静脉血气分析及其临床应用进展

动脉血气分析是严重心肺疾病和许多代谢性疾病的重要检测手段，在血流动力学稳定状态下，动、静脉血气的CO2气体含量和酸碱参数非常接近，但在循环功能衰竭等情况下，动、静脉血气出现分离现象，此时可能需同时作静脉血气。静脉血气分析对危重患者特别是循环衰竭的患者可以提供组织氧合和酸碱状态更切实的评价，并可能对有效复苏提供更好的指导。     

脉冲震荡法与常规通气在支气管激发试验中的对比研究

目的：探讨用脉冲震荡法(Impulse Oscilbmetry IOS)测定呼吸阻力在支气管激发试验中的诊断价值。方法：对72例门诊及住院就诊有自觉症状，临床怀疑为支气管哮喘而不能确诊的患者进行支气管激发试验，用IOS测定5～35赫兹震荡频率时的粘性阻力(R5-R35)，5赫兹时的周边弹性阻力(X5)，共振频率(Fres)，阻抗(Zre)，与常规通气一秒量(FEV1)，呼气峰流速值(PEF)，1秒率(FEV1／FVC％)进行对比研究。结果：支气管激发试验阳性组患者FEV1比试验前FEV1基础值降低20％的同时呼吸阻力明显增加，且阻力增加较FEV1下降出现早，部分支气管激发试验通气功能阴性的患者而阻力增加。结论：脉冲震荡法为一种新型肺功能测定方法，用于支气管激发试验可大大减少以往常规通气测定中的不足，对支气管激发试验阴性的患者在鉴别诊断上增加了新的内容。     

Epidemiology of gastro-intestinal and respiratory tract diseases in rural areas of Varanasi (India)

The pattern of gastro-intestinal (GIT) and Respiratory tract (RTI) diseases in rural areas of the Varanasi district, U.P. (India) was studied from the outpatient (OPD) attendance between July 1985 to June 1986. Out of a total of new patients, 19.71% had respiratory diseases in contrast to 27.9% with GIT disease. A decreasing trend was observed in attendance rates as age advanced. The difference in age distribution of males and females was statistically significant. The attendance rates for GIT diseases were higher in female (29.16%) than in males (25.16%) whereas in RTI, the rates were higher in males (19.39%) than in females (18.77%). The attendance rate was found to be higher in rainy season (23.59%) followed by summer (14.50%). Diarrhoea (15.44%) and upper (URTI) respiratory tract infection (19.93%) occupied the major recorded episodes.     

High-frequency ventilation (HFV) in hyaline membrane disease —a preliminary report

Eight premature babies affected by hyaline membrane disease and needing mechanical respiratory support were ventilated by means of a VDR 1 (Bird Space Technology) respirator at 10 Hz during a mean time of 51 h. Before HFV 7 infants had been on conventional mechanical ventilation (CMV) and one on nasal CPAP. The values of mean airway pressure (MAP) and oxygenation index (PaO₂/FIO₂) on CMV and HFV were (mean and range): 1. CMV: MAP 15 (4–29) mm Hg, ox. index 15.47 (5.07–23.19) kPa; 2. HFV after 1 h: MAP 15 (10–19) mm Hg, ox. index 24.13 (9.07–46.12) kPa. Improved oxygenation allowed rapid reduction of FIO₂ in the following hours. Only 3 infants were weaned directly from VDR 1, 5 were switched back to CMV mainly because of technical failures of the respirator. The change from HFV to CMV was associated with a fall of PaO₂/FIO₂ from 35.99 (15.86–74.52) to 22.39 (7.33–31.46) kPa. The mean time of artificial ventilation (CMV+HFV) was 121 h (range 46–166). Except for 1 pneumothorax no medical complications were seen during HFV, and all patients survived. Despite impressive improvements in oxygenation it is cautioned against the use of the VDR 1 because of the high incidence of technical problems.     

无创面罩通气BiPAP治疗COPD呼吸衰竭32例临床分析

目的 评价双水平气道正压通气（BiPAP）治疗COPD呼吸衰竭患者的疗效，可行性及相关影响因素。方法 回顾性临床分析随机选取32例COPD呼吸衰竭患者给予BiPAP治疗的临床资料，并与84例常规治疗作对照分析。结果 治疗组及对照组均有效，但治疗组住院时间明显缩短p〈0．05；BiPAP治疗后lh有效，一般情况下，3d后各项指标趋于正常。结论 应用BiPAP治疗有显著的临床疗效，可起到事半功倍的效率，减少住院天数。     

BiPAP ViSION 在慢性阻塞性肺疾病Ⅱ型呼吸衰竭的应用和护理

目的 探讨经鼻(面)罩双水平气道内正压通气(BiPAP)ViSION型呼吸机对慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭患者疗效及护理特点。方法 应用BiPAP ViSION型呼吸机对21例COPD伴Ⅱ型呼吸衰竭患者采用鼻/面罩连接单向呼气活瓣行双水平气道正压通气,观察其通气前后动脉血气及临床表现变化。结果 通气治疗后19例患者动脉血氧分压(PaO_2)及氧饱和度(SaO_2)明显升高(P<0.01),二氧化碳分压(PaCO_2)显著降低(P<0.05);肺性脑病症状消失,昏迷患者神志转清。2例病情恶化,其中1例改用有创通气后好转,1例拒绝有创通气死亡。结论BiPAP ViSION呼吸机治疗COPD伴Ⅱ型呼吸衰竭的疗效较为肯定,正确的护理对提高其疗效和减少并发症至关重要。     

