呼吸系统疾病患者正确掌握药物吸入技术的研究进展

药物吸入治疗是哮喘和COPD等呼吸系统疾病患者重要的治疗手段,但成人呼吸系统疾病患者正确掌握药物吸入技术的比例较低。该文总结了药物吸入技术正确性的评估方法,从患者、医护人员、设备等角度分析了影响呼吸系统疾病患者药物吸入技术正确性的因素,并从培养呼吸系统慢病管理专职护士、推广呼吸系统慢病分级诊疗模式、发展移动医疗服务等方面梳理了干预措施,旨在为提高呼吸系统疾病患者药物吸入技术的正确性提供科学依据。     

慢性呼吸衰竭患者的护理

在现代临床医学中,慢性呼吸衰竭是一种较为常见的呼吸系统疾病,对于患者的生命安全造成严重的威胁和影响.慢性呼吸衰竭的发病机制主要表现为:当人体各种呼吸系统疾病发展到一定程度,会引起呼吸功能障碍,进而导致呼吸衰竭.     

可穿戴设备在呼吸系统疾病中的应用现状与展望

我国呼吸系统疾病的管理存在诊断不足、治疗不规范的问题。可穿戴设备指将各种传感器结合到服装、配件中,可穿戴于身体各处的便携式设备,旨在感知与检测人体物理生化信息,在呼吸系统疾病的诊断、管理以及健康监测方面具有广阔前景。本文旨在总结医疗可穿戴医疗设备的发展现状,详细评述可穿戴设备在呼吸系统疾病中的应用现状,并对未来发展趋势进行展望。     

移动医疗在呼吸系统疾病患者药物吸入管理中的应用进展

掌握正确吸入技术是呼吸系统疾病患者接受吸入治疗的前提,移动医疗可以促进呼吸系统疾病患者正确掌握吸入技术。该文介绍了移动医疗在呼吸系统疾病患者药物吸入技术管理中的应用形式、应用效果,分析应用过程中存在的不足与挑战,以期为国内开发相应的移动医疗设备或应用程序提供借鉴。     

呼吸道疾病与细菌组学

正1背景在医学领域,随着高通量测序等生物技术的发展,人们越来越认识到在人体体表和肠腔器官拥有丰富的微生物群落——微生物组,参与人体免疫调节、食物消化、维生素合成等一系列生命活动。而众多疾病的发病机制涉及到微生物群落的组成和行为的改变,如胃肠道炎症性疾病、AIDS相关的机会性感染、呼吸系统疾病、某些肿瘤等。人体微生物组拥有数量惊人的微生物数量(人体细胞数量10倍之多)及基因数量(人体基     

氧疗湿化液温度对呼吸系统疾病病人氧疗舒适度和效果影响

[目的]探讨使用接近人体鼻腔温度（30℃～35℃）的湿化液进行加温湿化氧疗对呼吸系统疾病病人氧疗舒适度和氧疗效果的影响。[方法]将84例呼吸系统疾病病人随机分为试验组和对照组,对照组病人接受室温湿化氧疗,试验组病人接受加温湿化氧疗,比较两组病人的氧疗舒适度和氧疗效果。[结果]两组病人在氧气温度、湿度、鼻咽部感觉、咳嗽程度、咳痰难度、痰量、痰液性状方面的差异有统计学意义（P〈0.05）。[结论]对呼吸系统疾病病人,采用加温湿化氧疗较室温湿化氧疗更利于提高病人的氧疗舒适度和氧疗效果。     

李金兰主任医师

业务娴熟技术精湛，能够进行各类呼吸系统疾病的诊治，擅长肺炎、肺气肿、肺心病、肺肿瘤、支气管扩张、哮喘、胸膜炎、肺间质疾病、呼吸系统流行病等疾病的诊治。重视基础研究和临床教学，长期担任教学工作。     

氧疗湿化液温度对呼吸系统疾病病人氧疗舒适度和效果影响

[目的]探讨使用接近人体鼻腔温度(30 ℃～35 ℃)的湿化液进行加温湿化氧疗对呼吸系统疾病病人氧疗舒适度和氧疗效果的影响.[方法]将84例呼吸系统疾病病人随机分为试验组和对照组,对照组病人接受室温湿化氧疗,试验组病人接受加温湿化氧疗,比较两组病人的氧疗舒适度和氧疗效果.[结果]两组病人在氧气温度、湿度、鼻咽部感觉、咳嗽程度、咳痰难度、痰量、痰液性状方面的差异有统计学意义(P<0.05).[结论]对呼吸系统疾病病人,采用加温湿化氧疗较室温湿化氧疗更利于提高病人的氧疗舒适度和氧疗效果.     

