Presentation: A 59-year-old male presented with respiratory symptoms. Chest X-ray revealed classic indications of COVID-19 pneumonia. A PCR nasopharyngeal swab test confirmed a COVID-19 infection and hospital doctors prescribed Rocephin, azithromycin, and hydroxychloroquine. The patient was then prescribed Quercinex, a nebulized formula of quercetin-(cyclodextrin) (20 mg/mL) and N-acetylcysteine (100 mg/mL) three times daily for 14 days by physicians at Envita Medical Center for continued COVID-19 respiratory symptoms. Following 30 minutes after each nebulization treatment, the patient experienced immediate deep breathing relief that lasted for multiple hours. Within the following 48 hours after the first treatment, respiratory symptoms continued to diminish and resolve quickly. Finally, post-treatment follow-up chest X-rays revealed no pulmonary fibrosis (scarring) and clear lung fields. Conclusion: The Quercinex formula appeared to greatly alleviate the unresolved respiratory symptoms rapidly. Several mechanisms of the formula, namely antiviral and anti-inflammatory action, with direct administration via nebulizer to the deep lung tissue, could potentially explain the fast and complete recovery. We recommend that the Quercinex formula be considered for further clinical study as an adjuvant or on its own for COVID-19 and possibly other viral pulmonary conditions.

肺炎衣原体与新型冠状病毒共感染及其对机体炎症因子分泌水平的影响

目的明确肺炎衣原体(Cpn)与新型冠状病毒(SARS-CoV-2)共感染的特征及其对SARS-CoV-2诱导机体炎症反应的影响。方法选取2022年12月20日—2023年2月20日郴州市某医院就诊的新型冠状病毒感染(COVID-19)患者,按COVID-19严重程度将重型和危重型作为重症组,轻型和中型作为轻症组,再依据患者年龄(≥18岁为成年,<18岁为未成年)分为成年重症组、成年轻症组、未成年重症组、未成年轻症组。采用倾向性评分对重症组、轻症组患者的年龄、性别、基础疾病进行1∶1匹配。收集患者支气管肺泡灌洗液(BALF)、咽拭子及血清标本,应用酶联免疫吸附测定法(ELISA)检测Cpn IgG/IgM抗体,流式细胞术检测BALF中白细胞介素(IL)-8等12项常见细胞因子水平,并比较各组之间的差异。结果共纳入102例患者,其中重型和危重型(重症)患者61例,轻型和中型(轻症)患者41例;年龄≥18岁的患者71例,年龄<18岁未成年患者31例。成年重症组患者39例,成年轻型组患者32例,经倾向性评分成功匹配30对;未成年重症组患者22例,未成年轻型组患者9例,经倾向性评分成功匹配8对。COVID-19患者中Cpn IgG、IgM阳性率分别为36.27%(37例)、8.82%(9例),其中1例Cpn IgG和IgM同为阳性。成人重症组合并Cpn IgG阳性患者血清标本中干扰素(IFN)-α水平高于IgG阴性患者(P=0.037),两组患者BALF、血清标本中其他细胞因子水平比较差异均无统计学意义(均P>0.05);成人轻症组合并Cpn IgG阳性患者血清标本中IL-8和IL-17水平均高于Cpn IgG阴性患者(均P<0.05)。未成年轻症组合并Cpn IgM阳性患者BALF及血清标本中IL-8水平均高于Cpn IgM阴性患者(均P<0.05)。Logistic回归分析结果显示,Cpn IgG阳性和IgM阳性都不是导致COVID-19发展成重症的危险因素。结论合并Cpn感染不是导致COVID-19患者发展成重症的危险因素,Cpn感染对SARS-CoV-2导致的炎症因子分泌影响有限。

重症肺炎就是ARDS吗?