Characteristic modifications of the breathing pattern of mice to evaluate the effects of airborne chemicals on the respiratory tract

A system was developed for exposure of unanesthetized mice to airborne chemicals and for continuous measurement of their breathing pattern prior to, during and following exposure. By measuring inspiratory and expiratory airflows (VI and VE), and integration with time to yield tidal volume (VT), we obtained characteristic modifications to the normal breathing pattern. These permitted recognition that a specific portion of the respiratory tract was affected by the selected airborne chemicals. Following recognition, we also quantitated the degree of effect using one specific measurement in each case. An effect on the upper respiratory tract, induced by the sensory irritant, 2-chlorobenzylchloride, was quantitated by measuring a decrease in respiratory frequency. An effect on the conducting airways, induced by the airway constrictor, carbamylcholine, was quantitated by a decrease in VE at the mid-point of VT. An effect at the alveolar level, induced either by the vagal nerve ending stimulant, propranolol, or by the pulmonary irritant, machining fluid G, was quantitated by an increase in the length of a pause induced at the end of expiration. The system is easy to construct and operate and can be used to rapidly evaluate the effects of airborne chemicals on the respiratory tract.     

长春地区儿童急性呼吸道感染的病原趋势

目的:探讨北方地区小儿急性呼吸道感染(ARIs)病原构成特点,为临床诊断及治疗提供依据。方法:采用酶联免疫吸附试验(ELISA)方法,对574例ARIs患儿进行了肺炎支原体(Mp)、沙眼衣原体(CT)、肺炎支原体(CP)、呼吸道合胞病毒(RSV)、腺病毒(Adv)、流感病毒A型(Inf-A)、副流感病毒(PIV)等7种病原同步进行急性期血清特异性抗体IgM检测,同时设立健康对照组。结果:574例患儿共334例检出特异性IgM抗体,阳性率58.2%。按检出频率的高低依次为Mp28.9%(166/574),RSV13.6%(78/574),CP5.9%(34/574),CT4.4%(25/574),Adv3.3%(19/574),Inf-A1.2%(7/574),PIV0.9%(5/574),分别占阳性例数的49.7%(166/334)、23.3%(78/334)、10.2%(34/334)、7.5%(25/334)、5.7%(19/334)、2.1%(7/334)和1.5%(5/334);病原分布具有年龄差别。健康对照组仅检出1例MP-IgM阳性(1.7%)。结论:Mp、RSV及CT为小儿ARI的常见病原。Mp感染率逐渐增高,发病年龄有逐渐变小的趋势。     

氯喹对全肝缺血再灌注大鼠肺损伤的保护作用

目的 探讨氯喹对全肝缺血再灌注大鼠急性肺损伤（Au）的保护作用及其机制。方法 健康SD大鼠90只，雌雄不拘，体重300～350g，随机分为3组：假手术组（A组）、全肝缺血再灌注组（B组）、全肝缺血再灌注＋氯喹组（C组），每组30只。阻断肝门及肝上、肝下下腔静脉20min时开放血流，建立大鼠全肝缺血再灌注模型。C组于缺血前即刻经股静脉注射氯喹10mg／kg，A、B组给予等量生理盐水。于缺血20min、再灌注4h时每组分别处死10只大鼠，抽取门静脉血，测定血浆D-乳酸、内毒素（ETX）、肿瘤坏死因子-a（TNF-a）浓度，另外10只用于观察再灌注48h时大鼠生存率，并在电镜下观察肺组织超微结构的改变。结果 缺血再灌注可导致大鼠缺血期和再灌注期门静脉血D-乳酸、ETX、TNF-a浓度升高，大鼠生存率降低，肺组织超微结构严重受损，氯喹可减弱全肝缺血再灌注导致的上述改变。结论 氯喹对全肝缺血再灌注大鼠ALI有一定的保护作用，通过抑制磷脂酶A2激活，降低肠粘膜屏障通透性升高，降低肠黏膜内毒素移位。     

臂丛神经根性损伤膈神经移位术对青壮年患者早期呼吸功能的影响

目的研究臂丛神经损伤膈神经移位术对青壮年患者早期呼吸功能的影响.方法对16例接受膈神经移位治疗的患者,在术前、术后（10 d）进行肺功能指标的比较,同时定期进行门诊随访,观察呼吸系统自觉症状程度.结果13例术后出现了不同程度的供氧不足症状,16例全部出现一侧膈肌抬高,术后第10天肺活量（VC）、肺活量预计值百分数（VC%）分别比术前减少37.98%和26.88%,两者差异有统计学意义（tvc=11.532、tvc%=0,P＜0.01）.其它项目如残气量（RV）较术前轻度下降,肺总量（TLC）下降值达到术前肺总量的36.49%,残气量/肺总量比值（RV/TLC%）较术前上升了4.75%,上述各指标的差值均有统计学意义.1 s用力呼气量/用力肺活量比值（FEV1/FVC）和术前比基本无改变,但其差值有统计学意义.膈神经移位右侧（10例）与左侧（6例）术前、术后肺活量比较差异有统计学意义.术后随访8个月～2年,所有患者均无明显呼吸困难和胸闷等症状.结论膈神经移位术后对青壮年患者肺容量有较大的丧失,肺通气功能减弱和小气道阻力增加,但其丧失程度在机体自身代偿耐受范围内,不会导致急剧发生的严重呼吸功能障碍.建议对右侧臂丛神经根性损伤的患者,术前进行严格的肺、心功能检查,避免发生较为严重的并发症.