高原地区慢性阻塞性肺疾病患者体重对呼吸困难的影响

目的探讨高原慢性阻塞性肺疾病(COPD)低体重(UW)和正常体重(NW)患者肺功能、呼吸肌力量和血气与呼吸困难的关系.方法对高原地区COPD缓解期体重指数(BMI)＜21kg/m2的36例和BMI在21～26kg/m2的32例两组患者测定一秒钟用力呼吸气容积(FEV1)占预计值百分比(FEV1%预计值)、FEV1/用力肺活量(FVC)比值(FEV1/FVC)、口腔最大吸气压(PImax)、最大呼气压(PEmax)、最大跨膈压(Pdimax)、呼吸肌力量指数(RMS)、动脉血氧分压(PaO2)和二氧化碳分压(PaCO2),并评估了呼吸困难等级.结果UW组平均BMI(17.8±1.2)kg/m2显著低于NW组(23.2±1.4)kg/m2,P＜0.01.UW组呼吸困难平均等级(3.9±0.9)显著高于NW组(2.9±0.7),P＜0.01.两组FEV1%预计值、FEV1/FVC差异无显著性(P＞0.05).UW组PaO2(53.7±6.2)mmHg显著低于、PaCO2(37.5±3.6)mmHg显著高于NW组[分别为(57.2±6.5)mmHg、(35.2±3.4)mmHg],P均＜0.05.UW组PImax(48.2±14.4)cmH2O、PEmax(62.7±16.2)cmH2O、Pdimax(54.3±15.6)cmH2O和RMS(55.5±15.1)cmH2O较NW组显著降低[分别为(61.7±15.9)cmH2O、(72.4±18.5)cmH2O、(66.9±17.2)cmH2O、(67.1±16.5)cmH2O](P＜0.01或P＜0.05).呼吸困难等级与PImax、PEmax、Pdimax、RMS、FEV1%预计值、FEV1/FVC呈显著负相关(P均＜0.01).结论高原地区COPD低体重患者呼吸困难较正常体重患者严重,其原因与营养不良所致的呼吸肌力量降低有重要关系.     

高原慢性肺心病患者吸气肌功能失调与高碳酸血症的关系

目的:探讨高原肺心病患者吸气肌功能失调与高碳酸血症的关系.方法:对48例高原慢性肺心病缓解期患者测定了肺功能、血气、PImax、Pdimax的TTdi,与42例当地同龄健康人对比.结果:①肺心病组PImax、Pdimax明显低于健康组(均P<0.01),TTdi较健康组明显延长(P<0.01);②将肺心病分为正常碳酸血症(A组)、轻度高碳酸血症(B组)和重度高碳酸血症(C组).3组均有低氧血症,以C组最低,3组比较均P<0.01.FEV_1、PImax、Pdimax均明显降低,以C组最低,3组比较P<0.01或<0.05.TTdi均延长,以C组最明显,3组比较P<0.01;③PaCO_2与VD/VT比率和TTdi明显正相关,γ值分别为0.57、0.52,均P<0.01;与FEV_1、PImax、Pdimax明显负相关,γ值分别为-0.61、-0.51、-0.58,均P<0.001.结论:高原肺心病患者吸气肌疲劳和膈肌储备力下降在形成高碳酸血症中起重要作用.     