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是在严重感染、休克、创伤及烧伤等疾病过程中导致的急性低氧性呼吸功能不全,容易与重症肺炎合并低氧血症和重症新型冠状病毒肺炎等疾病相混淆。本文就ARDS的概念、发病机制、病理改变、病理生理以及定义进行了论述,并与重症肺炎合并低氧血症和重症新型冠状病毒肺炎的临床表现等异同进行深入的分析和解读。

D-D/FIB比值与重症肺炎患者发生急性呼吸窘迫综合征的关系分析

目的探究D-二聚体(D-D)/纤维蛋白原(FIB)比值与重症肺炎患者发生急性呼吸窘迫综合征(ARDS)的关系。方法回顾性分析2020年2月至2022年2月该院收治的190例重症肺炎患者临床资料,根据住院期间ARDS发生情况分为ARDS组(85例)和非ARDS组(105例)。采用医院自制临床资料调查表记录患者入院时年龄、性别、吸烟史、饮酒史、合并症、急性生理与慢性健康状况(APACHE)Ⅱ评分及氧合指数。记录患者入院时的实验室指标水平,包括血常规指标[白细胞计数(WBC)、血红蛋白(Hb)水平、血小板计数(PLT)]、炎症指标[C反应蛋白(CRP)水平]、凝血指标[凝血酶原时间(PT)、凝血酶原时间比值(PTR)、国际标准化比率(INR)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、FIB水平、D-D水平],计算D-D/FIB比值。采用多因素Logistic回归分析重症肺炎患者发生ARDS的影响因素。采用Pearson相关分析D-D/FIB比值与重症肺炎患者氧合指数及炎症指标的相关性。绘制受试者工作特征(ROC)曲线评价入院时D-D/FIB比值对重症肺炎患者发生ARDS的预测价值。结果ARDS组入院时APACHEⅡ评分高于非ARDS组,氧合指数小于非ARDS组,差异均有统计学意义(P<0.05)。ARDS组入院时CRP水平、PTR、INR、D-D水平、D-D/FIB比值均大于非ARDS组,PT长于非ARDS组,差异均有统计学意义(P<0.05)。两组其他实验室指标比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,入院时APACHEⅡ评分升高、CRP水平升高、D-D/FIB比值增大均为重症肺炎患者发生ARDS的独立危险因素(P<0.05),氧合指数升高为重症肺炎患者发生ARDS的保护因素(P<0.05)。Pearson相关分析结果显示,D-D/FIB比值与重症肺炎患者氧合指数呈负相关(r=-0.215,P<0.05),与炎症指标CRP水平呈正相关(r=0.162,P<0.05)。ROC曲线分析结果显示,入院时D-D/FIB比值预测重症肺炎患者发生ARDS的曲线下面积为0.761(95%CI:0.692~0.830),且当D-D/FIB比值为0.260时,灵敏度、特异度分别为90.59%、57.14%。结论重症肺炎患者D-D/FIB比值与ARDS发生有关,其水平越高,患者发生ARDS风险越大,可作为临床早期预测重症肺炎患者发生ARDS的辅助指标。

