布地奈德雾化吸入对急性加重期慢性阻塞性肺疾病的临床疗效分析

目的:探讨布地奈德雾化吸入对急性加重期慢性阻塞性肺疾病的临床疗效。方法:将2015年1月至2018年6月期间收治的急性加重期慢性阻塞性肺疾病患者70例随机分为对照组(n=35)和研究组(n=35),对照组患者予以常规基础治疗;观察组在对照组治疗的基础上应用布地奈德1 mg雾化吸入治疗,每日2次,比较两组临床效果。结果:两组患者治疗前FEV1/FVC无明显差异(P0.05),治疗1周后,观察组总有效率和FEV1/FVC明显高于对照组(P0.05)。结论:布地奈德雾化吸入可提高急性加重期慢性阻塞性肺疾病患者的FEV1/FVC,建议临床推广应用。     

布地奈德雾化吸入治疗慢性阻塞性肺疾病急性加重期的临床疗效

目的观察吸入布地奈德治疗慢性阻塞性肺疾病（COPD）急性加重期患者的临床疗效。方法将50例COPD急性加重期患者随机分为治疗组（25例）和对照组（25例）。两组均在常规治疗基础上每日3次雾化吸入布地奈德,治疗组每次2 mg,对照组每次1 mg。对比治疗7 d后患者症状缓解情况及第1秒钟用力呼吸容积（FEV1）、FEV1占预计值（FEV1%）、FEV1/FVC%的变化。结果治疗组临床缓解有效率明显高于对照组,P〈0.05,治疗组FEV1和FEV1/FVC%较对照组明显改善（P〈0.05）。结论每日吸入6 mg布地奈德对COPD急性加重期有更好的疗效,能显著缓解胸闷、喘息、气短症状,有效改善肺功能。     

布地奈德对慢性喘息型支气管炎急性期的临床疗效观察

目的：观察布地奈德混悬液喷射雾化吸入对慢性喘息型支气管炎急性期的临床疗效和气流阻塞的影响。方法：31例慢性喘息型支气管炎急性期患者随机分为治疗组和对照组，分别予布地奈德0．5mg喷射雾化机雾化吸入和甲基泼尼松龙40mg静滴，记录临床症状评分和FEV1%。结果：治疗3天后，治疗组FEV1％增加15％，和对照组差异无显著性（P＜0．05），两组对慢性喘息型支气管炎急性期咳嗽，喘息，气短，胸闷症状改善相似。结论：布地奈德混悬液喷射雾化吸入与静脉使用甲基泼尼松龙一样能明显改善慢性喘息型支气管炎急性期的咳嗽，喘息，气短，胸闷症状和气流阻塞。     

布地奈德混悬液联合多索茶碱治疗中重度慢性阻塞性肺疾病急性加重期的效果观察

目的探讨布地奈德混悬液联合多索茶碱治疗中重度慢性阻塞性肺疾病急性加重期的临床效果。方法将84例中重度慢性阻塞性肺疾病急性加重期患者随机分成两组,观察组和对照组各42例,均给予对症治疗,对照组给予布地奈德混悬液吸入治疗,观察组在对照组基础上联用多索茶碱静滴治疗,疗程均为1w,观察两组患者临床疗效及肺功能改善情况。结果观察组总有效率明显优于对照组(P<0.05),肺功能改善程度明显优于对照组(P<0.05),两组不良反应无统计学差异(P>0.05)。结论布地奈德混悬液联合多索茶碱治疗中重度慢性阻塞性肺疾病急性加重期疗效显著,安全性高,是一种有效的治疗方案。     

肾上腺素与布地奈德交替雾化吸入治疗小儿急性喉炎合并喉梗阻的疗效和护理干预

目的探讨小儿急性喉炎合并喉梗阻经肾上腺素与布地奈德交替雾化吸入治疗的临床效果。方法选取该院2013年1月1日至2016年1月1日60例小儿急性喉炎合并喉梗阻患者,随机分为对照组(30例)和试验组(30例)。对照组患者采用常规治疗;试验组患者使用肾上腺素与布地奈德交替雾化吸入治疗,比较2组的临床治疗效果。结果试验组治疗的有效率和患者满意度均显著优于对照组(P0.05);试验组的症状缓解时间、住院时间和气管切开率均优于对照组(P0.05)。结论肾上腺素与布地奈德交替雾化吸入和有效护理在小儿急性喉炎合并喉梗阻患者中的效果显著,护理结局理想,患者满意度高。     

沙丁胺醇联合不同剂量布地奈德雾化吸入治疗慢性阻塞性肺疾病急性加重期的疗效观察

目的:探讨沙丁胺醇联合不同剂量布地奈德雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效.方法:AECOPD患者121例随机分为C组(n=39)、B组(n=40)和A组(n=42),在常规治疗的基础上,C组予沙丁胺醇5 mg雾化吸入,B组、A组分别联合布地奈德1 mg、2 mg,每天雾化3次,连续治疗10 d.结果:治疗后第3 d、10 d,B组、A组呼吸困难评分和第1s用力呼气容积(FEV1)较C组明显改善(P <0.05及P <0.01),且A组较B组改善更明显(P <0.05); B、A组第10 d症状基本消失.结论:联合雾化吸入沙丁胺醇和布地奈德可明显缓解AECOPD患者呼吸困难等症状,改善肺功能,且6 mg/d较3 mg/d效果更好.     