高原慢性肺心病患者吸气肌功能失调与高碳酸血症的关系

探讨高原肺心病患者吸气肌功能失调与高碳酸血症的关系。对48例高原（海拔2260～3200m）慢性肺心病缓解期患者测定了肺功能、血气、口腔最大吸气压（PImax）、最大跨膈压（Pdimax）和漏肌张力—时间指数（TTdi），并与42例当地同龄健康人对比。结果：①肺心病组PLmax、Pdimax明显低于健康组（P均＜0.01），TTdi较健康组明显延长（P＜0.01）；②将肺心病分为正常碳酸血症（A组）、轻度高碳酸血症（B组）和重度高碳酸血症（C组）。三组均有低氧血症，以C组最低，三组比较P均＜0.01。一秒种用力呼气容积（PEV1）、PImax、Pdimax均明显降低，以C组最低．三组比较P＜0．01或＜0．05。TTdi均延长，以C组最明显，三组比较P，0.01；③PaCO2与VD／VT比率和TTdi明显正相关，r值分别为0.57、0．52，P均＜0．01；与FEV1、PIamx、Pdimax明显负相关，r值分别为-0．61、－0．51、－0．58，P均＜0．01。结论：高原肺心病患者吸气肌疲劳和膈肌储备力下降在其高碳酸血症形成中起重要作用。     

COPD患者呼吸驱动和呼吸肌力对静息状态与最大运动时呼吸困难的影响

 目的 探索慢阻肺(COPD)患者的呼吸中枢和呼吸肌的功能状态,明确COPD患者静息和运动时呼吸困难和动脉血氧含量的改变. 方法 对20例COPD 患者和20例健康对照者测定静态肺功能,检测最大吸气压力和最大呼气压力及0.1 s口腔压力(P0.1),行运动负荷试验.以BS评价受试者的呼吸困难,以经皮无创血氧仪测定受试者的血氧饱和度. 结果 COPD组的PImax为 (4.9±2.2)kPa ,低于健康人组的PImax(7.2±2.5)kPa(P<0.05),PEmax为 (7.3±3.8)kPa ,与健康人组的 PEmax(7.6±3.4)kPa没有差别(P>0.05); P0.1为(0.38±0.13)kPa,高于健康人组的P0.1 (0.25±0.08) kPa (P<0.05).COPD组的BSrest 为(2.2±1.7),高于健康人组的BSrest (0±0)(P<0.01),BSmax为(6.8±1.7),高于健康人组的BSmax(3.2±1.6)(P<0.01);SpO2rest 为(92±6)%,低于健康人组的 SpO2rest (95±3)%(P<0.05) ,SpO2max(86±3)%明显低于健康人组的SpO2max(92±2)%(P<0.01). 结论 COPD患者不仅存在着肺部阻塞性通气功能降低,也存在呼吸中枢异常和呼吸肌功能降低.COPD患者在最大运动时呼吸困难指数高于健康人,并存在体内氧含量的缺乏.     

高原地区老年慢性肺心病缓解期患者营养状态与呼吸肌力量的关系

慢性阻塞性肺疾病 (ＣＯＰＤ)和慢性肺源性心脏病 (肺心病 )患者多病程长 ,反复加重 ,常伴有营养不良。呼吸肌较一般骨髂肌需要更多的能量供应 ,营养不良易损害呼吸功能 ,导致呼吸肌肌力和耐力的下降 ,甚至呼吸肌功能衰竭。为了探讨高原地区慢性肺心病缓解期营养不良与呼吸肌力量的关系及营养补充对呼吸肌功能、肺功能和血气的影响 ,作者测定了 46例高原地区患者的体重与理想体重 (ＩＢＷ )百分比 (%ＩＢＷ)、体重指数 (ＢＭＩ)、肱三头肌皮皱厚度 (ＴＳＦ)、上臂中点肌肉周径 (ＭＡＭＣ)、口腔最大吸气压 (ＰＩｍａｘ)、最大呼气压 (ＰＥｍ…     