老年重症肺炎并发ARDS患者血清miR-27a、FOXO3与疾病严重程度及预后的关系

目的分析老年重症肺炎并发急性呼吸窘迫综合征(ARDS)患者血清微小核糖核酸(miRNA)-27a、叉头框蛋白O3(FOXO3)与疾病严重程度及预后的关系。方法选取2022年10月—2023年9月上海市静安区中心医院重症医学科收治老年重症肺炎并发ARDS患者108例(ARDS组)和老年重症肺炎未并发ARDS患者72例(非ARDS组),ARDS组患者再根据氧合指数分为轻度亚组26例、中度亚组34例、重度亚组48例,并根据28 d预后情况分为死亡亚组33例、存活亚组75例;另选取同期体检健康志愿者60例为健康对照组。采用实时荧光定量聚合酶链式反应检测血清miR-27a、FOXO3水平,TargetScan数据库预测miR-27a与FOXO3的结合位点。通过Pearson/Spearman相关性分析血清miR-27a与FOXO3 mRNA水平的相关性,多因素Logistic回归分析老年重症肺炎并发ARDS患者预后的影响因素,受试者工作特征(ROC)曲线分析血清miR-27a、FOXO3 mRNA水平对老年重症肺炎并发ARDS患者死亡的预测价值。结果健康对照组、非ARDS组、ARDS组血清miR-27a水平依次降低,FOXO3 mRNA水平依次升高(F/P=77.352/<0.001、62.956/<0.001);轻度亚组、中度亚组、重度亚组血清miR-27a水平依次降低,FOXO3 mRNA水平依次升高(F/P=83.597/<0.001、111.833/<0.001);miR-27a与FOXO3的3’-非翻译区3257~3264处存在结合位点。老年重症肺炎并发ARDS患者血清miR-27a与FOXO3 mRNA水平呈负相关(r/P=-0.736/<0.001),氧合指数与血清miR-27a水平呈正相关,与FOXO3 mRNA水平呈负相关(r/P=0.751/<0.001、-0.785/<0.001)。老年重症肺炎并发ARDS患者28 d死亡率为30.56%(33/108)。年龄增加、机械通气时间延长、FOXO3 mRNA升高为影响老年重症肺炎并发ARDS患者预后的独立危险因素[OR(95%CI)=1.199(1.033~1.393)、1.547(1.009~2.373)、1.108(1.040~1.180)],氧合指数升高、miR-27a升高为独立保护因素[OR(95%CI)=0.973(0.958~0.989)、0.903(0.844~0.965)];血清miR-27a、FOXO3 mRNA水平及二者联合预测老年重症肺炎并发ARDS患者死亡的曲线下面积分别为0.784、0.786、0.879,二者联合的AUC大于血清miR-27a、FOXO3 mRNA水平单独预测(Z/P=2.550/0.011、2.963/0.003)。结论老年重症肺炎并发ARDS患者血清miR-27a水平降低,FOXO3 mRNA水平升高,与疾病加重和预后不良密切相关,二者联合预测老年重症肺炎并发ARDS患者死亡的价值较高。

呼气末正压联合俯卧位通气治疗重症肺炎伴急性呼吸窘迫综合征的临床效果

目的:探讨呼气末正压(PEEP)联合俯卧位通气治疗重症肺炎伴急性呼吸窘迫综合征的临床效果。方法:选取2022年5月—2023年4月柳州市柳铁中心医院收治的重症肺炎伴急性呼吸窘迫综合征患者90例作为研究对象,采取随机数字表法分为两组,各45例。对照组采用仰卧位机械通气治疗,观察组采用PEEP联合俯卧位通气治疗。比较两组治疗效果。结果:治疗前,两组氧分压(PO_(2))、血氧饱和度(SO_(2))、二氧化碳分压(PCO_(2))水平比较,差异无统计学意义(P>0.05);治疗后,两组PO_(2)、SO_(2)高于治疗前,且观察组高于对照组,两组PCO_(2)低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组第1秒用力呼气容积(FEV_(1))、最大肺活量(FVC)、FEV_(1)/FVC比较,差异无统计学意义(P>0.05);治疗后,两组FEV_(1)、FVC、FEV_(1)/FVC高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.015)。观察组住院时间短于对照组,差异有统计学意义(P<0.001)。结论:PEEP联合俯卧位通气治疗重症肺炎伴急性呼吸窘迫综合征的临床效果显著,可改善患者呼吸功能及肺部功能,缩短住院时间。

