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.     

25岁典型急性心肌梗死一例分析

1临床资料 患者,男性,25岁,因发作性胸骨后压榨样疼痛伴大汗1d由急诊转入我科。胸痛前有大量吸烟史,洗澡后突发胸骨后压榨样疼痛向肩背部放射伴大汗及恶心、呕吐。舌下含服消心痛10mg 15min无效,急来我院急诊科。     

心踝血管指数与高血压血管病变的相关性研究

<正>北京医学,2014,36(2):81-83.该文探讨高血压患者心踝血管指数(cardio-ankle vascular index,CAVI)及其相关因素分析。方法:入选体检男性375人,分为对照组(n=233)和高血压组(n=142)。应用动脉僵硬度自动检测装置测定CAVI,作为反映动脉僵硬度的指标,分别应用腹主动脉CTA、直接眼底镜检测腹主动脉及眼底动脉硬化情况。结果:高血压患者CAVI水平显著高于对照组     

健康体检人群脉搏波传导速度及其相关因素分析

目的 健康体检人群脉搏波传导速度(pulse wave velocity,PWV)及其相关因素分析.方法 入选健康体检323人,根据PWV水平分为两组:对照组(PWV＜9 m/s)37人,观察组(PWV≥9m/s) 286人.PWV由Complior仪器测定.结果 观察组人群高血压发病率显著高于对照组.观察组收缩压、舒张压、脉压、甘油三酯水平均显著高于对照组[(141.2±19.9) mmHg比(129.0±18.8)mmHg,P＜0.001; (88.4± 11.1) mmHg比(82.1±10.8) mmHg,P=0.001; (52.8±12.9) mmHg比(46.8±10.6) mmHg,P=0.007;(2.13±1.64) mmol/L比(1.19±0.73) mmol/L,P＜0.001)].观察组高密度脂蛋白胆固醇(HDL-C)水平显著低于对照组[(1.26±0.37) mmol/L比(1.51±0.40)mmol/L,P=0.002)].相关性分析提示总体人群中PWV与年龄、收缩压、舒张压、脉压、血糖、糖化血红蛋白、尿酸、甘油三酯呈显著正相关性(γ=0.124,0.307,0.259,0.255,0.187,0.340,0.169,0.278,均P＜0.05),而与HDL-C呈显著负相关性(γ=-0.283,P＜0.001).多元线性回归分析提示PWV与收缩压、糖化血红蛋白有关(β=0.314,P=0.003;β=0.307,P=0.003).结论 PWV是动脉僵硬度的评价指标,高密度脂蛋白胆固醇可能参与了其中的保护作用,具体机制有待于进一步探讨.     

脂联素通过减轻内质网应激介导的凋亡抑制心肌细胞钙化

目的通过培养SD大鼠乳鼠心室肌细胞并建立细胞钙化模型,观察脂联素对心肌细胞钙化的影响及其机制。方法采用Ⅱ型胶原酶消化法原代培养SD大鼠乳鼠心室肌细胞,α肌动蛋白免疫荧光法进行鉴定。选用培养72 h的单层心肌细胞,实验分为3组:对照组、钙化组、脂联素+钙化组。β-甘油磷酸钠和丙酮酸钠联合诱导制备心肌细胞钙化模型,茜素红和Von Kossa染色法对钙化心肌细胞进行鉴定,通过细胞钙含量、碱性磷酸酶活性和骨钙素的测定判断钙化程度。通过乳酸脱氢酶活性测定和流式细胞术检测心肌细胞凋亡。用定量实时聚合酶链反应测定骨保护素及内质网应激指标葡萄糖调节蛋白78、半胱氨酸天冬氨酸蛋白酶12的表达。结果与对照组相比,单纯心肌细胞钙化后,钙含量、碱性磷酸酶活性和骨钙素分泌量显著增加(P<0.01),骨保护素及内质网应激指标葡萄糖调节蛋白78和半胱氨酸天冬氨酸蛋白酶12在mRNA水平表达明显增高,乳酸脱氢酶活性和细胞凋亡率显著增加(P<0.01)。用脂联素进行干预后,可较大程度地逆转上述指标变化,与心肌细胞钙化组相比均具有显著差异(P<0.05),并且呈现一定的浓度依赖性。结论钙化心肌细胞可以诱导心肌细胞内质网应激介导的凋亡;脂联素可促进血管保护因子骨保护素的表达,并通过减轻内质网应激来减轻心肌细胞钙化及凋亡,对心肌细胞有保护作用。     

心踝血管指数与高血压血管病变的相关性研究

目的 探讨高血压患者心踝血管指数（CAVI）及其相关因素分析.方法 入选体检男性375人,分为对照组（n=233）和高血压组（n=142）.应用动脉僵硬度自动检测装置测定CAVI,作为反映动脉僵硬度的指标.分别应用腹主动脉CTA、直接眼底镜检测腹主动脉及眼底动脉硬化情况.结果 高血压患者CAVI水平显著高于对照组（8.15±1.15 vs.7.66±1.00,P＜ 0.001）.腹主动脉硬化、眼底动脉硬化组CAVI水平显著高于对照组（8.59±0.52 vs.7.74±0.98,P＜0.001;8.38±0.86 vs.7.60±0.95,P＜0.001）.总体人群中,CAVI与年龄、颈-股动脉脉搏波传导速度（cfPWV）、收缩压（SBP）、舒张压（DBP）、脉压（PP）、甘油三酯（TG）、糖化血红蛋白（HbA1c）分别呈显著相关性（r=0.578、0.480、0.236、0.115、0.249、0.131、0.226,P均＜0.05）.多元回归分析提示年龄、HbA1c是CAVI的独立影响因素（β=0.508,P＜ 0.001;β=0.189,P=0.010）.结论 高血压患者CAVI水平明显升高,CAVI是高血压患者大血管、微血管病变的良好评价指标.     

吞咽困难怎么吃饭

老年人吃东西时常会出现吞咽困难、咳嗽、进食时间长等问题,很容易导致吸入性肺炎、营养不良、抵抗力差,甚至窒息等不良结果。可采用以下方法进行验证:取坐位,如往常一样饮用温水30毫升。若5秒内一饮而尽、无呛咳,为正常表现;5秒以上或两次以上喝完、无呛咳,则有吞咽困难的可能;若饮用时发生呛咳,甚至不能将水喝完,就要特别注意,要及时就医。