门脉充血指数的动态观察判定TIPSS支架管功能的价值

目的　探讨通过测定经颈静脉肝内门体分流 (TIPSS)手术前后门脉充血指数 (CI)的变化以判定支架管功能的价值。方法　测定并分析比较支架管功能正常组和支架管功能障碍 (狭窄或闭塞 )组TIPSS手术前后CI的演变情况。结果　术前支架管功能正常组和支架管功能障碍组CI无明显差异 (P >0 .0 5 ) ,术后 1周两组CI均较术前明显下降 (P <0 .0 1) ,但组间比较差异不显著 (P >0 .0 5 )。功能正常组术后各时相点 (1周、1月、3月、6月、12月、18月、2 4月 )之间CI均无明显差异 (P >0 .0 5 ) ,但均与术前差异显著 (P <0 .0 1)。而功能障碍组在出现狭窄或闭塞前各时相点 (1周、1月、3月 )之间所测CI也无差异 (P >0 .0 5 ) ,当出现狭窄、闭塞时 ,CI均较前各时相点显著升高 (P<0 .0 1)。结论　TIPSS手术前后CI的波动间接反映了支架管功能演变情况 ,动态观察CI变化可作为超声直接显像支架管评估其功能的方法的重要补充。若当超声直接显像支架管困难时 ,对CI的测定价值更大     

泵同类型瑜伽锻炼对女大学生身体形态及心血管功能的影响

目的:探究不同类型瑜伽对女大学生身体形态及心血管功能的影响.方法:从华中师范大学瑜伽俱乐部报名名单中随机抽取120名女大学生,对照组(40人)进行常规学习与生活,不进行瑜伽锻炼;实验1组(40人)进行18周流瑜伽练习,实验2组(40人)进行1 8周球瑜伽练习,每周练习3次,每次90分钟,强度为50～60％VO2max,包括准备活动、体式练习和放松.18周实验前后,测试各组身体形态指标:体重指数(BMI)、身高胸围指数(LIVI)、腰臀比(WHR)、维尔维克指数(VEWK)、腹部皮褶厚度;心脏功能指标:脉率(HR)、每搏心输出量(SV)、心搏指数(SI)、心脏指数(CI)、左心室有效泵力指数(VPEL);血管功能指标:平均收缩压(MSP)、平均舒张压(MDP)、血管顺度(AC)、血管弹性扩张系数( ETK)、标准周阻(STR).结果:两实验组实验后与实验前相比,BMI、LIVI、WHR、腹部皮褶厚度显著下降(P＜0.05,P＜0.01),VEWK显著上升(P＜0.01);HR显著下降(P＜0.01),SI、CI、SV、VPEL显著上升(P＜0.05,P＜0.01);MSP、MDP、STR显著下降(P＜0.05,P＜ 0.01),AC显著上升(P＜0.05).实验2组实验后与实验1组比较,LIVI、WHR、腹部皮褶厚度、MDP、STR显著下降(P＜0.05,P＜0.01),VEWK、SV、SI、VPEL、ETK显著上升(P＜0.05,P＜ 0.01).结论:18周流瑜伽和球瑜伽练习(时间90分钟,每周3次)均有减肥、改善女大学生身体形态和心血管功能的功效,且球瑜伽锻炼效果优于流瑜伽.     

尿胰蛋白酶抑制剂对体外循环心脏手术患者血浆内毒素水平及全身炎性反应的影响

目的 观察尿胰蛋白酶抑制剂(UTI)对行体外循环术(CPB)患者血浆内毒素水平及全身炎性反应的影响,并评价其对脏器功能的保护作用.方法 24例行CPB下心脏瓣膜置换术的患者随机分为UTI组及对照组,每组12例.UTI组患者于术中CPB转机前静滴UTI 5 000U/kg,术后第1～3天静脉用UTI 5 000U/kg,每12h一次;对照组在相同时间点静脉推注等量生理盐水.分别于术前、麻醉后主动脉阻断前、主动脉开放后及CPB术后4、8、24,48、72h等8个时间点采集患者外周静脉血,应用BET-24A内毒素分析仪检测血浆内毒素浓度.放免法检测血浆细胞因子TNF-α、IL-1β、IL-6、IL-8浓度.在麻醉后主动脉阻断前、主动脉开放后及CPB术后4h、8h等4个时间点测定心输出量指数(CI)、每搏量指数(SD、HR、平均动脉压(MAP)等血流动力学指标及动脉血气结果(PaO2、FiO2),根据呼吸监测指标计算肺动态及静态顺应性(CA和Cs)、氧合指数(OI).结果 UTI组与对照组血浆内毒素浓度无显著差异(P>0.05);UTI组血浆TNF-α、IL-β、IL-6、IL-8浓度均低于对照组(P<0.01),CI、SI、Cs、Cd、OI均高于对照组(P<0.05),而HR、MAP与对照组比较无显著差异(P>0.05).结论 UTI对CPB下心脏手术患者血浆内毒素浓度无明显影响,但可显著降低血浆炎性细胞因子水平,减轻术后全身炎性反应,且对循环和呼吸功能有一定保护作用,有利于患者早期恢复.     

