关注儿童肺血管疾病的研究

由于循环系统在个体生存和生长发育中的重要地位，以及肺脏是人体惟一具备体循环和肺循环两套系统的器官，肺血管疾病一直以来都是血管疾病研究的热点领域之一。随着儿科各亚专业临床技术的发展，儿童肺血管疾病获得了越来越多的关注。该文从儿童与成人肺血管疾病谱的差异、儿童肺高压的研究方向、儿童肺栓塞的疾病规律和早产后慢性肺疾病中的血管异常这四个方面对儿童肺血管疾病目前的研究进展和关注焦点进行综述，以期能够展示儿童肺血管疾病研究的重要性，在未来能够聚合多学科和多专业的交叉融合，以开展更为系统的研究。     

Comparative Analysis of Umbilical Nodules in Male and Female Patients: A 20-Year Retrospective Study

Background and aimsThe umbilicus is known to receive metastatic malignancy from diverse visceral organs. Accurate and correct diagnosis of umbilical lesions is imperative since metastatic malignancy signifies a serious underlying situation with dire prognosis. Identification of demographic features that can contribute to diagnostic resolution of umbilical lesions is desirable. We analyzed umbilical biopsies received over a 20-year period to determine any gender distinctive attributes of umbilical nodules.Materials and methodAll umbilical biopsies received in our department from 1st January 2000 to 31st December 2019 were identified and analyzed. Data acquired included patient's gender, age, date of biopsy, type of biopsy and histopathological diagnoses and these were analyzed using computer software.ResultsThere were 67 umbilical biopsies from 22 males and 45 females giving a male: female ratio of 1:2. The difference between the mean age (SD) of male patients [47.8 years (19.4 years)] and that of the females [42.8 years (13.9 years)] was not statistically significant (p = 0.28). Twenty-five of the 67 umbilical lesions were benign while 42 were malignant. About 90.9% of biopsies in males were malignant and 9.1% benign while 48.9% of biopsies in females were malignant and 51.1% benign. The odds of malignant umbilical biopsy in males compared to females is 10.5 [OR = 10.5; 95% CI = 2.2–50.1)].ConclusionUmbilical biopsies were relatively infrequent in our practice and were more common in females than males. Umbilical lesions presented by males are mostly malignant. Overall, 78% of all umbilical lesions in females were of gynecological derivation.     

射干麻黄汤联合沙丁胺醇对慢性阻塞性肺疾病患者肺功能、生活质量的影响

目的:探讨射干麻黄汤联合沙丁胺醇对慢性阻塞性肺疾病(COPD)患者肺功能、生活质量的影响。方法:选择COPD患者90例进行研究,以随机数字表法分为观察组48例和对照组42例。对照组给予沙丁胺醇治疗,观察组在对照组的基础上加用射干麻黄汤治疗。比较两组患者的临床疗效、第1秒用力呼气容积(FEV1)、最大呼气流量(PEF)、用力肺活量(FVC)、生活质量、中医症候积分、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)水平变化情况及不良反应发生情况。结果:治疗后,两组总有效率分别为93.75%、76.19%(P<0.05); 治疗后,两组患者FEV1、PEF、FVC水平均得到显著改善,且观察组高于对照组(P<0.05); 治疗后,两组躯体、认知、情绪、角色、社会功能、总体健康评分水平均得到显著改善,且观察组高于对照组(P<0.05); 治疗后,两组中医症候积分、日间咳嗽积分、夜间咳嗽积分水平显著改善,且观察组低于对照组(P<0.05); 治疗后,两组患者血清IL-6、TNF-α、Hs-CRP水平均得到显著改善,且观察组低于对照组(P<0.05); 观察组不良反应总发生率为10.42%,对照组为16.67%,差异无统计学意义(P>0.05)。结论:射干麻黄汤联合沙丁胺醇治疗慢性阻塞性肺疾病效果显著,可有效改善患者肺功能、生活质量水平。     