婴幼儿肺功能检测方法及进展

在婴幼儿常见病中，呼吸系统疾病占首位。肺功能检测作为一重要临床检查手段，对于判断呼吸系统疾病的病理生理改变、疾病严重程度及鉴别呼吸系统疾病性质，评估药物治疗效果，指导呼吸机参数合理调整等有着其他检查手段不可替代的作用。因受试患儿年龄小不能配合，加之适宜技术及设备的缺乏，测量准确性及重复性差、数据处理等诸多技术方面的问题，阻碍了婴幼儿肺功能检测方法的临床应用。     

儿童肺功能检测及临床应用

在儿童常见病中,呼吸系统疾病占首位,肺功能检测作为一项非创伤性的诊断技术,是儿童呼吸系统疾病诊断中的重要组成部分,对于判断呼吸系统疾病的病理生理改变、疾病严重程度及鉴别呼吸系统疾病性质,评估药物治疗效果,指导呼吸机参数合理调整等有着其他检查手段不可替代的作用[1]。由于儿童的解剖、生理、病理特点均与成人不同,故儿童有其自身的肺功能特点,尤其是婴幼儿。     

急性呼吸窘迫综合征患者下呼吸道重力依赖区气道关闭数值模拟

为了研究急性呼吸窘迫综合征（ARDS）患者下呼吸道重力依赖区气流特性的变化情况,基于CT影像建立真实人体下呼吸道三维模型,确定重力依赖区气道关闭位置,利用CFD技术对下呼吸道内气体进行瞬态数值模拟,得到了部分气道关闭后下呼吸道内空气流速、表面压力、壁面剪切应力等参数的变化趋势,理解了ARDS发生发展的病理生理变化,从而指导机械通气策略,避免呼吸机相关肺损伤的发生。     

Early discharge of people with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe any respiratory condition that causes long-standing airflow obstruction, which is non or only partially reversible with bronchodilator therapy. These diseases include emphysema, chronic bronchitis, chronic airflow limitation and some cases of chronic asthma. The World Health Organization global initiative for chronic obstructive lung disease (GOLD) recommendations proposed a new definition of COPD as 'a disease state characterised by a progressive airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases' (Pauwels et al, 2001).     

Evaluation of the forced oscillation technique for the determination of resistance to breathing

Total respiratory resistance (R(T)) was measured by the application of a sine wave of airflow to the mouth at the resonant frequency of the respiratory system. The mean respiratory resistance of 42 normal subjects, measured at a mean functional residual capacity of 3.3 liters, was 2.3, SD +/- 0.5, cm H(2)O/liter per sec, and the resonant frequency was between 5 and 8 cycle/sec. The airway resistance measured in these same subjects with the body plethysmograph at a mean panting thoracic gas volume of 3.5 liters was 1.3, SD +/- 0.3, cm H(2)O/liter per sec. Total respiratory resistance was found to vary inversely with lung volume (V) measured plethysmographically; prediction formulae for normal subjects based on this relationship are: R(T) (mean) = 7.1/V, R(T) (range) = 4.0/V to 11.6/V where V is in liters and R(T) is in cm H(2)O/liter per sec. When these criteria were applied to subjects with thoracic disease the following results were obtained: 17 subjects with obstructive lung disease all had elevated total respiratory resistance; 9 subjects with diffuse lung disease without airway obstruction all had normal respiratory resistance; all but 1 of 5 obese subjects and all but 2 of a heterogeneous group of 9 subjects without airway obstruction had normal respiratory resistance. Failure to take lung volume into account resulted in a considerable decrease in the ability to discriminate between obstructive and nonobstructive lung disease on the basis of the forced oscillation test. The resonant frequency of the respiratory system of patients with obesity or nonobstructive lung disease was similar to that obtained in the normal group; accurate evaluation of resonant frequency in subjects with obstructive lung disease was frequently not possible. The combined resistances of lung, thoracic wall and abdominal tissues were found to account for less than 43% of the total respiratory resistance in normal subjects and were only slightly increased by the presence of obesity, restrictive diseases of the thoracic wall, and hyperinflation of the thorax. The forced oscillation method is potentially of value in the study of resistance to breathing of patients who cannot undergo body plethysmography, such as acutely ill, anesthetized, or unconscious subjects. Accurate evaluation of R(T) requires an independent measure of lung volume as well as careful attention during measurements to the airflow rate, phase of respiration, and the adequacy of cheek compression and laryngeal relaxation.     

数字人体力学模型

笔者阐述了数字人体的力学模型,主要内容是数字人体的多体系统力学模型、非完整系统力学模型、变质量系统力学模型、碰撞系统力学模型、破坏系统力学模型、流体系统力学模型、热动力学系统模型和数字人体的突变模型等,为数字人体的动力学研究提供了理论基础.     