肺复张干预联合高侧卧位对重症肺炎合并ARDS机械通气患者康复效果与并发症的影响

目的探讨肺复张干预联合高侧卧位对重症肺炎合并急性呼吸窘迫综合征(ARDS)机械通气患者康复效果与并发症发生的影响。方法选择2021年12月至2023年12月接受机械通气治疗的重症肺炎合并ARDS患者70例,根据信封内置序号盲抽法均分成观察组(奇数者,n=35)和对照组(偶数者,n=35)。对照组予以高侧卧位机械通气,观察组在对照组基础上予以肺复张干预,比较2组患者的康复效果、机械通气相关指标、呼吸功能和并发症发生情况。结果观察组总住院时间、重症监护室(ICU)治疗时间和机械通气时间明显短于对照组,而脱机成功率高于对照组,差异有统计学意义(P<0.05)。观察组患者的氧合指数、静态肺顺应性(Cst)和动态肺顺应性(Cdyn)明显高于对照组,而浅快呼吸指数(RSBI)和气道峰压(PIP)水平低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为14.29%低于对照组的42.86%,差异有统计学意义(χ^(2)=7.000,P=0.008)。结论重症肺炎合并ARDS患者实施肺复张干预联合高侧卧位机械通气能够有效改善氧合功能,加速康复进程,提升呼吸功能和降低并发症的发生。

肺部超声联合血清sCD163对小儿重症肺炎并发急性呼吸窘迫综合征的诊断价值

目的评估肺部超声(LUS)联合血清可溶性单核巨噬细胞血红蛋白清道夫受体(sCD163)对小儿重症肺炎(SP)并发急性呼吸窘迫综合征(ARDS)的诊断价值。方法选取2019年6月—2022年6月在上海儿童医学中心三亚市妇女儿童医院就诊的SP患儿82例(SP组),SP并发ARDS患儿79例(ARDS组)。根据疾病严重程度将ARDS组分为轻、中、重度组。比较SP组、ARDS组LUS评分、血清sCD163水平;比较不同严重程度ARDS患儿LUS评分、血清sCD163水平;采用Spearman法分析LUS评分、血清sCD163水平与ARDS严重程度的相关性;绘制受试者工作特征(ROC)曲线评价LUS评分联合血清sCD163水平对ARDS的诊断效能。结果ARDS组LUS评分、血清sCD163水平均高于SP组(P<0.05)。中、重度组LUS评分、血清sCD163水平均高于轻度组(P<0.05),重度组LUS评分、血清sCD163水平均高于中度组(P<0.05)。Spearman相关性分析显示,LUS评分、血清sCD163水平与ARDS严重程度呈正相关(rs=0.809和.805,均P=0.000)。ROC曲线结果显示,LUS评分、血清sCD163水平诊断ARDS的最佳截断值分别为12分、72.79 ng/mL。LUS评分诊断ARDS的敏感性、特异性、准确性分别为64.56%(95%CI:0.595,0.697)、78.05%(95%CI:0.693,0.868)、71.43%(95%CI:0.632,0.796),曲线下面积(AUC)为0.768;血清sCD163水平诊断ARDS的敏感性、特异性、准确性分别为67.09%(95%CI:0.612,0.729)、78.05%(95%CI:0.685,0.876)、72.67%(95%CI:0.646,0.808),AUC为0.738;两者联合诊断ARDS的敏感性、特异性、准确性分别为84.81%(95%CI:0.755,0.941)、63.41%(95%CI:0.584,0.684)、73.91%(95%CI:0.651,0.827),AUC为0.778。结论LUS联合血清sCD163对小儿SP并发ARDS具有较高的诊断效能,可为ARDS诊断及病情严重程度评估提供有效参考。

乌司他丁辅助俯卧位机械通气对重症肺炎伴ARDS患者的效果

目的:分析乌司他丁+俯卧位机械通气对重症肺炎伴急性呼吸窘迫综合征(ARDS)患者的影响。方法:回顾性分析2020年2月—2023年10月广东医科大学附属第二医院收治的80例重症肺炎伴ARDS患者临床资料,按照治疗方法不同将其分为两组。行常规治疗+俯卧位机械通气治疗的40例患者纳入对照组,行常规治疗+俯卧位机械通气治疗+乌司他丁治疗的40例患者纳入观察组。对比两组血气指标、炎症因子水平、血管内皮功能、肺功能。结果:治疗后,观察组氧分压(PaO_(2))、一氧化碳(CO)、各肺功能指标高于对照组,二氧化碳分压(PaCO_(2))、各炎症因子水平、内皮素-1(ET-1)低于对照组,差异有统计学意义(P<0.05)。结论:乌司他丁辅助俯卧位机械通气可调节重度肺炎伴ARDS患者血气分析,减轻炎症,保护血管内皮功能,有利于肺功能的恢复。

