毛细支气管炎患儿潮气流速容量环及参数变化的临床意义

目的 探讨毛细支气管炎患儿肺功能变化的临床意义。方法 用美国森迪公司2600儿童肺功能检测仪对毛细支气炎患儿及对照组婴儿进行呼吸频率(BF)、到达呼气峰值的呼出量与总呼气量之比(VPEF/VE)、从开始呼气至达到最大呼气流速时间与总呼气时间之比(TPEF/TE)、呼出50％潮气量时呼气流速与呼气峰流速之比(50％PE)、呼出75％时呼出流速与呼气峰流速之比(25％PF)等参数的检测，并描记潮气流速容量环(TFV环)。结果 毛细支气管炎组患儿治疗前与治疗后相比、与对照组相比，VPEF／VE、TPEF／TE、50％PF、25％PF等指标均明显下降，差异有显著意义。治疗前后TFV环形状也有明显区别。结论 VHEF／VE、TPEF／TE、50％PF、25％PF及TFV环可作为评价婴幼儿气道阻塞程度的可靠指标。     

毛细支气管炎患儿治疗中测定潮气流速容量曲线的意义

潮气流速容量曲线测定是近年来国内开展的检测气道阻塞性疾病最好的方法之一,它能对气道阻塞的程度进行定性和定位诊断[1]。毛细支气管炎俗称喘憋性肺炎,主要由呼吸道合胞病毒、流感病毒、副流感病毒、腺病毒引起的毛细支气管的炎症,多发生于2岁以内的婴幼儿。2000年3月-2003年     

潮气呼吸流速容量环对毛细支气管炎患儿肺功能的评价

目的:研究毛细支气管炎时小气道阻塞的程度及动态变化的情况,并探讨其临床意义。方法:采用德国耶格公司MasterScreen小儿肺功能仪,运用潮气呼吸流速容量环评价115例毛细支气管炎急性期婴儿(按月龄分为3组)肺功能。并对其中30例患儿进行临床恢复期肺功能复查。结果:115例患儿中肺功能正常5例,单纯限制性改变3例,余107例患儿均有不同程度的气道阻塞性改变,其中轻度阻塞(达峰时间比为28%-22%)25例,占23.3%,中度阻塞(达峰时间比为22%-16%)34例,占31.7%,重度阻塞(达峰时间比为<16%)48例,占44.8%。中度以上阻塞的患儿约达76%。107例患儿中有38例同时伴有限制性改变。临床恢复期上述异常指标明显好转。结论:毛细支气管炎急性期,肺功能大多呈中度以上阻塞性通气功能障碍,主要为小气道阻塞,恢复期有显著好转。潮气呼吸流速容量环检测能较好地反映小婴儿的肺功能。     

毛细支气管炎婴幼儿患者潮气肺功能研究

毛细支气管炎（简称毛支）是〈2岁婴幼儿特有的呼吸道感染性疾病，主要为病毒感染，〉50％系呼吸道合胞病毒（RSV）感染。以婴儿为多见。近年来用TBFV环取代用力流速容量曲线（MEFV）在婴幼儿进行肺功能检查逐渐开展。作者自2002年12月至2007年2月对不同月龄毛支患儿及RSV与非RSV毛支患儿的肺功能改变进行观察，为临床提供参考。     

毛细支气管炎患儿血清白三烯及免疫功能指标测定的意义

目的 检测毛细支气管炎患儿血清白三烯水平及免疫功能指标.方法 用酶联免疫吸附试验法检测血清半胱氨酰白三烯水平;散射比浊法检测免疫球蛋白;流式细胞仪用于T细胞亚群检测.结果 毛细支气管炎组血清白三烯水平升高,与对照组比较,P＜0.05;血清免疫球蛋白A(IgA)水平与对照组比较降低,P＜0.05;血清IgM水平升高,P＜0.05;血清IgE水平升高,P＜0.05;T细胞亚群检测与对照组比较,CD3 CD4 淋巴细胞检测结果差异无统计学意义,CD3 CD8 检测结果升高、CD3 CD4 /CD3 CD8 比值降低,P＜0.05.结论 部分毛细支气管炎患儿可能存在免疫缺陷,血清白三烯水平升高,血清IgA水平降低,IgE水平升高,有助于呼吸道、肺部感染的形成,可能是引起毛细支气管炎后反复喘息和哮喘的因素之一.     

