慢性阻塞性肺疾病稳定期患者胸部定量CT变化分析

目的探讨慢性阻塞性肺疾病稳定期患者胸部定量CT变化。方法统计分析2011年至2013年我院收治的100例慢性阻塞性肺疾病稳定期患者的临床资料。结果 VC、DLCO、FEF750、FEV1%pred在四组患者之间的差异均显著（P〈0.05）;CT为-1 024--970,-960,-950,-940,-930,-920,-910HU下LAA%结果均一致,四组患者的LAA%之间的差异均显著（P〈0.05）;CT为-1 024-910HU时LAA%、症状评分和DLCO、FEF750、F E V 1%p r e d均呈显著的负相关关系（P〈0.05）;LAA%和MMRC呈显著的正相关关系（P〈0.05）。结论胸部定量CT变化可以作为评估慢性阻塞性肺疾病稳定期患者病情严重程度的重要指标。     

噻托溴铵治疗中重度慢性阻塞性肺疾病的临床分析

目的探讨噻托溴铵治疗稳定期Ⅲ～Ⅳ级慢性阻塞性肺疾病（COPD）的效果。方法将34例稳定期Ⅲ～Ⅳ级COPD患者随机分成两组,试验组（吸入噻托溴铵18g/次,1次/d）18例,对照组（吸入异丙托溴铵40g/次,4次/d）16例。于治疗前及治疗2周后测定肺功能。结果治疗后,试验组的FEV1、FEV1/FVC、FEV1占预计值的百分比均较治疗前高（〈0.01）;对照组的FEV1/FVC、FEV1占预计值的百分比较治疗前高（〈0.01）,但FEV1变化无统计学意义（〉0.05）;治疗后两组FEV1、FEV1/FVC、FEV1占预计值的百分比比较,差异有统计学意义（〈0.05）。结论噻托溴铵能够较异丙托溴铵更明显改善稳定期COPD患者的肺功能。     

探讨不同肺叶定量CT参数在慢性阻塞性肺疾病评估中的价值

目的：研究肺叶定量CT参数在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）病情评估中的意义。方法：纳入102例行胸部CT及肺功能检查的稳定期COPD患者。肺功能检测指标包括用力肺活量（forced expiratory volume,FVC）及其占预计值百分比（FVC%pred）、第1秒用力呼气容量（forced expiratory volume in one second,FEV1）及其占预计值的百分比（FEV1%pred）、第1秒率（FEV1/FVC）、最大分钟通气量（maximum ventilatory volume,MVV）及其占预计值百分比（MVV%pred）、最大呼气中期流量（maximum mid expiratory flow,MMEF）。测量CT图像中各肺叶低于-950 HU密度区容积百分比（low attenuation area percentage,LAA%）、分段肺叶主气道直径、分段肺叶主气道壁厚度,并进行统计学分析。结果：定量CT参数与肺通气功能指标呈线性负相关（P＜0.001）;左肺下叶LAA%取值13.5%时,预测MVV%pred＜50%和FEVI%pred＜50%的灵敏度分别为66.2%、75.0%,特异度为88.4%、81.0%;左肺下叶气道壁厚度预测FEV1%pred＜50%的截点值为3.35 mm,其灵敏度和特异度分别为60.5%、72.9%;LAA%联合气道测量值可以解释42%的FEV1%pred,52%的FEV1/FVC,31%的MMEF和35%的MVV%pred指标的变化。结论：COPD患者不同肺叶的定量CT参数能反映其肺功能的变化,并能预测气流受限的严重程度。     

