无创机械通气在重症肺炎合并急性呼吸衰竭中的疗效分析

目的：研究无创机械通气（NPPV）治疗重症肺炎合并急性呼吸衰竭（SP-ARF）的临床疗效。方法60例重症肺炎合并急性呼吸衰竭患者在征得患者家属同意的前提下随机分为两组,所有患者均在常规治疗的前提下,观察组应用NPPV治疗,对照组给予鼻导管吸氧,观察对比两组患者治疗前后血气分析和临床症状、体征等指标。结果两组患者治疗前血气分析指标pH、PaO2、PaCO2指标差异均无统计学意义（P＞0.05）;经过治疗之后,两组患者上述指标均显著下降,差异均有统计学意义（P＜0.05）;观察组治疗之后上述指标均显著低于对照组,差异有统计学意义（P＜0.05）。观察组因病情恶化改有创机械通气3例（10.00%）,对照组改有创机械通气14例（46.67%）,两组差异有统计学意义（P＜0.05）;观察组平均住院时间（12.57±5.30）d,显著少于对照组（21.48±6.30）d,差异有统计学意义（P＜0.05）;因患者出现病情恶化改有创机械通气,观察组抢救无效死亡1例（3.33%）,对照组3例（3.33%）,两组差异无统计学意义（P＞0.05）。结论 NPPV在临床应用效果满意,临床效果优于单纯应用鼻导管吸氧的方式,在有条件的医院应推广应用,但在应用过程中,在发现无创正压通气控制病情困难时,应尽早行有创正压机械通气（IPPV）治疗。     

慢性阻塞性肺疾病患者家庭应用无创机械通气疗效观察

目的 探讨家庭应用无创机械通气（DNPPV）对慢性阻塞性肺疾病（COPD）患者生活质量、运动耐量、肺功能及医疗费用的影响.方法 将45例COPD合并Ⅱ型呼吸衰竭患者随机分为治疗组19例和对照组26例.2组于医院应用无创辅助通气治疗缓解后出院.治疗组继续应用DNPPV治疗,对照组停止无创机械通气治疗.12个月后比较2组血气指标、肺功能、6min步行距离（6WMD）及急性发作住院次数、住院费用.结果 出院12个月后,治疗组患者6MWD长于对照组,治疗组PaCO2低于对照组,PaO2、FEV1高于对照组,差异均有统计学意义（P＜0.05）.急性发作住院次数及医疗费用少于对照组,差异均有统计学意义（P＜0.05）.结论 应用DNPPV能延缓COPD患者肺功能下降速度,减少医疗费用,减少住院次数,提高生存质量.     

无创呼吸机辅助通气治疗急性左心衰竭60例的临床分析

目的 探讨无创呼吸机辅助通气治疗急性左心衰竭的临床效果.方法 将本院收治急性左心衰竭患者60例随机分为治疗组和对照组,每组各30例.对照组采用常规药物治疗,治疗组在常规药物治疗的基础上给予无创呼吸机辅助通气治疗.观察并记录两组治疗前后平均动脉压（MAP）、呼吸频率（RR）、心率（HR）、动脉血气指标（PaO2）的变化.结果 治疗后,两组的MAP、RR、HR较治疗前明显降低,PaO2明显升高（P＜0.05）,治疗后,治疗组效果优于对照组（P＜0.05）;治疗组的总有效率为90.00％,高于对照组的70.00％（P＜0.05）.结论 无创呼吸机辅助通气治疗急性左心衰竭临床效果确切,可明显改善临床症状,缩短病程,值得临床应用和推广.     

Noninvasive Assessment of the Fractional Flow Reserve with the CT FFRc 1D Method: Final Results of a Pilot Study

Background:Until recently, Russia did not utilize noninvasive fractional flow reserve (FFR) assessment. We developed an automated algorithm for noninvasive assessment of FFR based on a one-dimensional (1D) mathematical modeling.Objective:The research aims to evaluate the diagnostic accuracy of this algorithm.Methods:The study enrolled 80 patients: 16 of them underwent 64-slice computed tomography – included retrospectively, 64 – prospectively, with a 640-slice CT scan. Specialists processed CT images and evaluated noninvasive FFR. Ischemia was confirmed if FFR < 0.80 and disproved if FFR ≥ 0.80. The prospective group of patients was hospitalized for invasive FFR assessment as a reference standard. If ischemic, patients underwent stent implantation. In the retrospective group, patients already had invasive FFR values.Statistical analysis was performed using GraphPad Prism 8. We compared two methods using a Bland–Altman plot and per-vessel ROC curve analysis. Considering the abnormality of distribution by the Kolmogorov-Smirnov test, we have used Spearman’s rank correlation coefficient.Results:During data processing, three patients of the retrospective and 46 patients of the prospective group were excluded. The sensitivity of our method was 66.67% (95% CI: 46.71–82.03); the specificity was 78.95% (95% CI: 56.67–91.49), p = 0.0052, in the per-vessel analysis. In per-patient analysis, the sensitivity was 69.57% (95% CI: 49.13–84.40); the specificity was 87.50% (95% CI: 52.91–99.36), p = 0.0109. The area under the ROC curve in the per-vessel analysis was 77.52% (95% CI: 66.97–88.08), p < 0.0001.Conclusion:The obtained indices of sensitivity, specificity, PPV, and NPV are, in general, comparable to those in other studies. Moreover, the noninvasive values of FFR yielded a high correlation coefficient with the invasive values. However, the AUC was not high enough, 77.52 (95% CI: 66.97–88.08), p < 0.0001. The discrepancy is probably attributed to the initial data heterogeneity and low statistical power.     

