无创正压通气治疗COPD并呼吸衰竭昏迷患者的临床疗效观察

目的 分析无创正压通气在慢性阻塞性肺疾病(COPD)合并呼吸衰竭昏迷患者的临床治疗作用.方法 44例COPD合并呼吸衰竭昏迷患者随机分为一般常规治疗组(22例)和BiPAP呼吸机治疗组(22例).监测治疗前、治疗后8 h及48 h患者意识状态、动脉血气、呼吸、心率及并发症的发生情况.结果 常规治疗组治疗48h后PaO2有显著上升(P＜0.05);但意识状态、pH值、PaC02改善不明显;BiPAP呼吸机治疗组治疗48 h后意识状态、动脉血pH值、Pa02、PaC02、呼吸、心率均有明显改善,且优于常规治疗组(P均＜0.05).结论 无创正压通气能明显改善COPD并呼吸衰竭昏迷患者的呼吸衰竭及并发症.     

无创正压通气(BiPAP模式)治疗COPD合并Ⅱ型呼吸衰竭的临床疗效

目的:观察无创正压通气(BiPAP模式)治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的疗效.方法:选择我院24例慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者,在常规给予低流量氧疗、抗感染、平喘、祛痰等对症治疗的基础上加用无创正压通气(BiPAP模式),观察治疗前后患者的临床症状、动脉血气分析指标变化.结果:无创正压通气(BiPAP模式)对提高PH值、Pa02、降低PaC02,改善呼吸的疗效显著.结论:无创正压通气(BiPAP模式)治疗COPD并Ⅱ型呼吸衰竭,能有效改善患者的动脉血气分析指标,即提高PH值、Pa02,降低PaC02,进而改善患者的呼吸困难程度.     

BiPAP在慢性阻塞性肺疾病急性发作期并Ⅱ型呼吸衰竭患者治疗中的临床价值

目的 观察经口/鼻面罩双水平气道正压通气(BiPAP)在慢性阻塞性肺病急性发作期(AECOPD)并II型呼吸衰竭中的临床价值.方法 49例AECOPD合并II型呼吸衰竭的患者,随机分为对照组25例,经常规吸氧,抗感染、解痉、平喘、化痰、呼吸兴奋剂等处理;治疗组24例在上述常规治疗基础上加用BiPAP治疗.比较治疗前、治疗后2 h、4 h、24 h,两组动脉血气分析及临床症状(呼吸、心率)变化.结果 治疗组24例在无创通气后2 h、4 h、24 h血气分析中pH值、PaO2、PaCO2、呼吸、心率次数较入院时有明显改善且差异有显著性(P<0.05).而对照组与入院时比较上述数值改善不明显,差异无显著性(P>0.05).结论 BiPAP是治疗AECOPD并II型呼吸衰竭经济、有效的方法.     

探讨无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床疗效

目的:探讨无创正压通气(NIPPV)在老年慢性阻塞性肺疾病合并重症呼吸衰竭治疗中的应用价值.方法:选举49例老年慢性阻塞性肺疾病合并重症呼吸衰竭患者,将其随机分为两组,即实验组(25例)和对照组(24例),给予对照组患者常规治疗,而实验组成员在常规治疗基础上再给予无创正压通气治疗8h.比较两组患者治疗前后的动脉血气结果以及临床症状等.结果:治疗组pH、Pa02及PaC02均明显改善(P＜0.05).结论:早期应用无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭患者,可以更好地提高pH和Pa02,降低PaC02,从而改善患者的临床症状.     

经面罩无创正压通气治疗AECOPD并呼吸衰竭的效果评价

目的探讨与评价经面罩无创正压通气治疗AECOPD并呼吸衰竭的效果。方法选择2010年5月～2011年5月来我院治疗的AECOPD并呼吸衰竭患者46例,对其回顾性分析,分为观察组与对照组各23例。对照组患者主要接受药物治疗．观察组患者在药物治疗的基础上接受经面罩无创正压通气治疗,观察并比较两组患者在治疗前后的心率与呼吸频率,并记录治疗前与治疗后的第3小时和第1、3、7天患者动脉血气的分析结果。结果两组患者在治疗前的心率与呼吸频率比较,差异无统计学意义（P〉0．05）;两组患者治疗后的心率与呼吸频率比较,差异有统计学意义（P〈0．05）;两组治疗前的pH、PaO2与PaC02比较,差异无统计学意义（P〉0．05）;与治疗前相比,两组治疗后3h和1、3、7d患者的pH、PaO2与PaCO2均有所改善,且具有显著差异（P〈0．05）;治疗后3h和1、3、7d,两组比较Pa02与PaC02具有明显差异（P〈0．05）;两组的pH在治疗第1、3天时比较,差异有统计学意义（P〈0．05）。结论经面罩无创正压通气治疗AECOPD并呼吸衰竭安全可靠,疗效显著。     

BiPAP在AECOPDⅡ型呼吸衰竭中的疗效

目的 评价经鼻面罩双水平气道正压通气(Bilevel Positive Airway Pressure Ventilation,BiPAP)治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of Chronic Obstructive Pulmonary Disease,AECOPD)并Ⅱ型呼吸衰竭的疗效.方法 治疗组为23例AECOPD并Ⅱ型呼吸衰竭患者,采用常规治疗及BiPAP治疗;对照组为23例AECOPD并Ⅱ型呼吸衰竭患者,仅采用常规治疗;观察两组治疗前后患者临床症状,呼吸频率、脉搏、血压、动脉血气分析等指标的变化.结果 两组治疗后临床症状均明显改善,治疗后呼吸频率、脉搏、pH值、PaCO2、PaO2改善明显(P＜0.05),收缩压和舒张压治疗后变化不明显(P＞0.05);但治疗组pH、PaCO2改善较对照组明显,差别显著(P＜0.05).结论 BiPAP治疗AECOPD并Ⅱ型呼吸衰竭患者是安全有效的.     

