射频消融术节律控制持续房颤合并心衰患者疗效观察

目的：分析射频消融术节律控制用于持续性房颤合并心衰患者的临床疗效情况。方法：选择2018年1月至2019年12月期间收治的61例持续性房颤合并心衰患者为研究对象，按随机抽签法分成观察组和对照组，其中观察组28例，对照组33例。两组患者均根据病情采用抗心衰药物治疗，主要为呋塞米、螺内酯、美托洛尔、培哚普利叔丁胺、缬沙坦、地高辛等，对照组采用单纯药物抗心衰治疗标准方案；观察组采用射频消融术节律控制治疗房颤同时给予药物抗心衰治疗标准方案。对所有患者进行12个月的随访，收集心脏彩超、6 min步行试验（6MWD），脑钠肽（Brain Natriuretic Peptide, BNP）、明尼苏达心衰量表评分、纽约心脏病协会（New York Heart Association, NYHA）心功能分级等心功能指标，同时记录窦性心律维持、心衰再住院、栓塞事件等发生情况。结果：治疗后观察组患者的心功能分级、明尼苏达心衰量表评分、左室射血分数（Left Ventricular Ejection Fractions, LVEF）、左房直径（Left Atrium Diameter, LAD）、左心室舒张末内径（Left Ventricular End Diastolic diameter, LVEDd）、BNP、6MWD、NYHA分级均优于对照组（P＜0.05）；观察组心衰再住院率更低、维持窦性心律比例更高，与对照组相比，差异有统计学意义（P＜0.05）；观察组脑卒中发生率更低，但两组差异无统计学意义（P＞0.05）。结论：对持续性房颤合并心衰患者采用射频消融术与抗心衰药物相结合的方法进行治疗，相较于单纯的药物抗心衰治疗，前者治疗效果更为显著，且患者预后更好。     

变化莫测的糖尿病合并冠心病(上)

糖尿病伴发冠心病时可出现无痛性心肌梗死,患者仅表现出轻微的胸闷、上腹部堵闷、不适、恶心、憋气等症状。糖尿病、闭塞性脑血管病或心衰的老年病人易出现无痛性心梗,容易漏诊,下面以系列病例详述。     

苯磺酸氨氯地平联合血塞通治疗脑梗死并发高血压的效果

目的:探讨苯磺酸氨氯地平联合血塞通治疗脑梗死并发高血压的临床效果。方法:抽取收治的96例脑梗死合并高血压的患者为研究对象,按照抽签的办法将其分为常规组和试验组,每组48例,常规组采用口服苯磺酸氨氯地平的方法治疗,试验组采用苯磺酸氨氯地平和血塞通联合用药的方法治疗。对比两组患者用药1个疗程后血压情况、脑卒中神经缺损程度[美国国立卫生研究院脑卒中量表(NIHSS)评分]、痴呆程度[简易精神状态检查(MMSE)评分]和自理能力[Barthel指数(BI)]。结果:1个疗程后试验组血压低于常规组,差异有统计学意义(P<0.05)。1个疗程后试验组NIHSS、MMSE和BI各项指标均优于常规组,差异有统计学意义(P<0.05)。结论:对于脑梗死合并高血压的患者采用苯磺酸氨氯地平与血塞通联合用药的方法治疗,患者身体功能各项指标恢复情况都比单一用药效果好。     

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.     

布地奈德合BiPAP治疗老年支气管哮喘并呼吸衰竭疗效观察

目的:探讨布地奈德联合双水平呼吸道正压通气(BiPAP)治疗老年支气管哮喘合并呼吸衰竭患者的疗效。方法:选取我院2016年10月～2018年9月收治的老年支气管哮喘合并呼吸衰竭患者74例,按照随机数字表法分为观察组和对照组,每组37例。对照组采用BiPAP治疗,观察组采用BiPAP+布地奈德治疗,观察比较两组临床疗效,治疗前后肺功能及血气分析各指标变化情况。结果:观察组治疗总有效率94.59%(35/37),高于对照组的75.68%(28/37)(P0.05);治疗后观察组最大呼吸峰值(PEF)、用力肺活量(FVC)、第1秒用力呼气容积率(FEV1%)水平高于对照组(P0.05);治疗后观察组动脉血二氧化碳分压(Pa CO2)低于对照组,动脉血氧分压(Pa O2)高于对照组(P0.05)。结论:布地奈德联合BiPAP治疗老年支气管哮喘合并呼吸衰竭患者可改善患者血气分析指标水平,促进患者肺功能恢复,效果显著。