AECOPD患者采用不同剂量布地奈德雾化吸入治疗的临床疗效

目的探究不同剂量布地奈德雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效。方法选取我院2016年6月～2017年6月间诊断及治疗的72例AECOPD患者,采用随机数表法分为观察组(36例)和对照组(36例),对照组和观察组在常规治疗的基础上予以不同量的布地奈德雾化吸入,分别为1mg/次及2mg/次,每次间隔均为8h,疗程7d。对比两组治疗前后的肺功能、血气指标及治疗总有效率。结果治疗前两组肺功能指标及血气指标均无明显差异(P0.05),治疗后两组上述指标均显著改善,且观察组治疗后FEV1、FEV1/FVC、FEV1%显著高于对照组(t=2.705,6.136,5.895;P=0.008,0.000,0.000),观察组治疗后PO2显著高于对照组(t=4.041,P=0.000),PCO2显著低于对照组(t=3.943,P=0.000)。观察组治疗总有效率显著高于对照组(97.22%vs 80.56%;t=5.063,P=0.024)。结论布地奈德雾化吸入能有效改善AECOPD患者肺功能及缺氧状态,临床疗效显著。     

异丙托溴铵联合布地奈德及沙丁胺醇治疗慢性阻塞性肺疾病急性加重期的临床疗效及安全性

目的探讨异丙托溴铵联合布地奈德及沙丁胺醇治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效及安全性。方法将本院收治的AECOPD患者118例随机分为2组,对照组59例实施布地奈德联合沙丁胺醇雾化吸入治疗,观察组59例以异丙托溴铵联合布地奈德及沙丁胺醇雾化吸入治疗,比较2组治疗效果。结果观察组临床疗效显著高于对照组(P0.05);治疗前,2组血气指标、肺功能指标无显著差异(P0.05),治疗后,观察组均显著优于对照组(P0.05);观察组憋喘、咳嗽、哮鸣音、湿啰音等症状消失时间均显著短于对照组(P0.05);2组不良反应发生率无显著差异(P0.05)。结论采用异丙托溴铵联合布地奈德及沙丁胺醇对AECOPD患者的治疗效果显著,能显著改善患者症状及肺功能,且具有较高的安全性。     

三联雾化吸入治疗在小儿喘息性支气管肺炎中的应用

【摘要】目的：探究异丙托溴铵、布地奈德、特布他林三联雾化吸入治疗小儿喘息性支气管肺炎疾病的疗效及安全性。方法：选取我院收治的62例喘息性支气管肺炎疾病患儿（2019.12-2021.11）为研究对象,采用随机方法将所有患者分为对照组（n=31）与观察组（n=31）,对照组采用布地奈德、特布他林、生理盐水治疗,观察组采用吸入用异丙托溴铵、布地奈德、特布他林联合雾化吸入治疗,观察两组临床症状改善情况、肺功能、不良生活发生率、免疫因子水平、生活质量评分、总有效率。结果：治疗后,观察组临床症状消失时间少于对照组,数据差异明显（P＜0.05）;治疗前,两组肺功能对比无差异（P＞0.05）;治疗后,观察组肺功能较对照组高,数据有差异（P＜0.05）;两组不良反应发生率对比无差异（P＞0.05）;治疗前,两组免疫因子水平对比无差异（P＞0.05）;治疗后,观察组免疫因子水平较对照组低,数据有差异（P＜0.05）;治疗前,两组生活质量评分对比无差异（P＞0.05）;治疗后,观察组活动能力、健康感受以及家庭支持等评分显著高于对照组,数据差异明显（P＜0.05）;观察组总有效率（96.77%）明显高于对照组（70.97%）,两组数据有差异（P＜0.05）。结论：对小儿喘息性支气管肺炎患儿给予异丙托溴铵、布地奈德、特布他林三联雾化吸入治疗,疗效显著,可消除喘息、咳嗽等症状,改善机体免疫力,提高肺功能,可推广。     

布地奈德混悬液雾化吸入联合桉柠蒎肠溶软胶囊治疗慢阻肺急性加重期效果分析

目的探讨在慢性阻塞性肺疾病急性加重期布地奈德混悬液雾化吸入联合桉柠蒎肠溶软胶囊治疗的效果。方法选择2021年1月至2022年2月我院收治的慢阻肺急性加重期患者60例,分为观察组和对照组各30例。对照组接受常规治疗联合布地奈德混悬液雾化吸入治疗,观察组在对照组基础上联合桉柠蒎肠溶软胶囊治疗。比较两组患者治疗前后的肺功能、炎症因子、不良反应发生情况。结果治疗后,两组患者FEV_(1)、PEF、FEF 50%、FEV_(1)/FVC均明显提高(P<0.05),且观察组均明显高于对照组(P<0.05);治疗后,观察组CPR水平明显低于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论布地奈德混悬液雾化吸入和桉柠蒎肠溶软胶囊联合治疗慢性阻塞性肺疾病急性加重期患者,可以有效提高治疗效果,有利改善患者肺功能和降低患者的炎性因子表达,且安全性高,值得推广应用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.