胸部CT定量技术对慢性阻塞性肺疾病病人心肺功能的评估价值

目的探讨胸部CT定量技术评估慢性阻塞性肺疾病（COPD）病人肺功能的应用价值。方法选取单纯COPD病人95例,采用胸部CT定量技术检测并比较不同病情程度病人的CT参数[低衰减面积百分比（LAA%）、吸气末肺容积/呼气末肺容积（Vex/Vin）、呼气末与吸气末CT平均肺密度比值[MLD（ex/in）]、最低1%肺衰减值（Prec1）、最低15%衰减值（Prec15）]、肺功能检测结果[肺总量（TLC）、残气量（RV）、RV/TLC、用力肺活量（FVC）、第1秒用力呼气量（FEV1）、FEV1/FVC、FEV1占预计值百分比（FEV1%）]、心脏指标[左心室射血分数（LVEF）、左心室内径（LVD）、左心房内径（LAD）、右心室内径（RVD）、右心房内径（RAD）]。另选取拟行手术治疗的肺癌合并COPD病人53例,比较不同术后心肺并发症发生情况病人的CT参数,并采用受试者工作特征曲线分析CT参数对病人预后的预测价值。结果随着COPD病人病情程度加重,LAA总占比、右肺占比、左肺占比、Vex/Vin、EI、MLD（ex/in）、Prec1、Prec15均呈升高趋势,FVC、FEV1、FEV1%、FEV1/FVC均呈降低趋势,RV、TLC、RV/TLC呈升高趋势,RVD呈升高趋势,LVEF呈降低趋势,不同病情程度病人以上参数间差异均有统计学意义（P < 0.05~P < 0.01）。LAA%、Vex/Vin、EI、MLD（ex/in）、Prec1、Prec15与FVC、FEV1、FEV1%、FEV1/FVC、LVEF均呈负相关关系,与RV、TLC、RV/TLC、RVD均呈正相关关系（P < 0.05~P < 0.01）。53例病人中14例术后发生心肺并发症,其中心律失常4例,心肺并发症病人术前LAA%、Vex/Vin、EI、MLD（ex/in）、Prec1、Prec15均高于未发生心肺并发症病人（P < 0.05）。LAA左肺占比预测发生心肺并发症AUC为0.819,当截断值>32.53%时,敏感性为71.43%,特异性为84.62%。结论随COPD进展,肺过度膨胀会导致心功能降低,CT定量参数与病人心功能、肺功能均具有相关性,可应用于肺功能检测,同时可用于预测肺癌合并COPD病人行肺叶切除术后的心肺并发症发生情况。     

肺音可以作为首诊慢阻肺严重程度的判断指标

目的 探讨肺部听诊肺音对首诊慢性阻塞性肺疾病（慢阻肺）严重程度的判断价值。方法 入选我院2016年5月~2019年5月临床首次确诊慢阻肺患者,根据肺部听诊情况把肺音区分为5组：呼吸音正常、呼吸音减弱、呼吸音减弱并喘鸣、呼吸音明显减弱、呼吸音明显减弱并喘鸣。基于 GOLD 指南和欧洲标准,区分慢阻肺和哮喘慢阻肺重叠（ACO）诊断,并进行肺功能分级。结果 入组慢阻肺患者1046例,男性949例,女性97例,年龄62.6±8.71岁;根据GOLD标准,诊断为慢阻肺中度及以上占比88.1%,重度及以上占比为 50.0%,进一步诊断 ACO 为 347 例,占 33.2%。ANOVA 分析肺音 5 组间在病程、用力呼气容积（FEV1）、FEV1占预计值百分比（FEV1%）,FEV1/FVC、用力肺活量（FVC）、FVC占预计值百分比（FVC%）、mMRC均存在显著差别（P<0.001）,FENO未见显著差异（P=0.097）。ACO较单纯慢阻肺组表现更高比例的喘鸣（P<0.001）。Spearman相关分析示：肺音与疾病严重程度、FEV1、FEV1%及FVC%显著相关（P<0.001）。多元线性回归分析显示：病程、吸烟指数及肺音与疾病严重程度相关。结论 肺音可以作为首诊慢阻肺严重程度判断指标,临床需加强识别。     

