以癫痫发作为主要临床表现的线粒体脑肌病患者的临床及MRI特点分析

目的探讨总结以癫痫发作为主要临床表现的线粒体脑肌病的临床及脑部MRI表现特点,以提高对其认识及诊断正确率。方法回顾性分析7例临床确诊的以癫痫发作为主要临床表现的线粒体脑肌病患者的临床表现、简易乳酸运动试验、脑部MRI表现特点,进行分析总结。结果7例患者中男性3例,女性4例,年龄最大者39岁,最小者13岁,7例均有长期反复发作四肢抽搐病史,伴视物模糊1例,肢体乏力1例;7例患者行简易乳酸运动试验,6例患者高于正常参考值;7例患者脑部MRI均显示为大脑半球受累,6例为双侧大脑半球,其中颞、顶、枕叶较额叶多见,3例皮层受累为主,4例皮层及皮层下白质受累,1例累及双侧基底节区及右侧小脑半球,出现软化灶及脑萎缩;6例患者行多体素磁共振波谱成像检查,5例局部病变区可见乳酸峰;5例扩散加权成像提示病变区轻度扩散受限;2例患者行增强扫描,病变区皮层呈脑回样强化。结论以癫痫发作为主要临床表现的线粒体脑肌病的临床及脑部MRI特点多不典型,易于与其他疾病相混淆,诊断较困难,综合分析病史、简易乳酸运动试验、脑部MRI表现特点,有助于提高对疾病的认识和诊断的正确率。     

有氧运动对慢性阻塞性肺疾病稳定期患者外周血调节性T细胞亚群与心肺运动功能的干预研究

目的:探讨COPD稳定期患者有氧运动前后调节性T细胞(Treg)亚群细胞及心肺运动功能变化情况,研究有氧运动改善COPD稳定期患者临床症状、促进COPD患者康复的机制。方法:选取2016年1月—2017年12月我院住院COPD稳定期患者为研究对象。COPD对照组30例用12周吸氧、化痰、舒张支气管等常规药物治疗,COPD试验组30例用常规治疗同时施加有氧运动干预12周。比较患者治疗前后外周血中的Treg细胞亚群比例、IL-17和TGF-β表达水平与心肺运动功能变化情况。结果:有氧运动干预后,试验组Treg细胞亚群比例较干预前及对照组治疗后升高,且IL-17及TGFβ表达水平降低(P0.05);峰值公斤摄氧量(Peak VO_2/kg)、峰值功率(Peak Power)、峰值CO_2排出量(Peak VCO_2)较干预前及对照组药物治疗后得到一定改善(P0.05)。结论:有氧运动对COPD稳定期患者具有调节免疫功能、减轻炎症反应、改善肺功能和促进肺康复的作用,为临床COPD稳定期患者的有氧运动在免疫学上提供理论依据。     

Dependence of maximum performance time on work intensity in patients with a hereditary myopathy with succinate dehydrogenase deficiency

Summary. Patients with a hereditary mitochondrial myopathy with succinate dehydrogenase (SDH) deficiency and abnormal lactacidosis during physical exercise have a low work capacity when exercising for about 10–15 min. Their maximum voluntary muscular strength is fairly normal. The relationship between the time (t) and a constant workload (N) that a healthy subject can maximally sustain can be expressed as: log t =β+α log N. For normal subjects the constant a is approximately -5 and the constant β has a large interindividual variation. Of four myopathy patients a was determined from two or three maximum bicycle exercise tests of different duration (including ramp- and steady-state tests using a new application of the method of adding submaximal loads to the final maximum workload). The value of a varied between -1.0 and -1.81 and p had low values, both significantly different from those of healthy subjects. The a values explain the divergent results that may be obtained with different types of exercise tests in some of these patients, i.e. a normal or moderately reduced capacity in exercise tests of short duration (for example a short Tornvall or a ramp type of test) and a very low exercise capacity in tests of longer duration (for example a steady state type of test with workloads chosen to allow at least two loads). The low absolute value of α may be related to the abnormally increased anaerobic metabolism of these patients during exercise, caused by the SDH deficiency.     