双管喉罩在COPD呼吸衰竭患者无创通气中的应用效果

目的：探讨双管喉罩用于COPD呼吸衰竭无创通气中的应用效果。方法选取本院2012年1月~2014年6月收治的60例COPD合并Ⅱ型吸吸衰竭患者作为研究对象,随机分为两组,各30例。观察组给予双管喉罩,对照组给予普通口鼻面罩,比较两组的SpO2上升时间、动脉血气改善时间、通气失败率、脱机时间、并发症发生率。结果观察组的SpO2上升时间、脱机时间显著短于对照组,差异有统计学意义(P<0.01)。观察组的反流误吸率、通气失败率显著低于对照组,差异有统计学意义(P<0.05)。观察组治疗后8、48 h的pH、PaCO2水平显著高于对照组,观察组的PaCO2水平显著低于对照组,差异有统计学意义(P<0.01)。结论双管喉罩可以更好地改善COPD合并Ⅱ型呼吸衰竭患者的预后,能够替代口鼻面罩用于该类患者的无创通气治疗。     

动态光谱法无创检测人体血液胆固醇的探讨

目的：分析动态光谱法用于人体血液胆固醇含量无创检测的应用意义。方法：选取2013年10月-2014年1月本院96名健康体检者作为研究对象,对其进行在体测量动态光谱和抽血分析胆固醇含量,之后选用BP神经网络对获取的动态光谱数据和胆固醇含量实测值进行建模分析。结果：从96个体检样本中抽取81个作为校正集,另外15个作为预测集,得到校正集和预测集的相关系数分别为98.8%和95.65%,预测集的绝对误差最小为0.39%,最大为25.33%,平均相对误差为13.49%。结论：动态光谱法对胆固醇含量进行测量是一种精确性很高的无创检测分析方法,值得临床上推广。     

The efficacy of noninvasive ventilation in managing postextubation respiratory failure: A meta-analysis

Introduction

To determine the effectiveness of noninvasive ventilation (NIV) in the management of postextubation respiratory failure.

Methods

Databases including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to find relevant trials. Randomized and quasi-randomized trials studying NIV in adult patients with postextubation respiratory failure were included. Effects on primary outcomes (i.e., reintubation rate, and ICU or/and hospital mortality) were accessed in this meta-analysis.

Results

Ten trials involving 1382 patients were included: two used NIV in patients with established postextubation respiratory failure, and eight used NIV immediately after extubation. The use of NIV following extubation for patients (n = 302) with established respiratory failure did not decrease the reintubation rate (relative risk [RR] 1.02, 95% confidence interval [CI] 0.83-1.25) and ICU mortality (RR 1.14, 95% CI 0.43-3.00), compared to standard medical therapy (SMT). Early application of NIV after extubation (n = 1080) also did not decrease the reintubation rate (RR 0.75, 95% CI 0.45-1.15) significantly. However, in the planned extubation subgroup (n = 849), there were significant reductions in the reintubation rate (RR 0.65, 95% CI 0.46-0.93), ICU mortality rate (RR 0.41, 95% CI 0.21-0.82), and hospital mortality rate (RR 0.59, 95% CI 0.38-0.93) compared to SMT.

Conclusion

Current evidence suggests that the use of NIV in patients with established postextubation respiratory failure should be monitored cautiously. Early use of NIV can benefit patients with planned extubation by decreasing the reintubation rate and the ICU and hospital mortality rates.     

Can transient elastography,Fib-4, Forns Index,and Lok Score predict esophageal varices in HCV-related cirrhotic patients?

Background

Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, Forns Index and Lok Score as noninvasive predictors of esophageal varices (EV).

Methods

This prospective study included 65 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastroduodenoscopy. FIB-4, Forns Index and Lok Score were calculated. The diagnostic performances of these methods were assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves.

Results

All predictors (LSM, FIB-4, Forns Index and Lok Score) demonstrated statistically significant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of 18.2 kPa. Fib-4, Forns Index, and Lok Score could diagnose EV at cutoff values of 2.8, 6.61 and 0.63, respectively. For prediction of large varices (grade 2, 3), LSM showed the highest accuracy (80%) with a cutoff of 22.4 kPa and AUROC of 0.801. Its sensitivity was 84%, specificity 72%, PPV 84% and NPV 72%. The diagnostic accuracies of FIB-4, Forns Index and Lok Score were 70%, 70% and76%, respectively, at cutoffs of 3.3, 6.9 and 0.7, respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities. Moreover, this combination decreased the LR− in all tests.

Conclusion

Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology.     

异丙嗪对慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者使用无创正压通气耐受性及安全性的临床观察

目的 评估异丙嗪是否可以提高慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者对无创正压通气（NPPV）的耐受性及其安全性.方法 将41例因AECOPD合并Ⅱ型呼吸衰竭进行NPPV治疗的住院患者随机分为对照组和治疗组,在使用NPPV治疗前半小时,对照组给予生理盐水1 ml,治疗组给予异丙嗪25 mg,分别肌肉注射.观察NPPV治疗过程中患者PaO2、PaCO2、呼吸频率、心率、辅助呼吸肌评分以及NPPV不耐受例数.结果 治疗组患者在NPPV后2小时,PaO2、PaCO2、呼吸频率、心率、辅助呼吸肌评分均明显改善（P＜0.05）,NPPV不耐受例数明显低于对照组.NIPPV后24小时,两组患者PaO2、PaC02、呼吸频率、心率、辅助呼吸肌评分及NPPV不耐受新增例数比较,差异均无统计学意义（P＞0.05）.结论 异丙嗪可以在早期提高AECOPD合并Ⅱ型呼吸衰竭患者对NPPV的耐受性,并且安全性良好.