Exercise Ventilatory Parameters for the Diagnosis of Reactive Pulmonary Hypertension in Patients With Heart Failure

BackgroundReactive pulmonary hypertension (PH) in left heart disease is associated with poor prognosis. This study aimed to evaluate the diagnostic utility of exercise ventilatory parameters on cardiopulmonary exercise testing for the diagnosis of reactive PH in patients with heart failure (HF) and reduced ejection fraction.MethodsThis was a single-center, retrospective analysis of a prospectively collected database of 131 patients with HF who underwent in-hospital assessment for heart transplantation. Pulmonary hemodynamics was assessed by direct cardiac catheterization. Minute ventilation/carbon dioxide production (VE/VCO₂) slope, partial pressure of end-tidal carbon dioxide (ETCO₂) changes on exercise, oxygen pulse, and exercise oscillatory ventilation were determined from cardiopulmonary exercise testing.ResultsSixty-one of 131 consecutive patients had reactive PH. VE/VCO₂ slope (>41), change in ETCO₂ on exercise (<1.2 mm Hg) and exercise oscillatory ventilation were independently associated with reactive PH. These 3 parameters in combination produced 3 possible diagnostic scenarios: (1) if all 3 criteria (“if all”) were present, (2) if any 2 of the 3 criteria (“2 of 3”) were present, and (3) if any of the criteria (“if any”) were present. The corresponding positive/negative likelihood ratios for reactive PH if all 3 criteria were present were 3.73/0.83, if 2 of the 3 criteria were present were 2.19/0.45, and if any of the 3 criteria were present were 1.75/0.11. The posttest probability increased from 46% to 76% (“if all” present) and reduced to 9% (if none of the criteria was present).ConclusionVentilatory parameters on cardiopulmonary exercise test are associated with reactive PH in patients with HF. The absence of abnormalities in these 3 ventilatory parameters can effectively exclude reactive PH in patients with HF and poor ejection fraction.     

支气管肺泡灌洗术（ＢＡＬ）用于难治性肺部 感染的疗效分析

探讨支气管肺泡灌洗术（ＢＡＬ）用于难治性肺部感染的治疗效果。方法　选取２０１２年１月— ２０１４年１月入我院就诊的难治性肺部感染患者１６０例，随机分为观察组和对照组，各８０例，对照组采取常规抗 菌、雾化吸入、体位引流等治疗，观察者在此基础上进行支气管肺泡灌洗术。分析比较两组患者治疗效果以及患 者满意度情况。结果　观察组患者治疗效果明显优于对照组（９７５％ ＞６５０％），两组相比较差别具有统计学 意义（Ｐ＜００５）；观察组患者满意度为９６３％，对照组为５６３％，两组相比较差别具有统计学意义（Ｐ＜００５）。 结论　通过研究可知，支气管肺泡灌洗术用于难治性肺部感染效果显著，明显改善患者病情，提高满意度，值得 临床推荐应用。     

Medicine administration errors and their severity in secondary care older persons’ ward: a multi‐centre observational study

Aim and objectives. To assess the severity of medicine administration errors to older patients. Background. Severity of medicine administration errors has been determined in a variety of settings but not in care‐of‐older‐person wards, which this study aims to do. Design. Undisguised observational study. Participants. Sixty‐two nurses were observed administering oral medicines to 625 patients. Interventions. Data were collected on the preparation and administration of oral medicines. Thirty‐five cases of error were selected and analysed for their severity. Results. In the 65 drug rounds observed 2129 potential drug administrations were made to 625 patients, of which 817 doses (38·4%) were given incorrectly (95% CI = 36·3–40·4). The overall mean harm score of the 35 incidents analysed was 4·1 (range 1·1–8·6, SD 1·8) on a scale of 0–10. Conclusions. The number and severity of MAEs observed is high compared with previous studies. Relevance to clinical practice. There is a need to decrease the number and severity of MAEs, by increasing nurse awareness and error reporting.     

