经鼻高流量氧气湿化治疗老年慢性阻塞性肺疾病急性加重合并呼吸衰竭的可行性研究

ObjectiveTo investigate the feasibility of transnasal heated humidified high flow nasal cannula oxygen therapy (HFNC) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure in elderly patients. MethodsA total of 176 elderly patients with AECOPD complicated with respiratory failure who were hospitalized at Peking University Shougang Hospital from December 2016 to January 2022 were enrolled, including 82 patients in an HFNC group and 94 patients in an NPPV group. After treatment, pulse oxygen saturation (SPO₂), arterial partial pressure of carbon dioxide (PaCO₂), oxygenation index (OI), respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP), comfort score, discharge rate, rate of endotracheal intubation, rate of transfer to intensive care unit (ICU), and mortality were compared between the two groups. The independent sample t-test was used for comparison between the two groups. Statistical data are expressed in percentage or number of cases and the χ² test was used for their comparisons. ResultsThe SPO₂ values at 30 min, 1 h, and 6 h were significantly higher in the HFNC group than in the NPPV group (t=-2.049,-2.618, and -3.314, P=0.043, 0.010, and 0.001, respectively). SPO₂ before discharge was significantly lower than that of the NPPV group (t=2.162, P=0.033), but OI at each time point and before discharge had no statistical significance (P＞0.05). MAP at 6 h was significantly higher in the HFNC group than in the NPPV group (t=-2.209, P=0.029), but within the normal range. HRs at 2 h and 3 h in the HFNC group were significantly higher than those of the NPPV group (t=-2.199 and -2.336, P=0.030 and 0.021, respectively). There were no significant differences in RR, HR, or MAP between the two groups at other time points and before discharge (P＞0.05). There was no significant difference in PaCO2 between the two groups (P＞0.05). Comfort score in the HFNC group was significantly higher than that of the NPPV group (t=-46.807, P＜0.001). There were no significant differences in discharge rate, ICU transfer rate, endotracheal intubation rate, and mortality between the two groups (P＞0.05). ConclusionHFNC is as effective as NPPV in treating elderly patients with AECOPD complicated with type Ⅰ or mild type Ⅱ respiratory failure, and HFNC is more comfortable than NPPV.     

Dynamic Indicators That Impact the Outcomes of Thoracic Endovascular Aortic Repair in Complicated Type B Aortic Dissection

PurposeTo investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).Materials and MethodsSeventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (> 30 days) outcomes after intervention.ResultsOverall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA < 25% in 1 cardiac cycle (P = .049) and larger D-TLA (P < .001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730–0.967) for predicting early mortality and 0.742 (95% CI 0.611–0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA > 21.5% group compared with the D-TLA ≤ 21.5% group (all P < .001).ConclusionsLarger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.     

探讨替米沙坦对冠心病合并糖尿病肾病患者疗效的影响

目的:探究替米沙坦对冠心病合并糖尿病肾病患者疗效的影响情况。方法:56例探究目标对象均为某院接收的冠心病合并糖尿病肾病患者,挑选时间2018年6月~2019年6月。将"计算机表法"作为分组的参考,分配为参照组(n=28例)执行依那普利治疗,探究组(n=28例)执行替米沙坦治疗。结果:探究组的LVEF、LVEDd、肌酐、24h尿蛋白4项指标与参照组相比,差异有统计学意义(P<0.05);收缩压、舒张压、空腹血糖、餐后2h血糖4项指标与参照组相比,差异没有统计学意义(P>0.05)。结论:冠心病合并糖尿病肾病患者选择替米沙坦治疗后,心室功能的重构以及肾脏预后结局均得到改善,且临床效果比依那普利好,值得借鉴。     

复杂性严重胰腺外伤的外科综合治疗

目的 探讨复杂性严重胰腺外伤的抢救和治疗.方法 本组12例患者采取外科手术、胃造瘘和空肠造瘘、腹腔置管冲洗、深静脉高营养等综合治疗.结果 抢救成功10例,死亡2例.结论 复杂性重度胰腺外伤的患者,准确判断伤情,不断调整治疗方案;选择合理的手术方式和手术时机,胃造瘘和空肠造瘘,深静脉高营养是治疗的关键,胰周的通畅引流和灌洗是抢救治疗成功保证.     

加味薏苡附子败酱散对复杂性肛瘘患者术后的疗效观察

目的:探讨加味薏苡附子败酱散联合常规换药在复杂性肛瘘术后患者中的疗效观察及对视觉模拟疼痛(VAS)评分的影响。方法:选择复杂性肛瘘患者106例作为对象,电脑抽取随机数法分为两组,各53例。两组均采用手术治疗,对照组术后常规换药干预,观察组在对照组基础上联合加味薏苡附子败酱散干预,术后14 d对患者效果进行评估,并完成6个月随访,比较两组术后肛门功能、VAS评分、术后创面愈合评分及术后并发症、复发率。结果:观察组术后14 d排便干燥(0.68±0.14)分、不自主气体(0.70±0.16)分、需要衬垫(0.69±0.15)分、生活方式(0.72±0.18)分及稀便评分(0.63±0.12)分均低于对照组[排便干燥(1.69±0.45)分、不自主气体(2.10±0.46)分、需要衬垫(1.84±0.42)分、生活方式(1.67±0.36)分及稀便评分(2.16±0.39)分,差异有统计学意义(t=7.591、5.434、6.316、6.019、5.693,P0.001);观察组手术后14 d VAS评分(1.15±0.32)分、渗液(0.56±0.09)分及肉芽生长评分(1.72±0.16)分均低于对照组[VAS评分(3.24±0.41)分、渗液(1.69±0.11)分及肉芽生长评分(2.15±0.23)分],差异有统计学意义(t=7.493、5.671、6.434,P0.001);两组术后尿潴留、切口感染及肛门失禁发生率、术后1、3个月复发率差异均无统计意义(χ~2=0.343、1.101、1.039、1.101、0.343,P=0.558、0.315、0.308、0.315、0.558);观察组术后6个月复发率低于对照组(χ~2=4.970,P=0.026)。结论:加味薏苡附子败酱散联合常规换药用于复杂性肛瘘术后患者能提高患者肛门功能,减轻疼痛,能促进创面愈合,可降低术后复发率,且未增加手术并发症发生率。     