Changes in coronary haemodynamics and myocardial metabolism at rest and during exercise after a cardiotonic drug (prenalterol) in patients with coronary artery disease

Summary. To elucidiate the myocardial metabolic and haemodynamic effects of an inotropic drug in patients with coronary artery disease (CAD) without evident congestive heart failure (CHF), the acute effects of prenalterol were studied in nine patients. Patients with documented CAD by leftsided cardioangiography and end-diastolic pressure >15 mm Hg were included in the study. They were examined at rest and during supine exercise at a level just below their anginal threshold before and after prenalterol. At rest, rate pressure product (RPP) increased by 40% (P<0·01), cardiac index rose 20% (P<0·01), cardiac venous flow (CVF) increased by 18% (P<0·05), and myocardial oxygen consumption (MVO₂) increased by 20% (P<0·05) after prenalterol administration. Despite a decrease in mean pulmonary capillary venous pressure (PCV) of 40% (P<0·01), myocardial lactate extraction fell significantly (P<0·01) and lactate production was observed in three of nine patients compared to before prenalterol administration. During exercise, RPP increased by 20% (P<0·01), cardiac index remained unchanged, CVF increased by 25% (NS) and MV0₂ showed a tendency to an increase (NS) after prenalterol administration. Mean PCV pressure decreased by 30% (P<0·01). Myocardial lactate extraction was markedly reduced during exercise (P<0·01) and five of nine patients showed lactate production compared to that before prenalterol administration. Thus, despite a decrease in left ventricular filling pressure, increased myocardial oxygen demand occurred after acute administration of prenalterol. Prenalterol and probably similar inotropic drugs should be used cautiously in patients with CAD without clinical evidence of congestive heart failure.     

冠状动脉临界病变患者心肺运动试验的特点及临床意义

目的 回顾性分析冠状动脉临界病变患者心肺运动试验的临床特点和功能能力的变化。方法 回顾分析北京博爱医院2015年1月至2020年1月行冠状动脉造影并同期行心肺运动试验测试的患者,其中冠脉临界病变组184例,非冠心病组73例。比较两组症状、基线资料、实验室和超声心动图数据、心肺运动试验结果,并观察1年内主要心血管事件。结果 与非冠心病组相比,冠脉临界病变组男性比例显著升高(χ2=15.857, P <0.001),有吸烟史(χ2=9.067, P=0.003)、高血压病史(χ2=15.087, P <0.001)、高脂血症病史(χ2=13.507, P <0.001)的比例明显升高;糖化血红蛋白(Z=2.431, P=0.015)和超敏C-反应蛋白(Z=2.108, P=0.035)水平偏高;达到无氧阈比例明显偏低(χ2=10.702, P=0.001);无氧阈时的心率和呼吸交换率降低(Z> 2.156, P <0.05);两组1年后主要心血管事件发生率无显著性差异(P=1.000)。结论 冠脉临界病变患者心肺功能有所降低,应控制吸烟、高血压、高脂血症、糖尿...     

探讨肺癌患者胸腔镜肺切除术后肺部并发症发生的影响因素

目的:将心肺运动试验(CPET)与临床指标相结合评估肺癌患者胸腔镜肺切除术后肺部并发症(PPCs)的影响因素.方法:回顾性分析我院胸外科行胸腔镜(VATS)肺切除手术的肺癌患者,收集患者的基线资料、CPET及临床相关数据,通过单因素分析、Logistics多因素分析和受试者工作特征曲线(ROC),找出PPCs发生的影响...     