肺部微生物对心血管疾病的影响

肺部微生物对人类健康和疾病起重要作用,可通过氧化应激、免疫炎症和补体形成等多种机制对心血管疾病的发生发展产生促进作用,导致心血管疾病恶化,甚至威胁生命。本文综述肺部微生物的起源、进展、现状、组成和主要生理功能及其对心血管疾病的影响,为调控肺部微生物的抗心血管疾病策略提供新的理论依据,围绕肺部微生物的作用机理为心血管疾病的防治提供新的治疗靶点、拓展新思路。

重症肺炎并发ARDS患者肺部超声、肺炎程度评分与血清相关生化指标的检测结果及临床价值分析

目的:探讨重症肺炎(SP)并发急性呼吸窘迫综合征(ARDS)患者的肺部超声(LUS)特征、肺炎程度评分结果以及血清相关生化指标的检测结果,并对各项数据的临床价值进行分析。方法:选取2020年12月—2023年12月厦门医学院附属第二医院收治的100例SP并发ARDS患者作为研究对象,所有病例入院后均完成LUS检测、临床肺部感染评分(CPIS)评估以及实验室检查。根据患者入院后28 d内的转归情况,将患者分为预后不良组(n=23)与预后良好组(n=77),比较两组LUS检查特征、CPIS评分以及血清相关生化指标[C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)、白介素-10(IL-10)、前白蛋白(PAB)]的检测数据,分析其预测价值。结果:两组支气管充气征、肺实变征、胸膜异常征的检出率均较高,部分病例伴胸腔积液,但两组各特征检出率比较,差异无统计学意义(P>0.05);预后不良组的CRP、IL-6水平评分均高于对照组,IL-10水平低于对照组,差异有统计学意义(P<0.05);两组PCT与PAB指标比较,差异无统计学意义(P>0.05)。ROC曲线显示,CRP、IL-6、IL-10预测SP并发ADRS患者预后的曲线下面积(AUC)依次为0.768、0.724、0.804,各指标联合的预测效能有显著提升,AUC为0.930。结论:在SP并发ARDS患者中,血清CRP、IL-6、IL-10水平对不良预后的预测有一定的参考价值。

血清RAGE、PBEF水平对重症肺炎患儿继发急性呼吸窘迫综合征的预测价值

目的探讨血清晚期糖基化终产物受体(RAGE)、前B细胞克隆增强因子(PBEF)水平对重症肺炎(SP)患儿继发急性呼吸窘迫综合征(ARDS)的预测价值。方法选取2020年1月—2024年2月哈尔滨市儿童医院呼吸科及重症监护室收治的SP患儿875例,根据是否继发ARDS分为ARDS组83例和非ARDS组792例。采用酶联免疫吸附法检测血清RAGE、PBEF水平。Pearson相关系数分析血清RAGE、PBEF水平与儿童早期预警评分(PEWS)的相关性;以SP患儿继发ARDS为因变量,建立多因素非条件Logistic回归模型确定其影响因素;绘制ROC曲线评价血清RAGE、PBEF水平预测SP患儿继发ARDS的价值。结果875例SP患儿入院7 d内继发ARDS 83例(9.49%)。与非ARDS组比较,ARDS组血清RAGE、PBEF水平升高(t=8.801、9.082,P均<0.001);血清RAGE、PBEF水平与PEWS评分均呈正相关(r=0.691、0.625,P均<0.001);Logistic回归分析结果表明,PEWS评分增加、机械通气时间延长、氧指数增加、降钙素原升高、RAGE升高和PBEF升高是SP患儿继发ARDS的独立危险因素[OR(95%CI)=2.308(1.535~3.469)、2.525(1.619~3.938)、3.738(2.123~6.581)、6.916(3.034~15.768)、1.085(1.061~1.109)、1.464(1.303~1.646)];RAGE、PBEF及二者联合预测SP患儿继发ARDS的曲线下面积分别为0.791、0.789、0.905,二者联合优于各自单独预测效能(Z=4.256、4.419,P均<0.001)。结论SP患儿血清RAGE、PBEF水平升高,两者均为其继发ARDS的独立危险因素,血清RAGE联合PBEF水平预测SP患儿继发ARDS的价值较高。