双水平正压无创通气治疗COPD合并Ⅱ型呼吸衰竭的临床效果

目的探讨双水平正压无创通气(BiPAP)治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床效果。方法选取2016年6月至2017年6月黄科大医学院附属瑞康医院收治的100例COPD合并Ⅱ型呼吸衰竭患者,按治疗方法分为对照组与观察组,各50例。给予对照组患者抗感染、祛痰、低流量吸氧、平喘等对症治疗,观察组于对照组基础上接受BiPAP治疗。比较治疗前、治疗5 d后血气分析指标[动脉血氧分压(PaO_2)、血二氧化碳分压(PaCO_2)、氧饱和度(SaO_2)、pH]、心率、呼吸频率,记录住院时间。结果治疗5 d后,观察组患者PaO_2、SaO_2、pH水平均高于对照组,PaCO_2水平、心率和呼吸频率均低于对照组,差异有统计学意义(均P<0.05)。观察组住院时间短于对照组,差异有统计学意义(P<0.05)。结论采用BiPAP治疗COPD合并Ⅱ型呼吸衰竭患者,可平稳心率和呼吸频率,改善动脉血气指标,促进康复。     

双水平无创正压通气治疗AECOPD合并呼吸衰竭的疗效分析

目的：：探讨双水平无创正压通气治疗慢性阻塞性肺疾病急性加重期( AECOPD)合并呼吸衰竭的临床疗效。方法：将我院收治的AECOPD合并呼吸衰竭患者68例随机分为研究组和对照组,各34例。对照组给予抗炎、解痉、吸氧等常规治疗,研究组常规治疗的基础上实施双水平无创正压通气治疗。观察两组治疗前、治疗后3h及出院时血气分析指标、心率、呼吸频率、血压等变化及患者疾病转归情况。结果：①治疗前两组pH、PaO2、PaCO2比较无统计学差异( P>0.05),治疗3h后,研究组患者pH、PaO2、PaCO2较治疗前明显改善(P<0.05);对照组患者上述指标无明显变化(P>0.05)。②治疗前两组心率、呼吸、收缩压均高于正常,两组比较无统计学差异(P>0.05),研究组在治疗3h后心率、呼吸频率和收缩压明显降低( P<0.05),对照组治疗3h后心率、呼吸频率和收缩压无明显变化( P>0.05)。③对照组治疗3h后心率、呼吸频率和收缩压无明显变化( P>0.05)。结论：对于AECOPD合并呼吸衰竭患者,双水平无创正压通气可以显著改善患者的临床症状,纠正血气分析指标,是一种有效的治疗方法。     

呼吸机治疗慢性阻塞性肺气肿并发急性呼吸衰竭

目的:观察慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者应用B iPAP呼吸机正压通气治疗的效果。方法:45例COPD急性发作并Ⅱ型呼吸衰竭患者随机分为2组,治疗组23例采用B iPAP 常规治疗,对照组22例仅采用常规临床治疗,比较治疗前、治疗2h、24h后两组同期动脉血气及呼吸频率、心率改变。结果:治疗组PaO2、PaCO2、pH值较治疗前明显改善(P<0.05),改善与对照组比较,差异有显著性(P<0.05);呼吸频率、心率改变也较对照组明显(P<0.05)。气管插管发生率及平均住院天数均少于对照组(P<0.05)。结论:BiPAP是治疗慢性阻塞性肺气肿急性发作期并Ⅱ型呼吸衰竭经济、有效的方法。     

无创呼吸机治疗老年慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭31例

目的:探讨无创正压通气(NIPPV)对老年慢性阻塞性肺疾病急性发作(AECOPD)并发Ⅱ型呼吸衰竭的治疗效果。方法:将我院老年病科、急诊科64例AECOPD并发Ⅱ型呼吸衰竭患者随机分为常规对照组33例(常规抗感染、支气管扩张剂、祛痰药、激素、氧疗、纠正酸碱失衡的治疗)和NIPPV治疗组31例(在常规对照组的治疗基础上,采用美国伟康公司经鼻罩双水平气道正压BiPAP VERSION型呼吸机进行辅助通气)。观察两组患者治疗前后pH、PO2、PCO2、BE、心率、呼吸频率的变化,比较住院时间、气管插管率、病死率。结果:治疗2h、24h后,治疗组和对照组pH、PO2、PCO2、BE、心率、呼吸频率比较有显著性差异(P<0.05)。两组在住院时间、气管插管率、病死率方面也有显著性差异(P<0.05)。结论:NIPPV可加速改善AECOPD并发Ⅱ型呼吸衰竭患者的pH、PO2、PCO2、BE、心率、呼吸频率,可明显缩短住院时间,降低气管插管率、病死率。     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.