心肺运动试验指导下的心脏康复对冠心病PCI术后患者运动耐量及生活质量的临床研究

目的：探讨冠心病经皮冠状动脉介入术（PCI）后患者在心肺运动试验(CPET)指导下的心脏康复对其运动耐量及生活质量的影响。方法：将60例冠心病PCI术后患者随机分为观察组和对照组各30例,观察组在CPET评估下制定运动方案,对照组自行身体锻炼。治疗前后,用心肺运动试验评定患者最大摄氧量（VO2 Max）、无氧阈值（AT）、最大代谢当量、无氧阈时代谢当量、最大功率;等速肌力测试计算患者优势侧屈膝及伸膝的疲劳系数;简明健康调查量表（SF-36）和抑郁自评量表（SDS）评估患者生活质量。结果：治疗12周后,观察组VO2 Max、AT、最大代谢当量、无氧阈时代谢当量、最大功率较治疗前及对照组均明显提高(均P＜0.05);2组屈、伸膝疲劳系数均明显低于治疗前（均P＜0.05）,且观察组屈、伸膝疲劳系数均低于对照组（均P＜0.05）;观察组SF-36各项评分均高于治疗前（均P＜0.05）,对照组总体健康（GH）、社会功能（SF）、情感职能（RE）、精神健康（MH）四个维度评分均比治疗前提高（均P＜0.05）,观察组躯体疼痛（BP）、GH、活力（VT）、SF、MH五个维度评分均高于对照组（均P＜0.05）。观察组SDS评分明显低于治疗前及对照组（均P＜0.05）。结论：CPET指导下的心脏康复能改善冠心病PCI术后患者的运动耐量及生活质量,值得临床推广。     

心肺功能运动试验和静态肺功能用于COPD患者应用支气管扩张剂后疗效评定的比较

目的：比较心肺功能运动试验（CPET）和静态肺功能（PFT）评定支气管扩张剂治疗COPD患者疗效的准确性。方法：选择20例初诊的COPD患者,给予为期2周的支气管扩张剂治疗,治疗前后分别给予CPET和PFT检查,记录检查中的一些参数并进行比较。结果：治疗前后PFT参数中第一秒用力呼气容积(FEV1)、FEV1%（占预计值%）无显著差异,深吸气量（IC）有显著差异。治疗后CPET参数最大运动功率(Wmax)、最大摄氧量(VO2max)明显增加,而最大运动负荷时Borg呼吸困难评分有显著下降。△IC与△Wmax、△VO2max呈显著正相关;与△Borg scale评分呈显著负相关。结论：CPET中Wmax、VO2max、Borg Scale呼吸困难评分可以作为支气管扩张剂对COPD患者治疗疗效评定首选的方法。PFT中IC可部分替代CPET中相应参数来进行对COPD患者治疗的评估。     

脓毒症患者血糖、乳酸、乳酸清除率以及碱剩余的监测及其临床应用价值

目的探讨脓毒症患者血糖、乳酸、乳酸清除率以及碱剩余的变化及其对治疗效果及预后判断的应用价值。方法测定89例脓毒症患者入院时的乳酸、碱剩余和入院6h的乳酸并计算6h乳酸清除率;动态测定血糖并选取入院后24h内测定的最差值,另外选取81例患者作为对照组。依据APACHEⅡ分值将观察组分0<20分组、21-30分组和>30分组三组,对患者的观察值进行比较,采用pearson相关分析APACHEⅡ分值与各观察值之间的相关性,另外将存活组的各观察值与死亡组对比。结果观察组的血糖、血乳酸及碱剩余与对照组相比均有统计学意义,观察组组间各观察值比较亦具有统计学意义,且随APACHEⅡ分值的增大血糖、乳酸相应增高、6小时乳酸清除率、碱剩余浓度相应下降,pearson相关分析显示血糖、血乳酸与APACHEⅡ分值呈正相关(r分别为0.594,0.713),而6小时乳酸清除率、碱剩余浓度与APACHEⅡ分值呈负相关(r分别为-0.647,-0.615),死亡组与存活组相比较A-PACHEⅡ评分与血糖、血乳酸明显增高,而6小时乳酸清除率、碱剩余明显降低,差异具统计学意义。结论血糖、乳酸、6小时乳酸清除率联合碱剩余可以综合评估脓毒症患者治疗的疗效和判断预后。     

Evaluation of oxygen uptake kinetics and oxygen kinetics of peripheral skeletal muscle during recovery from exercise in patients with chronic obstructive pulmonary disease