乌司他丁联合HFNC对重症肺炎伴ARDS患者的治疗效果

目的:探讨乌司他丁联合高流量鼻导管氧疗(HFNC)对重症肺炎伴急性呼吸窘迫综合征(ARDS)患者的治疗效果。方法:选取2022年1月—2023年10月在厦门市第三医院确诊的98例重症肺炎伴ARDS患者作为研究对象,根据治疗方案分为A组(n=51,乌司他丁联合HFNC治疗)和B组(n=47,NFNC治疗)。两组均持续治疗7 d,比较两组氧合状态[动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO_(2))、氧合指数(PaO2/FiO2)、pH值]、血流动力学[心率(HR)、平均动脉压(MAP)]及炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平。观察两组不良反应发生情况。结果:治疗后,两组PaO2、PaO2/FiO2、pH均较治疗前升高,且A组高于B组,两组PaCO_(2)均较治疗前降低,且A组低于B组,差异有统计学意义(P<0.05)。治疗后,两组MAP均较治疗前升高,HR均较治疗前降低,差异有统计学意义(P<0.05)。治疗后,两组炎症因子水平均较治疗前降低,且A组低于B组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:乌司他丁联合HFNC可有效进一步降低炎症因子水平,改善患者氧合状态,稳定患者血流动力学,提高临床疗效,具有安全性。

集束化护理在重症肺炎合并急性呼吸窘迫综合征患者机械通气中的应用及对其预后的影响分析

目的探讨集束化护理在重症肺炎合并急性呼吸窘迫综合征患者机械通气中的应用及对其预后的影响。方法回顾性选取2021年6月—2023年10月于徐州医科大学附属医院进行机械通气治疗的80例重症肺炎合并急性呼吸窘迫综合征患者的临床资料,根据不同护理方法分为两组,各40例。对照组采用常规护理,观察组在对照组的基础上进行集束化护理。比较两组的舒适程度、心理状态及不良反应发生情况。结果护理后,观察组舒适度评分高于对照组,焦虑和抑郁评分均低于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率为2.50%(1/40),低于对照组的20.00%(8/40),差异有统计学意义(χ^(2)=4.507,P<0.05)。结论对于采用机械通气治疗的重症肺炎合并急性呼吸窘迫综合征患者而言,采用集束化护理能提高舒适度,减轻其负面情绪,降低不良反应发生风险。

综合护理对重症肺炎合并急性呼吸窘迫综合征患者生活质量、俯卧位机械通气功能及压力性损伤发生率的影响

目的探讨综合护理对重症肺炎(severe pneumonia,SP)合并急性呼吸窘迫综合征(acute respiratory dis-tress syndrome,ARDS)患者生活质量、俯卧位机械通气功能及压力性损伤发生率的影响。方法方便选取2022年10月—2023年10月广西防城港市第一人民医院重症监护病房收治的98例SP-ARDS患者为研究对象,根据护理模式的不同,分为观察组(n=49)和对照组(n=49)。观察组给予综合护理,对照组给予常规护理,对比两组患者的肺通气功能指标、生活质量评分、不良反应发生情况。结果两组患者肺通气功能指标比较,护理后最大通气量、肺活量、第1秒用力呼气容积指标水平均高于护理前,且观察组高于对照组,差异有统计学意义(P均<0.05)。观察组护理后生活质量评价量表评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为4.08%(2/49),低于对照组的18.37%(9/49),差异有统计学意义(χ^(2)=5.018,P<0.05)。结论针对SP-ARDS患者开展综合护理可以提高术后生活质量,减少压力性损伤的发生,可为临床提供参考。