无创正压通气治疗慢性阻塞性肺疾病呼吸衰竭伴意识障碍的疗效观察

目的观察无创正压通气（NPPV）治疗慢性阻塞性肺疾病（COPD）呼吸衰竭伴意识障碍患者的疗效。方法将入选的16例COPD呼吸衰竭伴意识障碍患者分为A组,16例意识障碍不明显患者分为B组。在常规治疗的基础上行双水平无创正压通气（BiPAP）,动态观察治疗前后动脉血气、Glasgow昏迷评分、NPPV天数、住院天数、最高IPAP、NPPV成功率、住院病死率及不良反应情况。结果 A组NPPV成功率和住院病死率分别为68.75%（11/16）和18.75%（3/16）,B组分别为81.25%（13/16）和12.5%（2/16）,差异无统计学意义（P均〉0.05）。A组最高IPAP均值较B组高6 cmH2O,且NPPV和总住院时间也较B组长3和7 d（P〈0.05或P〈0.01）。A组胃肠胀气和面部皮肤损伤较B组发生率高（68.75%比18.75%,25.0%比6.25%,P〈0.05）。结论 NPPV对COPD呼吸衰竭伴意识障碍患者也有较好的疗效,意识障碍不是NPPV治疗的绝对禁忌症。     

先天性心脏病患儿血清氨基末端脑利钠肽水平与肺动脉压的关系

目的:探讨血清氨基末端脑利钠肽(NT-pro-BNP)水平与先天性心脏病肺动脉高压的相关性.方法:将52例先天性心脏病患儿分成先心病组(A组)24例,先心病并轻度肺动脉高压组(B组)15例,先心病并中重度肺动脉高压组(C组)13例,并设正常对照组(N组)20例.对所有实验对象采用电化学发光法进行血清NT-pro-BNP浓度检测,并行心脏彩超检查测量肺动脉压力.结果:血清NT-pro-BNP浓度水平在N组(91.2±16.9)pg/mL、A组(92.5±14.7)pg/mL及B组(98.1±18.3)pg/mL之间无显著差异(P>0.05),但在C组显著升高(223.6±68.1)pg/mL(P<0.01).结论:血清NT-pro-BNP水平在先天性心脏病患儿并中重度肺高压时显著升高,可作为早期判断肺动脉高压的辅助手段.     

预防性心包内肺循环短暂阻断术在局限性T4期肺癌外科治疗中的应用

目的 探讨预防性心包内肺循环短暂阻断术在局限性T4期肺癌外科治疗中的应用价值.方法 开胸后探查肺癌、转移淋巴结与肺血管的关系,切开心包,在心包内游离患侧肺动脉根部和肺上、下静脉,通过肺循环短暂阻断术结合成形术完成肺癌切除.结果 肺动脉阻断时间为(22±4) min,肺静脉阻断时间为(18±3) min,术中出血量为(239±71) ml.24例患者均成功实施肺癌切除,未行全肺切除术.术中无死亡病例,术后无严重并发症.结论 预防性心包内肺循环短暂性阻断术能提高T4期肺癌手术的安全性和肿瘤切除的彻底性,减少全肺切除的施行.     

Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: the effect of dialyzer composition

Pulmonary hypertension (PHT) increases mortality rate in hemodialysis (HD) patients. Numerous clinical, hemodynamic, and metabolic abnormalities have been suggested to be associated with the development of PHT in HD patients. We aimed to investigate the acute effects of two different dialyzer membranes on pulmonary arterial pressure (PAP) throughout a HD session in maintenance HD patients. Seventy-four HD patients dialyzed through permanent tunneled jugular central venous catheter were enrolled. A first-use cellulose acetate and high-flux polysulfone dialysis membrane were tested using a crossover design. For each membrane, pre- and post-dialysis pulmonary artery pressures were measured echocardiographically. Elevated pulmonary artery pressure was observed in 68.8% of patients (n = 51), whereas mild PHT was observed in 28.3% of patients (n = 21) and moderate PHT in 40.5% (n = 30). Decrease in pulmonary artery pressure following HD procedure performed using high-flux polysulfone membrane was significantly higher than the decrease observed following HD procedure performed using cellulose acetate membrane (p < 0.05). Significant decrease in pulmonary artery pressures was observed only after HD procedures performed using high-flux polysulfone membrane (p < 0.05). Ultrafiltered volume was only significantly correlated with the decrease in pulmonary artery pressure observed after HD procedure performed through high-flux polysulfone membrane (β = 0.411, p < 0.05). PHT seems to be prevalent among HD patients even in the absence of AV fistula and abnormal cardiac functions. Membrane composition seems to be important, which may overwhelm the improving effects of ultrafiltration.