The biochemical features of skeletal muscle and its contribution to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD) is under active investigation. Near-infrared spectroscopy (NIRS) can non-invasively provide information on the oxidative capacity of muscle. To clarify whether oxygenation of peripheral muscle is one determinant of exercise tolerance, we simultaneously examined the oxygen uptake (V O 2off) kinetics and oxygen kinetics of peripheral skeletal muscle evaluated by NIRS during recovery from exercise in COPD patients. Fifteen patients with COPD and five normal control subjects performed a symptom-limited incremental exercise test. On the following day, all patients performed a constant work rate exercise test while being monitored using NIRS continuously for changes in concentration of oxygenated haemoglobin (HbO2) and during expired gas analysis. We found that the time constant of during recovery from constant work rate exercise (V O 2off) and the time constant of V O 2off during recovery (tau V O 2off) were significantly longer in COPD patients than in normal control subjects. was inversely correlated with absolute values of forced expiratory volume in 1 s (FEV1.0) and FEV1.0 (% predicted). However, no significant correlation was found between and FVC (forced vital capacity), FEV1.0/FVC, or diffusing capacity of the lung for CO (DLCO). Moreover, was inversely correlated with maximal V O 2off and maximal work rate. In contrast, exhibited a significant positive correlation with tau V O 2off. These results indicate that V O 2off kinetics during recovery is related to re-oxygenation of peripheral skeletal muscle evaluated by NIRS in patients with COPD. Therefore, NIRS may be a useful tool to estimate the impairment of cardiopulmonary responses and re-oxygenation of peripheral skeletal muscle during the immediate recovery phase after exercise in COPD patients.     

Influence of oxygen administration on pulmonary haemodynamics and tissue oxygenation during exercise in COPD patients with different ACE genotypes

We previously found that the angiotensin-converting enzyme (ACE) DD genotype is associated with exaggerated pulmonary hypertension and disturbance of tissue oxygenation during exercise in chronic obstructive pulmonary disease (COPD) patients. This study was designed to compare the effect of oxygen administration on pulmonary haemodynamics and tissue oxygenation during exercise in COPD patients with different ACE genotypes. Forty-three COPD patients (II=16, ID=12, DD=15) underwent right heart catheterization, and then performed an exercise test with room air or oxygen. We measured pulmonary haemodynamic variables and indices of tissue oxygenation such as mixed venous oxygen tension (PVO2) and arterial lactate concentration, both at rest and after exercise. The magnitude of difference in mean pulmonary arterial pressure and pulmonary vascular resistance after exercise between breathing of room air and breathing of oxygen did not significantly differ among the three groups. PVO2 after exercise with room air or oxygen was significantly higher in patients with the II genotype than in those with the ID or DD genotype. In contrast, lactate concentration after exercise with room air or oxygen was significantly lower in patients with the II genotype than in those with the ID or DD genotype. Moreover, the magnitude of difference in PVO2 and lactate concentration after exercise between breathing of room air and breathing of oxygen was the II>ID>DD genotype. These findings suggest that the ability of oxygen administration to improve tissue oxygenation during exercise is associated with the ACE genotypes in COPD patients.     

肝素加运动治疗稳定型心绞痛疗效探讨

为探讨肝素在冠心病治疗中的作用，将２０例冠心病患者分两组进行比较分析。Ａ组：肝素加运动，共１０例患者，按标准方法进行２０次踏车运动试验，每次踏车运动前２０分钟静脉注射肝素钠５０００Ｕ；Ｂ组：单独肝素组，共１０例患者，进行皮下注射１０次，每次肝素钠１００００Ｕ，试验期间不做运动试验。全部患者在第１次应用肝素前２４小时和最后１次应用肝素后２４小时均行症状限制性踏车运动试验。在Ａ组，运动总时间从７．１３±０．８９分钟（ｘ±ｓｘ，下同）增加到１１．６７±１．０４分钟（Ｐ＜０．００１），最大血压心率乘积从２４０４．００±３１２．００ｋＰａ／ｍｉｎ增加到３１８２．００±４９５．００ｋＰａ／ｍｉｎ（Ｐ＜０．００１），而Ｂ组上述参数无明显改变。结论：肝素配合运动能够加速侧枝循环的建立，而单独应用肝素则无此作用。运动诱发心肌缺血可始动肝素再生血管的作用。本试验为冠心病的治疗提供了又一新的、有效的、实用的治疗方法     