定量CT参数评价COPD疾病严重 程度的研究

目的 探讨定量CT参数评价慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）严重程度的价值。方法 选取2019年2月至2021年2月于温岭市中医院就诊并确诊为COPD的患者205例，所有患者均进行CT扫描及肺功能检查，比较不同分期患者的管腔面积（lumen area，LA）、管壁面积百分比（percentage of wall area，WA%）、管壁厚度与体表面积比值（ratio of tube wall thickness to body surface area，T/BSA）、管壁厚度与直径比值（thickness to diameter ratio，TDR）、肺叶低衰减区占整个肺体积的百分比（percentage of total lung area occupied by low attenuation area，LAA%）、肺气肿指数（emphysema index，EI）、空气潴留指数（air retention index，ATI）、第一秒用力呼气容积占预计值百分比（forced expiratory volume in one second as a percentage of predicted value，FEV1%）、FEV1/用力肺活量（forced vital capacity，FVC）情况，并进行相关性分析。结果 随着COPD严重程度的增加，体质量指数、FEV1%、FEV1/FVC、LA均逐渐降低（P<0.05），WA%、T/BSA、TDR、LAA%、EI、ATI均逐渐增加（P<0.05）；Pearson相关性分析结果显示，FEV1%与WA%、TDR均呈负相关（P<0.05），FEV1/FVC与WA%、TDR均呈正相关（P<0.05），FEV1%、FEV1/FVC与LAA%、EI、ATI均呈负相关（P<0.05）。结论 肺实质衰减参数、气道参数可作为COPD严重程度的预测因子，评价疾病进展。     

检测血清PCT、CRP、IL-6联合NLR、PLR对AECOPD患者病情严重程度评估及预后转归的临床价值

目的 探讨检测降钙素原（PCT）、C反应蛋白（CRP）、白介素-6(IL-6)、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）在慢性阻塞性肺疾病（COPD）急性加重期（AECOPD）患者的临床意义。方法 选择2021年5月-2022年5月于深圳市龙岗中心医院就诊的80例AECOPD患者为AECOPD组,根据肺功能分级标准分为A组24例（GOLDⅠ级）、B组19例（GOLDⅡ级）、C组20例（GOLDⅢ级）、D组17例（GOLDⅣ级）,根据随访6个月内患者预后情况分为预后良好组（n=58）和预后不良组（n=22）;同期纳入80例COPD稳定期（SCOPD）患者作为SCOPD组及80名健康体检者作为对照组。检测及计算NLR、PLR、PCT、CRP、IL-6水平、一秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）。结果 对照组、SCOPD组、AECOPD组FEV1、FEV1/FVC依次降低,PCT、CRP、IL-6、NLR、PLR依次升高（F=415.603、344.576、700.091、1 478.186、561.854、332.932、125.060,P均...     

中药联合舒利迭治疗稳定期慢性阻塞性肺疾病120例疗效观察

目的：探讨中药联合舒利迭治疗稳定期慢性阻塞性肺疾病（COPD）的临床疗效。方法选取2012年7月至2013年7月期间我院诊治的120例COPDⅢ级稳定期患者,根据随机数字法将其分为对照组（舒利迭治疗）和观察组（中药联合舒利迭治疗）,每组各60例,治疗3个月,比较两组患者的临床疗效、第一秒用力呼气容积（FEV1）和第一秒用力呼气容积（FEV1）/用力肺活量（FVC）、不良反应。结果观察组治疗总有效率为91.7%,明显高于对照组的76.7%,差异有统计学意义（P〈0.05）;治疗后观察组的FEV1和FEV1/FVC明显高于对照组,差异均有统计学意义（P〈0.05）;观察组的不良反应发生率（13.3%）也低于对照组（28.3%）,差异有统计学意义（P〈0.05）。结论中药联合舒利迭治疗慢性组塞性肺疾病稳定期患者疗效显著,具有较高的治疗安全性,值得临床推广。     

