“呬”字诀呼吸操对稳定期 COPD 患者生存质量的影响

目的：探讨“呬”字诀对稳定期COPD患者生存质量的影响。方法选取稳定期COPD患者63例，随机分为试验组（31例）和对照组（32例），试验组在常规治疗和护理基础上进行3个月“呬”字诀呼吸操训练，对照组仅进行常规治疗和护理。待训练结束后，采用吸系统疾病特异性生存质量量表（ SGRQ）、医疗资源利用情况（住院次数、住院时间、访问急诊次数）等指标对两组患者的生存质量进行评价。结果经过3个月干预后，试验组SGRQ总分、活动领域、影响领域三者得分明显低于对照组（ P＜0.01）；住院次数、住院天数显著少于对照组患者（P＜0.01）。结论“呬”字诀简单易行，且能有效减少稳定期COPD患者住院次数、缩短住院时间，从而提高其生存质量，值得在临床、社区康复工作中推广、应用。     

ICU机械通气患者呼吸困难的研究进展

<正>重症监护病房(Intensive care unit,ICU)是随着新型医疗设备的诞生而出现的集现代化医疗技术为一体的特殊场所。机械通气(Mechanical ventilation,MV)是在患者自然通气和(或)氧合功能出现障碍时,应用呼吸机使患者恢复有效通气并改善氧合的方法,它是挽救各种原因所导致的呼吸衰竭的有效工具,是ICU最基本的抢救手段~([1])。调查~([2])显示,在     

Oral breathing and speech disorders in children

ObjectiveTo assess speech alterations in mouth-breathing children, and to correlate them with the respiratory type, etiology, gender, and age.MethodA total of 439 mouth-breathers were evaluated, aged between 4 and 12 years. The presence of speech alterations in children older than 5 years was considered delayed speech development. The observed alterations were tongue interposition (TI), frontal lisp (FL), articulatory disorders (AD), sound omissions (SO), and lateral lisp (LL). The etiology of mouth breathing, gender, age, respiratory type, and speech disorders were correlated.ResultsSpeech alterations were diagnosed in 31.2% of patients, unrelated to the respiratory type: oral or mixed. Increased frequency of articulatory disorders and more than one speech disorder were observed in males. TI was observed in 53.3% patients, followed by AD in 26.3%, and by FL in 21.9%. The co-occurrence of two or more speech alterations was observed in 24.8% of the children.ConclusionMouth breathing can affect speech development, socialization, and school performance. Early detection of mouth breathing is essential to prevent and minimize its negative effects on the overall development of individuals.     

The effect of surgically assisted rapid maxillary expansion on sleep architecture: an exploratory risk study in healthy young adults

Maxillary transverse deficiencies (MTD) cause malocclusions. Rapid maxillary expansion treatment is commonly used treatment for correcting such deficiencies and has been found to be effective in improving respiration and sleep architecture in children with obstructive sleep apnoea (OSA). However, thus far, the effect of surgically assisted rapid maxillary expansion (SARME) treatment on sleep architecture and breathing of normal subjects has not been assessed. We hypothesised that sleep quality will improve after maxillary expansion treatment. The objective of this study is to access the effect of maxillary expansion treatment on sleep structure and respiratory functions in healthy young adults with severe MTD. This is a prospective and exploratory clinical study. Twenty‐eight consecutive young adult patients (15 males and 13 females, mean age 20·6 ± 5·8 years) presenting with severe MTD at the orthodontic examination were recruited into the study. All the participants underwent a standardised SARME procedure (mean expansion 6·5 ± 1·8 and 8·2 ± 1·8 mm, intercanine and intermolar distance, respectively) to correct malocclusion caused by MTD. An overnight in‐laboratory polysomnography, before and after the treatment, was performed. The mean follow‐up time was 9 months. The main outcome parameters were the changes in sleep architecture, including sleep stages, arousals, slow‐wave activity (SWA) and respiratory variables. Before surgery, young adult patients with MTD presented no evidence of sleep breathing problems. At baseline sleep recording, 7 of 28 (25%) had apnoea‐hypopnoea index (AHI) ≥ 5 events per hour. No negative effect of the SARME was observed in questionnaires or sleep laboratory parameters. In the patients with a higher baseline AHI (AHI ≥ 5 h of sleep), we observed a reduction in AHI after surgical treatment (P = 0·028). SARME did not have a negative effect on any sleep or respiration parameters in healthy young individuals with MTD. It normalised the breathing index in the patients with a mild AHI index.     

How to use noninvasive positive airway pressure device data reports to guide clinical care

There has been a significant increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. At present, PAP therapy can be successfully used in children of all ages, for a variety of indications. Data acquired from PAP devices is clinically useful, providing objective information regarding adherence, leak, and efficacy of PAP therapy. However, guidelines outlining a standardized approach to interpretation of PAP device data in pediatrics is currently lacking. Given the rapidly expanding use of PAP therapy in pediatric practice, we aim to provide an overview of the interpretation of data reports, otherwise called “data downloads,” from PAP devices and illustrate how they can be used to guide clinical care.     

院前急救使用气管插管和球囊面罩的效果对比

目的探究在院前心脏停搏患者应用气管插管和球囊辅助呼吸进行急救的效果。方法选自本院2010年²012年进行院前急救的心脏停搏患者共50例,以随机的方式分为对照组与观察组,每组各有患者25例。对照组患者接受气管插管辅助呼吸,观察组患者接受球囊人工通气治疗。对比2组患者的各项临床指标。结果相对于对照组患者,观察组患者在建立通气时间方面有显著优越性,二者对比具有统计学意义(P<0.05);其余各项临床指标对比无统计学意义(P>0.05)。结论对心脏停搏患者进行院前急救的时候,应用球囊或者气管插管的急救方法,在临床效果对比方面相似,但是球囊辅助呼吸建立通气的时间要比气管插管短很多。