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.     

Colles骨折手法复位的治疗体会

Colles骨折是指桡骨下端2～3cm以内、骨折远端向背及桡侧移位的骨折.本院门诊于1994年1月至2005年4月共诊治Colles骨折240例,其中40例关节内骨折,经闭合复位后,关节面的移位仍大于2mm者,收住院手术治疗;门诊复位满意的200例患者中186例获得随访,总结如下.     

烧伤兔血清对培养内皮细胞的影响

本实验采用血管内皮细胞培养模型，动态观察了家兔烧伤（３０％Ⅲ度）早期烧伤表对内皮细胞结构和功能的影响，通过相差显微动态观察、台盘菜染色、ＨＥ染色光镜检查及扫描电镜观察。同时检测孵育不同时相点增减液中ＬＤＨ、６－ｋｅｔｏ－ＰＧＥ１α、ｔＰＡ及内皮细胞抗上板粘附能力变化。结果显示：（１）烧伤血清对内皮细胞有明显的损伤作用功能改变早于结构损害，而结构损害又以细胞间连接及其表达结构改变为早；（２）烧伤血     

UVA对人角质形成细胞的氧化损伤作用

①目的　探讨紫外线A(UVA)对人角质形成细胞氧化损伤的机制。②方法　用 5J/cm2 UVA照射角质形成细胞 ,酶生化法检测活性氧 (ROS)的含量及超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH PX)活性的变化 ,流式细胞仪测定紫外线对角质形成细胞凋亡的影响 ,原位杂交技术观察 p2 1mRNA的变化 ,并与非照射组比较。③结果　与对照组比较 ,UVA照射组ROS含量升高 (t =113.6 8,P <0 .0 0 1) ,SOD、GSH PX活性下降 (t =5 7.2 3、19.0 4 ,P <0 .0 0 1) ,细胞凋亡率升高 (t=5 3.2 8,P <0 .0 0 1) ,p2 1mRNA表达增强。④结论　UVA对人角质形成细胞的损伤与氧自由基生成增多及细胞抗氧化能力抑制有关     

急性间歇性卟啉症的分子诊断学

希腊Ioannina大学微生物系的Dr Vrioni等收集了243例急性布鲁氏菌病患者的全血和血清，这些患者经血培养、血清学检测及患者临床特征确诊，其中通过血培养鉴定布鲁氏菌种类诊断的病人为179例；通过临床体征和血清学检测诊断的病例为64例；同时选取50名健康个体做对照组。研究者选取对布鲁氏菌类起特异性免疫反应的细胞膜蛋白的编码基因中一段长223bp保守序列进行扩增，     

bcl-2和P~(53)蛋白在喉鳞癌中的表达及其意义

目的 :探讨 bcl-2、P53基因蛋白在喉鳞状细胞癌中的表达及其临床意义。方法 :采用免疫组化 SP法检测 60例喉癌 ,1 0例喉息肉组织中 bcl-2、P53蛋白的表达水平 ,分析bcl-2、P53表达水平与喉鳞癌组织学分级 ,颈淋巴转移和预后的关系。结果 :bcl-2与 P53表达呈负相关。 bcl-2和 P53表达与组织学分级有关 ;bcl-2表达随分级增加阳性率降低 ,P53则相反 ;P53表达与淋巴结转移有关 ;bcl-2表达与颈淋巴结转移无关。结论 :bcl-2和 P53阳性表达与喉鳞癌的发生和组织学分级有关 ,P53表达与喉鳞癌颈淋巴结转移有关 ,可单独作为喉癌的预后指标     

沈阳地区肾综合征出血热病人血清分型的微量细胞病变中和试验法

目的：探讨沈阳地区肾综合征出血热(HFRS)的型别。方法：对采自沈阳市传染病院临床确诊及免疫荧光法确认的HFRS患者恢复期血清92份，用MCPENT法进行检测。结果：检出姬鼠型66份，占71．7％；家鼠23份，占25％；未定型3份，占3．3％。结论：证实了沈阳地区是以姬鼠型为主的HFRS混合感染疫区。同时由于MCPENT方法的特异性和稳定性使之成为疫区型别研究的较理想方法之一。     

中医药防治高脂血症信息分析

高脂血症是常见而多发的现代难治的代谢与内分泌疾病之一,又称血脂过多、高脂蛋白血症。人体脂质和脂蛋白代谢紊乱与许多疾病有密切的因果关系,如动脉粥样硬化、糖尿病、脂肪肝、肾病,尤其是心脑血管病的发病的物质基础与危险因素。目前西医学多采用控制饮食或使用调血脂药物,但这些药物常有一定毒副作用与禁忌,因此人们就仰求中医药学在防治此病症方面发     

什么声音最扰人美梦?

有人问医生,他在睡觉时喜欢整夜都把收音机开着,这是否会降低睡眠的质量?医生的答案是:可能会。因为声音可能使人睡得不那么熟。而睡眠效果最好、休息最充分的一段是在熟睡的那段时间里。 一位睡眠专家说,经过训练,一个人几乎可以在任何条件下睡着,再吵也没有关系。     

大佃液压力蒸汽灭菌中的体会

作者在大输液压力蒸汽灭菌中，观察了５－羟甲糠醛值的变化，以及如何控制升温速度和维持灭菌时间等问题。提出了适速升温，足够的维持与尽快的降温等操作原则。