白内障超声乳化吸除术联合人工晶体植入术治疗葡萄膜炎并发白内障的临床研究

目的 观察白内障超声乳化吸除术联合人工晶体植入术治疗葡萄膜炎并发白内障的临床效果。方法 选取2017年1月—2019年3月本院收治的92例(92只眼)葡萄膜炎并发白内障患者为研究对象,遵循随机对照原则将其分为对照(n=46)和观察组(n=46)。对照组行常规小切口白内障囊外切除术联合人工晶体植入术治疗,观察组行白内障超声乳化吸除术联合人工晶体植入术治疗。观察两组视力、炎症细胞计数及术后并发症情况。结果 对照组术后1周视力(0.59±0.08)及3个月视力(0.87±0.12)均低于观察组的(0.78±0.10)、(1.08±0.18),差异有统计学意义(P值均<0.05);对照组术后1周炎症细胞计数(20.67±8.36)个/0.5 mm3、1个月炎症细胞计数(8.68±4.36)个/0.5 mm3高于观察组的(14.65±6.54)个/0.5 mm3、(3.68±2.65)个/0.5 mm3,差异有统计学意义(P值均<0.05);较对照组相比,观察组术后并发症发生率较低(4.35% VS 21.74%),差异有统计学意义(P<0.05)。结论 白内障超声乳化吸除术联合人工晶体植入术可有效提高葡萄膜炎并发白内障患者视力,且术后并发症发生率低,安全性更高。     

关思友治疗疑难病的临床辨证思路撷菁

关思友先生治疗疑难病时,在辨证论治的基础上,借鉴前医经验,注重逆向思维,取得良好的临床疗效。临证时,不囿表面所见,把细究病因放在重要地位,并提倡“治病不可因循守旧,固守古训,要圆机活法,因人、因地、因时治宜,有是证用是药。”     

慢性阻塞性肺疾病继发院内真菌感染的危险因素及药物经济学分析

目的 :分析慢性阻塞性肺疾病 (COPD)急性加重期继发院内深部真菌感染的危险因素及其药物治疗的经济学意义。方法 :查阅 2 0 0 0年 10月～ 2 0 0 1年 10月我院 74例COPD急性加重期患者的病历 ,对其抗生素应用种类、应用时间、糖皮质激素应用情况、真菌感染部位、菌种类型、抗真菌药物、住院费用及平均住院日进行分析。结果 :高龄及营养状况差是院内真菌感染的危险因素之一 ,而广谱抗生素长期大量应用则是造成真菌感染的重要因素 ,另外 ,合并应用糖皮质激素也是院内真菌感染的又一发病因素。继发院内真菌感染 ,明显延长了住院时间 ,增加了住院费用。结论 :减少院内真菌感染 ,对遏制医疗费用的增长 ,节约国家的卫生资源 ,具有重大意义     

非膨胀浓度全氟丙烷治疗黄斑孔视网膜脱离

目的　探讨玻璃体切除联合非膨胀浓度的全氟丙烷 (C3 F8)气体治疗复杂性黄斑孔视网膜脱离的价值。方法　玻璃体切除联合 12 %～ 16%的C3 F8气体治疗复杂性黄斑孔视网膜脱离 2 0例 (2 0眼 ) ,并与膨胀浓度C3 F8气体治疗 2 0例 (2 0眼 )作对照 ,观察其疗效及并发症。结果　两组总治愈均为 19眼。术后并发性白内障两组各 3眼 ;术后高眼压 :非膨胀浓度组 1眼 ,膨胀浓度组 9眼 ,两组差异有显著意义 (P <0 0 1)。结论　玻璃体手术联合非膨胀浓度的全氟丙烷气体治疗复杂性黄斑孔视网膜脱离疗效好、并发症少。     

玻璃体切割术治疗复杂性玻璃体视网膜病变

目的：回顾性分析玻璃体切割术治疗复杂性玻璃体视网膜病变的疗效。方法：对58例（61日艮）复杂性玻璃体视网膜病变病人行常规睫状体平坦部三通道玻璃体切割术。并根据病情相应处理视网膜病变，选择眼内激光及眼内填充物。结果：随访3～13mo，术后矫正视力不同程度改善46眼（75％），12眼（20％）不变，3眼（5％）视力减退。结论：玻璃体切割术联合视网膜手术及光凝、眼内气体、硅油填充治疗复杂性玻璃体视网膜病变有效。