急性加重高风险慢性阻塞性肺疾病患者的睡眠质量及相关因素

目的调查急性加重高风险慢性阻塞性肺疾病（简称“慢阻肺”）患者的主、客观睡眠质量及其影响因素。方法回顾性收集26例急性加重高风险慢阻肺患者资料，患者于出院前1 d晚行整夜多导睡眠监测，记录患者肺功能、Epworth嗜睡评分（ESS）、匹兹堡睡眠质量问卷（PSQI）、英国医学研究委员会呼吸困难量表（mMRC）、慢阻肺患者自我评估测试（CAT）结果等临床信息。将PSQI评分＞5分定义为睡眠质量下降，根据睡眠监测结果将患者分为单纯慢阻肺组12例和重叠综合征组14例。入选同期睡眠室检查者27例，根据睡眠监测结果分为对照组13例和单纯阻塞性睡眠呼吸暂停低通气综合征（OSAHS）组14例。比较4组患者的主、客观睡眠参数并进行相关分析。结果26例急性加重高风险慢阻肺患者中23例存在睡眠质量下降。与对照组相比，单纯慢阻肺患者PSQI总分、ESS评分、觉醒次数、睡眠期总觉醒时间明显升高（P<0.05），总睡眠时间、客观睡眠效率明显低于对照组，差异有统计学意义（P<0.05）；重叠综合征组患者PSQI总分、客观睡眠潜伏期、觉醒次数明显高于OSAHS组（P<0.05）；与单纯慢阻肺组患者相比，重叠综合征患者慢波睡眠明显减少（P<0.05）。相关分析结果显示过去一年急性加重次数、呼吸困难指数、ESS评分与PSQI总分呈正相关；睡眠期总觉醒时间与CAT、mMRC评分呈正相关；快动眼睡眠占总睡眠时间百分比与FEF 25%～75%、PEF%呈正相关，慢波睡眠占总睡眠时间百分比与睡眠呼吸暂停低通气指数（AHI）呈负相关。结论慢阻肺急性加重高风险患者的主、客观睡眠质量均较差，重叠综合征患者睡眠质量较罹患单一疾病患者更差，PSQI与过去一年急性加重次数、呼吸困难指数、ESS评分相关，客观睡眠参数与气流阻塞程度、CAT评分、mMRC评分相关。     

软坚散结法治疗甲状腺结节有效性 和安全性Meta分析

目的:系统评价具有软坚散结功效的中药复方治疗甲状腺结节的疗效和安全性。方法:检索具有软坚散结功效的中药复方治疗甲状腺结节的RCTs,进行方法学质量评价并提取数据,用Revman5.3软件进行Meta分析。结果:纳入34篇临床随机对照试验。分析结果显示中药+西药组vs西药组、中药组vs西药组,在总有效率、甲状腺结节直径缩小方面差异有统计学意义。结论:中药治疗甲状腺结节疗效优于西药治疗,且不良反应少,相对安全。     

中西医结合治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭的临床研究

目的:分析中西医结合治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭的临床效果。方法:将我院在2017年3月-2018年9月期间收治的72例慢性阻塞性肺疾病急性加重合并呼吸衰竭患者作为研究对象,应用计算机分组法进行分组,一组给予常规治疗,为常规组,一组给予中西医结合治疗,为观察组,比较两组患者的治疗效果。结果:观察组患者的治疗有效率高于常规组,数据差异有统计学意义;观察组患者治疗后用力肺活量(Forced Vital Capacity,FVC)为(2.11±0.21)L,格拉斯哥昏迷评分量表(Glasgow Coma Scale,GCS)为(42.19±6.47)m/s,1秒用力呼气肺容积(Forced Expiratory Volume in 1 second,FEV1)为(1.37±0.22)L,各项数据优于常规组,数据差异有统计学意义(P<0.05);观察组患者治疗后咳嗽评分为(1.0±0.1)分,喘息评分为(1.2±0.1)分,咳痰评分为(1.2±0.2)分,各项数据均优于常规组(P<0.05)。结论:中西医结合治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭,可叠加药物疗效,治疗疗效显著,有效率较高,可以显著改善肺功能,临床应用价值较高,建议在临床中推广使用。     

经皮肺动脉瓣植入术在肺动脉瓣反流患者中的临床应用

经皮肺动脉瓣植入术(PPVI)在我国作为一种新兴的技术,开展相对较晚,但随着我国医疗水平的不断提高以及临床对于右心室流出道梗阻的先天性心脏病患者术后出现重度肺动脉瓣反流的不断重视,PPVI在我国得到了飞速发展。近十几年来,欧美国家已在临床成熟应用PPVI,相对于传统外科手术而言其具有微创、可重复性、术后疗效好等优点。现对PPVI在肺动脉瓣反流患者中的临床应用进行叙述。     

Analysis of retinopathy of prematurity screening in Tianjin, China

AIM: To analyze the findings of retinopathy of prematurity (ROP) exam in Tianjin, and study the impact of pulmonary surfactant Curosurf and nasal continuous positive airway pressure (NCPAP) in ROP. METHODS: A multicenter retrospective review. 2894 preterm infants (1592 males, 1302 females) from several hospitals in Tianjin were screened from January 2009 to December 2013. Demographic information, ophthalmic outcomes and possible systemic risk factors were recorded. Gestation age, birth weight, oxygen supplementation, Curosurf and NCPAP were used to estimate risk factors for ROP. RESULTS: ROP was found in 448 eyes of 224 patients (7.7%). Among which, severe ROP developed in 98 eyes of 49 patients (21.9%). There was significant statistical difference in RDS, NCPAP, and Curosurf usage between control and ROP groups (P=0.000). Multiple logistic regression analyses of ROP indicated that lower birth weight, younger gestational age, and oxygen supplementation were the risk factors leading to ROP. As the usage rate of Curosurf and NCPAP increased year by year, the usage of oxygen supplementation gradually decreased, the incidence of ROP was also on the decline. CONCLUSION: Low birth weight, young gestational age and oxygen supplementation are associated with ROP. The use of Curosurf and NCPAP may be the factor that reduces the occurrence of ROP.