Obstructive lung diseases: COPD, asthma, and many imitators.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that occurs in 10% to 15% of people who smoke, an estimated 16 million Americans. Asthma is also common. Spirometry is generally used to detect early COPD in smokers and to evaluate patients with respiratory symptoms. Although COPD and asthma account for most obstructive lung diseases, a broad spectrum of other disorders, including bronchiectasis, upper airway lesions, bronchiolar diseases, and some interstitial lung diseases, are associated with airflow obstruction. These less common forms of obstructive lung diseases are often misdiagnosed because of their uncommon occurrence and poor recognition. We describe the heterogeneous spectrum of disorders that can present with evidence of airflow obstruction and outline a diagnostic approach to obstructive lung disease.     

Microfluidic characterization of cilia-driven fluid flow using optical coherence tomography-based particle tracking velocimetry

Motile cilia are cellular organelles that generate directional fluid flow across various epithelial surfaces including the embryonic node and respiratory mucosa. The proper functioning of cilia is necessary for normal embryo development and, for the respiratory system, the clearance of mucus and potentially harmful particulate matter. Here we show that optical coherence tomography (OCT) is well-suited for quantitatively characterizing the microfluidic-scale flow generated by motile cilia. Our imaging focuses on the ciliated epithelium of Xenopus tropicalis embryos, a genetically manipulable and experimentally tractable animal model of human disease. We show qualitative flow profile characterization using OCT-based particle pathline imaging. We show quantitative, two-dimensional, two-component flow velocity field characterization using OCT-based particle tracking velocimetry. Quantitative imaging and phenotyping of cilia-driven fluid flow using OCT will enable more detailed research in ciliary biology and in respiratory medicine.     

骨科老年患者术后精神障碍的相关因素分析

目的探讨骨科老年患者手术后发生精神障碍的相关因素。方法选择2006年5月至2009年5月在我科接受手术治疗的146例60岁以上老年患者,按术后有无精神症状分为有症状组和无症状组。其中有症状组17例,年龄63～104岁,平均(74±8)岁;无症状组129例,年龄60～86岁,平均(68±6)岁。结果发现有症状组在年龄,吸入麻醉方式及时间,术中失血量,术后低血色素及低氧血症,水、电解质紊乱,术前合并糖尿病、高血压病、脑血管疾病、呼吸系统疾病等因素与无症状组比较,差异有统计学意义(P0.05)。结论骨科老年患者手术后发生精神障碍与年龄,吸入麻醉方式及时间,术中失血量,术后低血色素及低氧血症,水、电解质紊乱,术前合并糖尿病、高血压病、脑血管疾病、呼吸系统疾病等因素有关。     

Diagnosis and management of asthma]

Asthma is a chronic inflammatory disorder of the airways with many inflammatory cells such as eosinophils, mast cells, T lymphocytes and basophils. This inflammation causes airflow limitation, airway hyperresponsiveness, respiratory symptoms and disease chronicity. Long-term-control medication are needed to prevent and control asthma symptoms.     

Respiratory airflow pattern in patients with chronic airway obstruction

Summary. Previous experimental evidence has shown that in healthy humans inspiratory airflow waveform can be optimized according to minimum rate of work criteria when the respiratory energetic requirements become a substantial fraction of the general metabolism (i.e., during exercise hyperpnea and maximum voluntary ventilation). In patients with chronic airway obstruction (CAO) the relative energetic expenditure devoted to respiration is also greatly enhanced at rest. To investigate the performance of a system also controlling airflow wave pattern in this condition we evaluated by Fourier analysis the harmonic content of respiratory flow waves recorded at rest and during exercise hyperpnea (25 and 50 W on cycloergometer) in 15 patients. The results were compared with those we previously obtained in normal subjects and with some theoretical models. It was found that, while normal subjects display at rest an inspiratory flow waveform reasonably close to a sinusoidal model and adopt a more rectangular and economical flow shape during exercise hyperpnea, patients with CAO show a rather rectangular inspiratory flow shape also at rest, without any remarkable change at higher levels of ventilation. So, in general terms, the airflow pattern employed by patients at rest entails a reduction in the rate of dynamic inspiratory work of about 12% over that required by a sinusoidal waveform, and no further advantage is observed during exercise hyperpnea. Some features of the expiratory flow wave were also analysed. As no model of the respiratory system mechanics presently developed can explain the findings obtained in CAO patients purely on the basis of their altered mechanical parameters, it has been suggested that more complex control of respiratory airflow is operating in this class of patient.