心肺运动试验评估肺癌患者放射治疗前后整体功能变化的临床研究

目的:探讨心肺运动试验(cardiopulmonary exercise testing,CPET)对肺癌患者放射治疗前后整体功能的评估作用。方法:选择2017—2018年在徐州市中心医院住院拟行放疗的肺癌患者12例为研究对象,于放疗前一天和放疗结束后1周均进行症状限制性CPET及静态肺功能一体化检查,通过对数据标准化分析计算其核心指标,并从系统软件导出静息状态、热身状态、无氧阈状态、极限状态及恢复状态时的循环指标、呼吸指标及静态肺功能检查指标;通过SF-36、SAS和SDS量表评估患者放疗前后的生存质量、焦虑及抑郁情况。结果:患者放疗后峰值摄氧量、峰值负荷功率和递增功率运动时间较放疗前明显降低,二氧化碳通气当量斜率及二氧化碳通气当量最低值较放疗前显著升高,均有显著性差异(P<0.05);无氧阈、峰值氧脉搏、摄氧量与功率比值、呼吸储备及代谢当量等值与放疗前比较,差异均无显著性意义(P>0.05)。患者放疗后静息状态下的心率和极限状态、恢复状态下的二氧化碳通气当量较放疗前显著升高(P<0.05);氧脉搏在各个阶段变化不显著(P>0.05)。静息、热身、无氧、极限以...     

Response of plasma neuropeptide Y and noradrenaline to dynamic exercise and ramipril treatment in patients with congestive heart failure

Summary. Forty-two patients with congestive heart failure were studied in order to clarify whether the plasma level of neuropeptide Y-like immunoreactivity (NPY-LI) rises in parallel with plasma noradrenaline (NA) during physical exercise in congestive heart failure (CHF). All patients were studied in a randomized placebo-controlled trial with the ACE-inhibitor ramipril during 12 weeks to determine whether ACE-inhibition alters the response of plasma NPY-LI to exercise. The patients were treated with diuretics and had stable congestive heart failure (NYHA classes II-III). Plasma NPY-LI was 50 5 pmol 1^-1 (mean standard error of the mean) at rest and 60 6 pmol l^-1 at the end of exercise at baseline (P < 0–01). The corresponding values for plasma NA were 2–8 0-2nmoll^-1 and 15-3 l-2nmoll^-1(P < 0–001). Before ACE-inhibition, there was a correlation between high NPY-LI and NA values after exercise. After treatment with ramipril or placebo for 12 weeks, there was no difference in plasma NPY-LI and NA at rest or after exercise between the two treatment groups. The maximal exercise time was unchanged. It is concluded that plasma NPY-LI and NA were elevated at rest in CHF. The additional rise of plasma NPY-LI and NA after exercise was attenuated in CHF compared to healthy individuals. ACE-inhibition with ramipril did not alter plasma NPY-LI or NA at rest or after exercise compared to placebo.     

系统心肺康复训练对冠心病病人运动耐力和生活质量的影响

[目的]探讨系统心肺康复训练对冠心病(CHD)病人运动耐力和生活质量的影响。[方法]按随机数字法将100例康复期CHD病人分为对照组和实验组各50例。对照组按照CHD治疗指南进行常规药物治疗及常规干预,而实验组在对照组基础上进行系统心肺康复训练。于干预前及干预后检测两组病人心功能各项指标,采用6min步行距离测试(6MWD)评价运动耐力,并采用健康调查量表(SF-36)评价病人生活质量。[结果]实验组病人干预后心功能各项指标及6MWD结果较干预前均有明显改善,且优于对照组,差异有统计学意义(P0.05);实验组干预后SF-36量表中各维度评分均高于对照组(P0.05)。[结论]系统心脏康复训练能明显改善康复期CHD病人心功能,提高病人的运动耐力,改善病人的生活质量。     