COPD患者HRCT容积成像特点与肺功能的关系研究

目的：探讨慢性阻塞性肺疾病(COPD)患者高分辨CT (HRCT)容积成像特点与肺功能的关系。方法选取2011年3月至2015年2月十堰市郧阳区人民医院收治的62例COPD患者作为研究对象,所有患者均接受HRCT容积扫描及肺功能检查,图像传输至工作站,记录肺容积、肺密度各项参数,并按照COPD严重程度分组,分析HRCT参数与患者肺功能指标的相关性。结果随着COPD病情严重程度的上升,患者一秒用力呼气容积(FEV1)、用力肺活量(FVC)、一秒率(FEV1/FVC)、一秒用力呼吸容积占预计值比例(FEV1%)降低,残气量/肺总量(RV/TLC)上升;Ⅳ级COPD患者FEV1、FVC、FEV1/FVC、FEV1低于Ⅰ级者[(0.8±0.1) L、(2.2±0.3) L、(34.6±10.2)%、(56.3±3.6)%vs (2.3±0.3) L、(3.5±0.3) L、(81.6±8.3)%、(73.2±5.3)%],RV/TLC高于Ⅰ级者[(75.2±8.6)%vs (45.1±5.8)%],差异均有统计学意义(P<0.05);随着COPD病情严重程度的上升,患者深吸气、呼气末肺密度均上升;Ⅳ级COPD患者深吸气、呼吸末肺密度高于Ⅰ级者[(-956.8±22.4) HU、(-899.5±22.7) HU vs (-865.3±24.5)HU、-744.2±30.2) HU],差异均有统计学意义(P<0.05);其深吸气末容积（Vin）、深呼气末肺容积(Vex)上升,但差异均无统计学意义(P>0.05),仅Ⅱ级、Ⅲ级、Ⅳ级与Ⅰ级Vin对比,Ⅳ级与Ⅱ级Vin,Ⅲ级、Ⅳ级与Ⅰ级Vex对比差异有统计学意义(P<0.05);肺气肿体积(TEV)、肺气肿指数(EI)上升,Ⅳ级COPD患者TEV、EI高于Ⅰ级者[(1.1±0.2) L、(17.8±3.4)%vs (0.3±0.2) L、(6.1±4.2)%],差异均有统计学意义(P<0.05),但不同病情严重程度全肺体积(TLV)无明显变化(P>0.05);Vin与FVC、FEV1、FEV1/FVC相关,Vex、TEV、EI与所有肺功能指标均相关,深吸气肺密度、TLV与FEV1/FVC相关(P<0.05)。结论 HRCT容积成像可清晰显示COPD肺实质破坏,其定量参数与肺功能指标有较好的相关性,可用于评定COPD患者病情严重程度。     

慢性阻塞性肺疾病评估测试与肺功能相关性分析

目的:探讨慢性阻塞性肺疾病(COPD)评估测试(CAT)与第1秒用力呼气量占预计值百分比(FEV1%)及深吸气量(IC)相关性。方法:将COPD稳定期患者60例进行CAT评分和肺功能测试,对两者结果做Spearman相关分析。结果:COPD全球倡议(GOLD)分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者分别为9、15、24、12例,CAT评分轻微、中度、严重、非常严重患者分别为13、15、19、13例。CAT评分与FEV1%及IC%总体上存在显著的相关性(r=-0.409、-0.689,均P<0.05),但GOLD分级为Ⅰ、Ⅲ、Ⅳ级的COPD患者的CAT评分与FEV1%无相关性(P>0.05),而GOLD分级为Ⅰ级的COPD患者的CAT评分与IC%无相关性(P>0.05)。对病情严重程度不同的4组COPD患者进行CAT总评分比较,差异有统计学意义(χ2=47.137,P<0.01),且任意两组间CAT总评分比较,差异均有统计学意义(χ2=13.01-75.09,均P<0.01)。结论:CAT评分与FEV1%及IC%相关性较好,可用于不同程度的COPD患者的临床检测和评估。CAT评分和FEVl、IC互为补充,能更好地反映COPD患者整体状态,对疾病的评估更全面可靠。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.