Objective To study the efficacy of bronchoalveolar lavage and drug injection by bronchofibroscope in patients with refractory pneumonia.Methods 62 cases with refractory pneumonia were divided into therapy group(40 cases) and control group(22 cases).All patiens were treated with conventional therapy,bronchoalveolar lavage and drug injection by bronchofibroscope were treated for patients in therapy group in addition.Therapeutic effects were compared between two groups.Results The effective rates of therapy group were significantly higher than that in control group(85.0％ vs 54.5％,x2 =8.511,P=0.014).The control of temperature,amount of sputum,absorption of the lesions and hospitalization days in therapy group were better than those in control group (all P ＜0.05).Conclusion Bronchoalveolar lavage and drug injection by bronchofibroscope is effective for patients with refractory pneumonia,which can shorten the course of treatment,improve prognosis,and deserve the clinical expansion.

Objective To investigate the desensitization therapy combined with budesonide/symbicort inhalant for treatment of allergic bronchial asthma.Methods 80 patients with allergic asthma randomly divided into observation group and control group,each group of 40 cases.Two groups were given conventional treatment and desensitization therapy,the control group required glucocorticoid,the observation group received budesonide/symbicort inhalant.were evaluated.Results The total effective rate in the observation group was 92.5％ (37/40),the control group was 72.5％(29/40),the difference was statistically significant (P ＜0.05).FEV1.0％ in the two groups after treatment,PET and symptom score were significantly improved after treatment(P ＜0.05).The observation group improved more significantly than that of the control group (P ＜0.05).The incidence of adverse reaction in observation group was 15％(6/40),significantly less than that in the control group 35％ (14/40),the difference was statistically significant (P ＜0.05).Conclusion Desensitization therapy combined with budesonide/symbicort inhalant in asthma symptoms could improve asthma and lung function,which has high safety and worthy of clinical application.

Objective To study and analyze the short-term effect of glucocorticoid in patients with idiopathic interstitial pneumonia by analyzing the semi quantitative scores of high resolution CT.Methods 50 cases of idiopathic interstitial pneumonia treated in our hospital from May 2015 to October 2016 were selected as the research object.Clinical data were analyzed, including smoking, signs of hospitalization and dyspnea score.High resolution CT level for the right diaphragmatic top tube, bifurcation, left atrium roof, in 3 aspects from the calculation of cellular disease and shadow grid as a percentage of average, the critical point of high resolution CT scores were 10%, 20%, 30%, 40% and 50%.The accuracy, sensitivity and specificity of glucocorticoids were analyzed.The chi square test was used to examine the enumeration data.Results The accuracy was 72% when the high resolution CT score was 20% critical point.In patients treated with corticosteroids, the high resolution CT score was greater than or equal to 20% for patients and 25 for patients with a score of less than 20% for 25 patients.20% or more patients died during hospitalization, 10 cases, the mortality rate was 40%, and the effective rate of glucocorticoid treatment was 8%.Less than 20% of the patients died during hospitalization, 1 cases, the mortality rate was 4%, and the effective rate of glucocorticoid treatment was 50%.Conclusion High resolution CT semi quantitative score judgment of idiopathic interstitial pneumonia patients treated with glucocorticoid efficacy of high accuracy, high resolution 20% scores higher accuracy, and the diagnosis is well, with further clinical promotion and application significance.

Objective To compare the effect of continuous positive airway pressure (CPAP)and bilevel positive airway pressure(BiPAP)on the cardiac structure and function of patients with obstructive sleep apnea and hypopnea syndrome(OSAHS).Methods 100 patients with OSAHS were selected as the research subjects.The patients were randomly divided into two groups by digital table method,CPAP group had 50 cases,adopted the CPAP ventilation mode,BiPAP group had 50 cases,adopted the BiPAP ventilation mode.The heart rate,blood pressure, blood brain natriuretic peptide(BNP),nitric oxide(NO),endothelin -1 protease,matrix metalloprotein 9(MMP -9), C -reactive protein (CRP) and polysomnography (PSG) related indicators,cardiac structure and function and endothelial function changes before and after treatment were observed in the two groups,compared the clinical effect of the two modes.Results Before treatment,in both groups,there were no statistical differences in blood pressure,heart rate,BNP,NO,endothelin -1,MMP -9,CRP,PSG related indicators,cardiac structure and function,endothelial function.After six months of noninvasive ventilator treatment,results of the heart rate,systolic pressure,diastolic blood pressure,blood oxygen saturation,oxygen partial pressure,the BNP,endothelin -1,NO,MMP -9,CRP,body mass index,the Epworth sleepiness scale(ESS),Apnea hypoventilation index(AHI),oxygen and lowest at night,aortic di-ameter(AO),left ventricular inner diameter (LA),right ventricular(RV)inside diameter,left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP)of the CPAP group were (79.83 ±11.47)times/min, (114.06 ±11.45)mmHg,(72.44 ±7.38)mmHg,(97.6 ±1.45)%,(93.17 ±1.86)mmHg,(110.78 ±38.32)ng/L, (17.58 ±2.07)ng/L,(8.55 ±0.55)μmol/L,(372.73 ±189.00)μg/L,(3.34 ±2.29)mg/L,(23.87 ±1.59), (0.98 ±0.70),(0.65 ±0.30),(94.04 ±1.62)%,(31.52 ±2.17 )mm,(31.19 ±1.09 )mm,(20.86 ± 1.69)mm,(61.13 ±5.02)%,(20.74 ±5.49)mmHg.which of the BiPAP group were (80.96 ±8.56)times/min, (114.58 ±9.34)mmHg,(71.67 ±8.57)mmHg,(96.96 ±1.43)%,(94.52 ±1.66)mmHg,(87.63 ±28.33)ng/L, (17.76 ±2.20)ng/L,(8.54 ±0.52)μmol/L,(359.63 ±268.95)μg/L,(4.96 ±2.00)mg/L,(24.15 ±1.65), (0.85 ±0.75 ),(0.58 ±0.19 ),(94.50 ±1.18)%,(31.73 ±1.57 )mm,(31.97 ±1.12)mm,(21.58 ± 2.43)mm,(62.24 ±5.79)%,(21.45 ±3.76)mmHg.In the oxygen partial pressure,the BNP,MMP -9,CRP,ESS score,AHI,LA,LVEF and other indicators,BiPAP mode were better than CPAP mode(t =2.13,4.32,2.13,4.32, 1.39,4.93,2.58,4.36,all P <0.05 ).Conclusion BiPAP mode and CPAP mode can improve cardiovascular function in patients with OSAHS,improve the symptoms of low ventilation,reduce obesity,but in terms of reducing cardiac load,improve blood vessel function,BiPAP mode is better than CPAP.