有氧运动对冠状动脉慢血流患者的疗效及血小板功能的影响

摘要 目的：探讨有氧运动对冠状动脉慢血流患者的疗效及血小板功能的影响。 方法：冠状动脉造影诊断为冠状动脉慢血流的患者43例,观察在常规治疗的基础上,规律有氧运动前后的临床症状,血小板膜CD62P、CD61的阳性百分率（%）及血小板聚集率的变化。 结果：在常规治疗的基础上行运动疗法3个月,胸痛症状明显减轻; 运动后与运动前相比,血小板膜CD62P阳性百分率(%)分别为23.6±3.5及30.3±3.4 (P<0.05) 、CD61阳性百分率(%)分别为22.1±2.8及28.3±3.5 (P<0.05),血小板聚集率(%)分别为61.3±4.3及71.5±5.7 (P<0.05)。 结论：规律运动可以改善冠状动脉慢血流患者的症状,降低患者血小板表面活化受体分子的活性及血小板聚集。     

特发性肺动脉高压患者营养风险与运动耐量间相关性的研究

目的：探讨特发性肺动脉高压患者（idiopathic pulmonary arterial hypertension, IPAH）营养风险与运动耐量间的关系。方法：根据营养风险筛查2002标准（Nutritional Risk Screening 2002, NRS-2002）（以下简称NRS）, 对96例IPAH患者进行营养风险评估, 并根据评分结果分为有营养风险组（n=46）及无营养风险组（n=50）, 2组分别进行血气分析、肺功能检测及心肺运动试验,比较2组间的差异。结果：IPAH有营养风险组与无营养风险组间的性别、年龄、身高及血气分析结果差异均无统计学意义（P均>0.05）, 而有营养风险组患者的体重及体质量指数显著低于无营养风险组（P<0.01）。肺功能检测, 有营养风险组的用力肺活量（forced vital capacity, FVC）、第一秒用力呼气容积（forced expiratory volume in one second, FEV₁）、FVC占预计值百分比（FVC%pred）、FEV₁占预计值百分比（FEV₁%pred）、一氧化碳弥散量（diffusing capacity for carbon monoxide, DL_CO）、DL_CO占预计值百分比（DL_CO%pred）均低于无营养风险组（P均<0.05）, 而2组间其他指标[一秒率（FEV₁/FVC）、深吸气量、肺总量、残气量、残总比（残气量/肺总量比值）]差异无统计学意义（P均>0.05）。心肺运动试验检查, 有营养风险组的峰值功率、峰值摄氧量、峰值通气量、峰值公斤摄氧量、峰值摄氧量占预计值百分比均低于无营养风险组（P 均<0.05）, 而2组间的峰值氧脉搏差异无统计学意义（P>0.05）。96例IPAH患者的NRS评分与峰值功率、峰值摄氧量呈显著负相关（r=-0.335和-0.342, P均<0.01）, NRS评分与峰值公斤摄氧量呈负相关（r=-0.213, P<0.05）。结论：有营养风险的IPAH患者的肺通气功能及弥散功能降低更显著, 运动耐量下降更明显,而NRS评分可反映其运动耐量。     

