Birthweight, early passive respiratory system mechanics, and ventilator requirements as predictors of outcome in premature infants with respiratory failure.

Early respiratory mechanics have been reported to predict outcome in newborns with respiratory failure. However, it remains unknown whether measurements of pulmonary function add significantly to the predictive value of more readily available variables The present study was designed to answer this question. Passive respiratory system mechanics were measured by an airway occlusion technique in 104 ventilator-dependent premature infants between 6 and 48 hours of life and corrected for infant size. A ventilation index [FiO2 x mean airway pressure (MAP)] was calculated at the time of pulmonary function testing. Poor outcome was defined as death from respiratory failure or need for supplemental oxygen at 28 days. Stepwise logistic function regression examined whether ventilation index and respiratory mechanics added predictive power over and above birthweight. Five infants died, and 45 patients required supplemental oxygen at 28 days. Birthweight was a strong predictor and would have entered the logistic model first in any case. Ventilation index added significantly to the predictive model (P = 0.038). Respiratory system conductance (P = 0.15) and compliance (P = 0.93) entered on the third and last step, respectively. We conclude that in premature infants with respiratory failure, birthweight is a strong predictor of outcome. Early ventilator requirements but not respiratory system mechanics, add significantly to this predictive model.     

疑诊肺部真菌感染的10例经验性用药分析

目的 探讨疑诊肺部真菌感染的经验性抗真菌用药方案.方法 对疑诊肺部真菌感染并以经验性广谱抗真菌治疗好转10例患者的临床资料进行回顾分析.结果 10例患者主要临床表现为发热（10/10）、咳嗽、咳痰（8/10）.胸部CT检查均表现为密度较高的感染性病灶（5例伴空洞,8例伴光晕征）.4例痰培养见真菌孢子和菌丝.8例有真菌感染危险因素,3例初用氟康唑治疗无效,改用伊曲康唑好转;6例用伊曲康唑好转;1例用两性霉素B好转.结论 肺部真菌感染确诊困难,流行病学调查显示非白念真菌发病率有增高趋势,疑诊肺部真菌感染应及时将广谱抗真菌治疗作为一线药物.     

慢性阻塞性肺疾病患者肺动脉高压时肺动脉平滑肌细胞的增殖与凋亡

目的探讨慢性阻塞性肺疾病（COPD）患者肺动脉高压及肺血管重塑的机制。方法将患者分为非COPD非肺动脉高压组（A组）、COPD非肺动脉高压组（B组）和COPD并肺动脉高压组（C组），应用免疫组织化学方法检测肺动脉平滑肌细胞增殖细胞核抗原（PCNA），用原位缺口末端DNA碎片标记技术检测肺动脉平滑肌细胞凋亡。结果A组肺小动脉管壁较薄，管腔较大；B组管壁厚度增加，管腔变窄，其程度介于A组和C组之间；C组肺小动脉管壁明显增厚，管腔明显变窄，平滑肌细胞增生肥大，呈现明显的肺血管重塑现象；图像分析结果表明。B组及C组管壁厚度占外径的百分比（WT％）和血管壁横断面积占血管总面积的百分比（WA％）分别为（20±4）和（35±5）％、（28±5）和（50±6）％，明显高于A组的（16±3）和（25±3）％。C组与B组相比，WT％及WA％明显增高。3组肺小动脉壁平滑肌细胞均存在一定比例的增殖与凋亡，B组和C组肺小动脉平滑肌细胞增殖指数（PI）为（19±5）和（38±7）％，明显高于A组的（8±2）％；两组凋亡指数为（4．5±1．3）和（3．1±1．3）％，均明显低于A组的（6．9±1．9）％；B组肺动脉平滑肌细胞增殖指数低于C组，而凋亡指数高于C组。C组及B组氧分压与肺动脉平滑肌细胞增殖指数成负相关（r=-0．519，P=0．003），与肺动脉平滑肌细胞凋亡指数成正相关（r=0．441，P=0．015）。结论肺动脉平滑肌细胞增殖增加和凋亡减少。由此引起增殖与凋亡失衡是COPD患者肺血管重塑及发生肺动脉高压的主要机制；缺氧是引起肺动脉平滑肌细胞增殖增加和凋亡减少的主要原因之一。     