不同舰船种类海员的血压差别探讨

目的　探讨我国不同舰船种类的海员血压差别的影响因素。方法　将水面小船 (A组 ) ,水面大船 (B组 )及潜艇 (C组 )的海员按统一方法进行血压调查。结果　 13个组间海员高血压患病率差异有显著性 ,A、B、C组依次为 15 .0 8% ,6 .15 % ,9.71% (P<0 .0 5 )。2 A组心率显著高于其它两组 (P<0 .0 1) ,A组年龄、体重指数 (BMI)和海龄显著高于 B组 (P<0 .0 1)。 3相关分析示舰船种类分别与收缩压和舒张压呈显著相关 ,相关系数 r值分别为 0 .0 6 8,0 .0 76 (P<0 .0 1)。回归系数 β值分别为 1.0 5 32 ,0 .0 76 0 (P<0 .0 0 1)。结论　不同舰船种类海员血压差别的影响因素与心率、年龄、BMI、海龄及舰船种类有关     

高原地区慢性肺心病痰中P物质浓度与病情及肺通气功能的关系

目的 :探讨P物质在高原地区慢性肺心病发病中的作用及其与病情及肺功能的关系。方法 :用放射免疫分析法检测高原地区 (海拔 2 2 6 0～ 330 0m) 30例健康受试者 ,30例慢性肺心病患者急性加重期和缓解期痰中P物质浓度 ,同时检测肺功能 ,分析痰中P物质含量与一秒钟用力呼气容积 (FEV1)占预计值百分比 (FEV1% )、FEV1/用力肺活量 (FVC)比值的相关关系。结果 :肺心病组急性加重期痰中P物质浓度 ( 73.8± 12 .5 )pmol·L-1显著高于缓解期 ( 5 7.3± 10 .1)pmol·L-1(P <0 .0 1) ,并显著高于健康对照组 ( 8.2± 2 .2 )pmol·L-1(P <0 .0 1)。肺心病组急性加重期和缓解期痰中P物质浓度与FEV1%、FEV1/FVC比值均呈显著负相关 (r值分别为 - 0 .6 5 4、- 0 .5 98、- 0 .6 6 7、- 0 .5 76 ,P均 <0 .0 1)。结论 :神经源性炎症可能参与了高原慢性肺心病气道炎症过程及随后的气道狭窄     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Sex differences in neuromuscular fatigability in response to load carriage in the field in British Army recruits

Objectives

Women are resistant to neuromuscular fatigue compared to men in response to a range of exercise tasks. The sex differences in the neuromuscular responses to load carriage have yet to be investigated.

Decrease in eccentric hamstring strength in runners in the Tirol Speed Marathon

Background

The local muscular endurance of knee flexors, during eccentric work in particular, is important in preventing or delaying kinematic changes associated with fatigue during treadmill running. This result, however, may not be transferable to overground running.

Objective

To test the hypothesis that overground running is associated with eccentric hamstring fatigue.

Methods

Thirteen runners (12 male and one female) performed an isokinetic muscle test three to four days before and 18 hours after a marathon. Both legs were tested. The testing protocol consisted of concentric and eccentric quadriceps and hamstring contractions.

Results

There were no significant differences between peak torque before and after the race, except that eccentric peak hamstring torque (both thighs) was reduced.