步行运动对高血压合并糖尿病患者糖代谢、动态血压及生活质量的影响

目的 观察在常规药物治疗基础上辅以步行运动对高血压合并2型糖尿病患者糖代谢、动态血压及生活质量的影响.方法 应用计步器筛选出62例在我科门诊或住院治疗且步行运动量＜5000步/d的高血压合并2型糖尿病患者,采用随机数字表法将其分为运动组(32例)及对照组(30例).2组患者均给予常规药物(包括缬沙坦、二甲双胍、阿卡波糖)治疗,运动组患者在此基础上每天步行10000步以上(对其运动持续时间及运动强度不作限定),对照组仍按照日常习惯生活.于入选时、干预3个月后观察2组患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性(HOMA-IS)、动态血压参数及生活质量变化情况.结果 2组患者分别经3个月干预后,发现运动组患者FPG[(5.41±1.23) mmol/L]、HbA1c[(6.16 ±0.87)％]、FINS[(8.72±2.43) mIU/L]、HOMA-IR[(2.27±1.41)、HOMA-IS[(0.0182 ±0.0034)]、动态血压参数[24h收缩压为(126±13) mmHg,24h舒张压为(72±8) mmHg,白天收缩压为(132±8)mmHg,白天舒张压为(74.4 ±8.3)mmHg,夜间收缩压为(123.1±8.7) mmHg,夜间舒张压为(70.5±6.1) mmHg]及生活质量评分[生理功能为(87.2±11.5)分,生理职能为(73.0±14.3)分,总体健康为(78.6±15.5)分,生命活力为(68.4 ±18.8)分,情感职能为(68.7 ±20.4)分,精神健康为(78.6 ±19.4)分]均较入选时及对照组明显改善(P＜0.05),其间差异均具有统计学意义(P＜0.05).结论 在常规药物治疗基础上每天步行10000步以上可进一步改善缺乏运动的轻度高血压合并2型糖尿病患者糖代谢及动态血压参数,对提高患者生活质量具有重要意义.     

早期乳酸清除率和中心静脉血氧饱和度监测对重症肺炎患者预后的研究

目的：探讨重症肺炎患者早期动脉血乳酸清除率、中心静脉血氧饱和度（ScvO2）的监测价值。方法回顾性研究2012年1月—2013月12月56例重症肺炎患者,入科即刻和6 h时测定动脉血乳酸浓度和早期ScvO2,计算6 h乳酸清除率,并进行急性生理与慢性健康（APACHEⅡ）评分,根据APACHEⅡ评分将患者分为3组：10-＜20分组（A组）,20-＜30分组（B组）,≥30分组（C组）,比较不同组别早期乳酸清除率和ScvO2的差别,并分析其与预后的关系。结果①B组初始动脉血乳酸较A组高,C组初始动脉血乳酸较B组高,但组间差异均无统计学意义（均 P＞0．05）;②B组早期6 h乳酸清除率、ScvO2均较A组低,差异有统计学意义（ P＜0．05）,C组早期6 h乳酸清除率、ScvO2均低于B组,差异有统计学意义（ P＜0．05）。③B组病死率高于A组,C组病死率高于B组,差异均有统计学意义（均 P＜0．05）;④死亡组APACHE Ⅱ评分高于存活组,早期动脉血乳酸清除率和ScvO2水平低于存活组,差异均有统计学意义（均 P＜0．05）;⑤APACHEⅡ评分与早期乳酸清除率呈显著负相关（r＝0．661,P＜0．01）,与早期ScvO2水平呈显著负相关（r＝0．579,P＜0．01）。结论早期动脉血乳酸清除率及ScvO2水平是反映重症肺炎患者病情严重程度和预测患者转归的参考指标。     

Home-based exercise is associated with improved cardiac functional performance in patients after acute myocardial infarction

ObjectiveTo evaluate the effects of home-based exercise and physical activity on cardiac functional performance in patients after acute myocardial infarction (MI) during the coronavirus disease 2019 (COVID-19) pandemic.MethodsThis retrospective study enrolled patients that received treatment of acute ST-segment elevation MI between and were followed-up 6 months later. The patients were divided into physically active and inactive groups based on their levels of home exercise after hospital discharge.ResultsA total of 78 patients were enrolled in the study: 32 were physically active and 46 were physically inactive. The baseline characteristics were comparable between the two groups. At the 6-month visit, left ventricular ejection fraction and six-minute walking test (6MWT) were significantly improved while the proportion of patients with a New York Heart Association (NYHA) functional III classification was decreased in the active patients, whereas these parameters were not significantly changed in the inactive patients. In addition, the 6MWT was greater while the proportion of patients with an NYHA III classification was lower in the active group than the inactive group at the 6-month visit.ConclusionMaintaining physical activity at home was associated with improved cardiac functional performance in patients after acute MI during the COVID-19 pandemic.