复方甘草甜素联合还原型谷胱甘肽治疗48例抗结核药物性肝炎的疗效分析

目的　探讨复方甘草甜素和还原型谷胱甘肽对结核药物性肝炎的临床疗效。方法 采用前瞻性研究,对2001年1月—2004年12月诊断为抗结核药物性肝炎48例住院患者随机分为治疗组和对照组,前者予复方甘草甜素和还原型谷胱甘肽治疗,后者进行常规治疗,疗效进行χ²统计学分析。结果 结核药物性肝炎大多发生于强化期内,临床表现为恶心、呕吐,严重者出现乏力、纳差、黄疸、腹胀、肝区疼痛及肝大,复方甘草甜素和还原型谷胱甘肽的疗效显著优于对照组。结论 复方甘草甜素和还原型谷胱甘肽治疗1周内可明显改善药物性肝炎表现及恢复肝功能作用,对于结核药物性肝炎有较高疗效,而且临床应用安全。     

Neuman理论对住院COPD患者焦虑及抑郁情绪的干预效果

目的：探讨Neuman理论对住院慢性阻塞性肺疾病（ COPD）患者焦虑、抑郁状况的影响。方法选取2012年1月—2014年1月120例焦虑、抑郁COPD患者作为研究对象,应用随机数字表法将其分为观察组和对照组各60例。对照组采用常规护理方法,观察组应用以Neuman理论为基础的模式进行护理。护理前后分别应用汉密尔顿焦虑量表（ HAMA）和汉密尔顿抑郁量表（ HAMD）评估两组患者焦虑、抑郁状况。结果护理前两组患者HAMA与HAMD评分比较,差异无统计学意义（ t值分别为0．9340,0．4506;P＞0．05）;护理后两组患者HAMA评分均下降,观察组为（12．6±6．4）分,低于对照组的（17．2±7．9）分,差异有统计学意义（t＝3．5046,P＜0．05）;护理后两组患者HAMD评分亦均下降,观察组为（11．9±6．7）分,低于对照组的（16．1±6．3）分,差异有统计学意义（t ＝3．5375,P＜0．05）。结论应用Neuman理论可以缓解住院COPD患者的焦虑、抑郁情绪。     

复合序贯排痰法在颈髓损伤患者中的应用

目的：探讨复合序贯排痰法在颈髓损伤( CSCI)患者中的排痰效果。方法选取2011年1月—2013年12月收治外伤性CSCI患者86例,按入院时间分为观察组和对照组,每组各43例。观察组采用复合序贯排痰法,对照组采用常规的护理措施排痰。评价两组患者肺部感染和肺不张发生情况及人工气道的使用情况。结果观察组肺部感染及肺不张发生率为9.3%,对照组为37.2%,两组比较差异有统计学意义(χ2=9.382,P<0.05);观察组治愈时间低于对照组,差异有统计学意义(t=-6.339, P<0.05)。观察组人工气道使用率为7.0%,对照组为30.2%,两组比较差异有统计学意义(χ2=7.679, P<0.05);观察组使用人工气道患者的带管时间低于对照组,差异有统计学意义(t =-5.490,P <0.05)。结论复合序贯排痰法可有效促进CSCI患者痰液排出,降低肺部感染和肺不张的发生率,提高其治愈率,降低人工气道使用率并缩短平均带管时间。     

Accelerated development of pulmonary complications due to illicit intravenous use of pentazocine and tripelennamine

To gain information concerning the natural history and prevalence of pulmonary gas exchange abnormalities resulting from intravenous drug abuse, 45 intravenous drug users were studied. Twenty subjects used a mixture of the synthetic opiate pentazocine and the antihistamine tripelennamine, which, under the street name T's and B's, has become very popular in some urban areas as an available substitute for heroin. Compared with the 19 heroin addicts studied, the pentazocine and tripelennamine users had a significantly shorter mean duration of intravenous drug abuse (2.7 +/- 0.4 years versus 7.6 +/- 0.9 years, p less than 0.01), a greater frequency of respiratory symptoms (75 percent versus 36 percent, p less than 0.05), a significant reduction in the mean diffusing capacity of the lung for carbon monoxide (58.4 +/- 3.3 percent predicted versus 75.5 +/- 5.6 percent predicted, p less than 0.01), and abnormal responses to submaximal steady-state exercise testing. The intravenous use of pentazocine and tripelennamine and probably most other drug preparations intended for nonparenteral use represents a particularly noxious form of drug abuse that may lead to early respiratory complications in a large proportion of users.