Conclusion

Overground running (running a marathon) is associated with eccentric hamstring fatigue. Eccentric hamstring fatigue may be a potential risk factor for knee and soft tissue injuries during running. Eccentric hamstring training should therefore be introduced as an integral part of the training programme of runners.     

新疆石河子地区奶牛隐性乳房炎的调查与分析

采用LMT法对新疆石河子地区三个规模化奶牛场泌乳牛群进行了隐性乳房炎检测,共检测994头泌乳牛3976个乳区.结果表明:奶牛隐性乳房炎阳性率为81.9%,乳区阳性率为49.1%.数据分析表明,不同年龄、胎次以及有无卧床奶牛的隐性乳房炎阳性率差异显著(P<0.05),后乳区的隐性乳房炎感染率显著高于前乳区感染率(P<0.05),隐性乳房炎乳区发生数也明显影响当日产奶量(P<0.05).     

Oxalosis in primary hyperoxaluria in infancy

Primary hyperoxaluria (PH1) is a rare inborn autosomal recessive metabolic disorder due to the deficiency of hepatic alanine-glyoxylate-aminotransferase. This deficiency results in excessive synthesis and urinary excretion of oxalate, inducing renal stone formation and deposition of calcium oxalate in the kidney, bone, myocardium, and vessels (systemic oxalosis, SO) in the most severely affected individuals. We report renal and skeletal changes in a 3-month-old girl with PH1 and SO. Intense cortico-medullary hyperechogenicity and increased homogeneous radiopacity of normal-sized kidneys suggested the diagnosis of SO. Skeletal survey showed osteopenia and characteristic symmetrical metaphyseal transverse bands in long bones, progressively becoming more dense and migrating towards the diaphysis. Multiple pathological and slowly healing fractures of the limbs occurred at the dense band level. A radiopaque rim was then observed in flat bones, epiphyseal nuclei, and vertebral bodies. Inflammatory granulomatous reaction, induced by the presence of oxalate crystals in the marrow spaces, coexisted with progressively evident radiological signs of secondary hyperparathyroidism, with partially overlapping features. The patient was treated by peritoneal dialysis and hemodialysis until combined liver–kidney transplantation. There are no previous reports of infants treated with hemodialysis for more than 2 years.     

胎龄和日龄对新生儿局部脑血流的影响

目的探讨胎龄及日龄对新生儿局部脑血流(rCBF)变化的影响及规律.方法对早产儿组、足月早期新生儿组、足月晚期新生儿组进行99Tcm-双半胱乙酯(ECD)SPECT脑血流灌注断层显像,并作半定量分析和读片分析.结果早产儿组原始感觉运动区和枕叶rCBF低于足月早期新生儿组(P<0.05),显著低于足月晚期新生儿组(P<0.01),其额叶中份、顶叶rCBF也低于足月晚期新生儿组(P<0.05),其余各叶皮质rCBF随胎龄和日龄的增大有增加趋势.早产儿组脑血流显像图与足月早期新生儿组和晚期新生儿组比较有明显差异.结论早产儿与足月儿rCBF的变化可能与新生儿大脑皮质相应区域发育成熟度和时间顺序有关.     

Radiological strategy in acute stroke in children

The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management.Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment.Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%).This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.     

Recent advances in imaging technologies in dentistry

Dentistry has witnessed tremendous advances in all its branches over the past three decades. With these advances, the need for more precise diagnostic tools, specially imaging methods, have become mandatory. From the simple intra-oral periapical X-rays, advanced imaging techniques like computed tomography, cone beam computed tomography, magnetic resonance imaging and ultrasound have also found place in modern dentistry. Changing from analogue to digital radiography has not only made the process simpler and faster but also made image storage, manipulation (brightness/contrast, image cropping, etc.) and retrieval easier. The three-dimensional imaging has made the complex cranio-facial structures more accessible for examination and early and accurate diagnosis of deep seated lesions. This paper is to review current advances in imaging technology and their uses in different disciplines of dentistry.