住院哮喘患者行机械通气治疗情况分析

目的分析住院哮喘患者行机械通气治疗情况。方法采取回顾性方法,收集6年内住院哮喘患者中行机械通气治疗的患者年龄、性别、所患疾病种类和住院费用等临床资料,分别进行统计和分类汇总。结果 2009~2014年共有1327哮喘患者住院治疗,行机械通气的患者占6.6%,其中行无创机械通气治疗占3.4%,有创机械通气占3.2%。行机械通气治疗哮喘患者倾向于高龄、入住ICU,出现II型呼吸衰竭。有创机械通气治疗组与无创治疗组和非机械通气组比较,肺炎、糖尿病、脑血管病和肾功能不全等伴发疾病多。无创机械通气治疗组患者,男性多,合并支气管扩张多,冠心病、肝功能不全等合并症与非机械通气组相似。进一步进行危险因素分析,发现无创机械通气危险因素较少,只有年龄大于65岁、男性、入住ICU、出现II型呼吸衰竭和合并支气管扩张;有创机械通气的危险因素较多,为年龄大于65岁、入住ICU、出现II型呼吸衰竭、合并肺炎、冠心病、糖尿病、脑血管疾病和肝、肾功能不全。非机械通气哮喘住院患者住院人均费用为11667元,而机械通气治疗的住院哮喘患者人均费用42460元,与非机械通气患者比较,差异有显著性统计学意义(P0.05)。住院非机械通气哮喘患者死亡率为0.2%,无创通气治疗组死亡率为2.2%,有创通气治疗组死亡率为27.9%,各组间差异有显著统计学意义(P0.05)。结论高龄和合并症是导致患者行机械通气治疗的主要原因。     

无创正压通气治疗有效的证据

在过去的10年，无创通气再度崛起，它可较之有创通气更加方便、舒适、安全和经济地提供通气辅助。本文探讨应用无创机械通气的趋势，并提供无创机械通气治疗慢性和急性呼吸衰竭等疾病的当前视角以及有效的证据。     

无创正压通气和支气管灌洗术在哮喘重度急性发作伴有呼吸衰竭治疗中的价值

目的 探讨无创正压通气结合支气管灌洗术在哮喘重度急性发作伴有呼吸衰竭治疗中的价值。方法 将23例哮喘重度急性发作伴有呼吸衰竭患者分为2组,常规治疗组（A组）和常规治疗＋无创正压通气＋支气管灌洗组（B组）,比较两组的疗效。结果A组有9例最后接受有创通气治疗（90％）,共4例死亡（40％）;B组仅3例（23．1％）最后接受有创通气治疗,共3例死亡（23．1％）。结论 哮喘重度急性发作伴有呼吸衰竭患者先试行无创正压通气结合支气管灌洗术治疗有可能避免有创机械通气。     

机械通气对老年肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响

目的 探讨机械通气对肺动脉高压伴呼吸衰竭患者血浆脑钠肽(BNP)水平的影响.方法 选择肺动脉高压伴呼吸衰竭患者60例,随机分成两组,每组30例,有创机械通气组在常规治疗的基础上给予气管切开或气管插管呼吸机辅助呼吸,无创机械通气组在常规治疗的基础上给予面罩呼吸机辅助呼吸,分别观察治疗前及治疗24 h后两组患者血气分析、血浆BNP含量及肺动脉压的变化.结果 治疗24 h后两组患者动脉血气分析指标均较治疗前有明显改善(P＜0.05),并且有创机械通气组较无创机械通气组改善明显(P＜0.05);治疗24 h后无创机械通气组和有创机械通气组患者血浆BNP含量及肺动脉压力明显降低(P＜0.05),无创机械通气组患者较有创机械通气组患者下降明显(P＜0.05).结论 机械通气治疗肺动脉高压伴呼吸衰竭患者效果显著,明显改善血气分析指标,降低BNP水平及肺动脉压力,并且有创机械通气效果优于无创机械通气.     

个性化心理干预提高慢性阻塞性肺病23例无创通气治疗依从性

无创通气是指不建立人工气道，采用鼻（面）罩进行呼吸支持的机械通气技术，是呼吸内科用于治疗慢性阻塞性肺病（chronic obstructive pulmonary disease，COPD）、重症哮喘及呼吸衰竭的早期主要治疗方法，可达到一定水平的气体交换和改善氧合的目的。且相对于传统有创机械通气而言，     

无创正压通气治疗有效的证据

在过去的 10年 ,无创通气再度崛起 ,它可较之有创通气更加方便、舒适、安全和经济地提供通气辅助。本文探讨应用无创机械通气的趋势 ,并提供无创机械通气治疗慢性和急性呼吸衰竭等疾病的当前视角以及有效的证据。     

序贯性机械通气在救治老年慢性阻塞性肺疾病急性呼吸衰竭患者中的应用

近年来国内外对从有创机械通气过渡到无创通气的研究较多，如何更合理、更有效使用序贯机械通气，是治疗慢性阻塞性肺疾病（COPD）急性呼吸衰竭的重要课题。我们通过有创-无创序贯性机械通气抢救COPD急性呼吸衰竭患者24例，取得了较好效果，现报道如下。     

BiPAP无创通气治疗重症哮喘20例疗效观察

目的探讨BiPAP无创通气对重症哮喘的治疗作用。方法在常规治疗基础上,应用BiPAP呼吸机对20例重症哮喘并呼吸衰竭者进行无创通气治疗,观察临床表现及血气指标等的变化。结果2例于无创通气2h临床症状及血气指标无改善或恶化、2例在治疗过程中出现极度烦躁而改用气管插管有创机械通气治疗。其余16例患者经无创通气治疗2h后症状及血气即有不同程度改善,24h改善更明显,于2~5d（平均3.2d）内撤离呼吸机,住院时间5~11d,平均8.2d。无创通气有效率80.0%。除1例面部皮肤压伤,2例出现腹胀外,无其他机械通气并发症。结论BiPAP无创通气是治疗重症哮喘并发呼吸衰竭的安全而有效的方法。     

无创正压通气在严重急性呼吸综合征呼吸衰竭中的应用

临床实践表明，有23％～32％的严重急性呼吸综合征（SARS）患者可能合并急性肺损伤和（或）急性呼吸窘迫综合征的呼吸衰竭，需机械通气辅助呼吸。应用低潮气量的肺通气保护策略进行有创机械通气治疗SARS呼吸衰竭已得到广泛认同。但无创正压通气（NPPV）的应用价值在国际上尚存争议。在SARS暴发早期，中华医学会出版的相关指南中推荐尽早应用NPPV以改善患者的缺氧状态。     

无创呼吸机治疗重症支气管哮喘15例临床分析

重症支气管哮喘是呼吸科急症,除药物治疗外有创机械通气常作为抢救的最后手段,无创通气是近年来呼吸衰竭治疗的重要进展,这避免有创通气所带来损伤及并发症,我们于2004年偿试无创通气抢救重症支气管哮喘,亦取得满意疗效,现报告如下:1对象与方法本组男8例,女7例,均为2004-2005年     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.