糖皮质激素在毛细支气管炎治疗中的应用

目的 对糖皮质激素在毛细支气管炎疾病治疗中的临床运用效果进行探讨。方法 选取我院2014年4月至2015年4月所收治的毛细支气管炎患者93例作为研究的对象,按随机数字表法均分成三组,即甲组、乙组、丙组,甲组予以常规治疗,在此基础之上,乙组予以静脉滴注甲泼尼龙琥珀酸钠,丙组予以雾化吸入布地奈德混悬液,然后比较三组患者的临床治疗效果。结果 丙组患者的有效率高于甲、乙组两组,差异明显,有统计学意义(P＜0.05)；丙组患者的止咳、平喘、啰音消失时间以及住院时间等均比其他两组短,差异明显,有统计学意义(P＜0.05)。结论 对毛细支气管炎患者予以糖皮质激素治疗,疗效确切,尤其是采取布地奈德混悬液雾化吸入治疗,起效更快,效果好,值得在临床上大力推行与应用。     

毛细支气管炎患儿108例的护理

总结108例毛细支气管炎患儿的护理。护理重点为加强呼吸道护理,保持呼吸道通畅,纠正低氧症状,做好给药护理、发热护理,加强病情观察,同时保持环境舒适和做好饮食指导,以促进患儿康复。经治疗和护理,107例痊愈,1例心力衰竭严重转院治疗;住院时间4～15d。     

毛细支气管炎患儿血小板与红细胞参数测定及临床意义

目的探讨毛细支气管炎急性期血小板和红细胞参数的变化及临床意义。方法毛细支气管炎急性期患儿153例（疾病组）,同期体检健康儿103例（对照组）,采用全自动血细胞分析仪进行外周血血小板（PLT、PCT、MPV、PDW）和红细胞（RBC、HGB、HCT、MCV、MCH、MCHC）等参数的测定。结果疾病组血小板四参数均有改变,其中PLT较对照组增高,差异有统计学意义（P〈0.05）;PCT、PDW较对照组增高,MPV较对照组减低,差异有统计学意义（P〈0.01）。疾病组红细胞参数中RBC、HGB较对照组增高,差异有统计学意义（P〈0.01）,HCT较对照组增高,差异有统计学意义（P〈0.05）,而MCH降低,差异有统计学意义（P〈0.01）。结论测定毛细支气管炎急性期血小板和红细胞各项参数对毛细支气管炎的临床治疗具有指导意义。     

毛细支气管炎合并心力衰竭患儿的护理

毛细支气管炎是呼吸道合胞病毒、腺病毒、流感病毒及其他病原体所致的一种常见的下呼吸道感染,多见于6月以下的婴儿[1]。因病变毛细支气管充血、水肿及局部黏液分泌物增多可致局部肺气肿和肺不张,进一步导致呼吸困难,常累及心血管系统而导致心力衰竭。2006年1月—2011年12月我科收治毛细支气管炎并发心力衰竭患儿例,经精心护理,效果满意。     

婴幼儿哮喘治疗前后的潮气呼吸肺功能变化

[目的]了解耍幼儿哮喘治疗前后潮气呼吸肺功能变化.[方法]选择湖南省人民医院儿科2005年4月至2006年4月住院及门、急诊治疗的婴幼儿哮喘患儿35例,正常对照组38例.哮喘组在治疗前后、正常对照组分别进行潮气呼吸肺功能测定.主要参数:每分通气量(MV),呼吸频率(RR),潮气量(VT/kg),吸气时间(TI),呼气时间(TE),吸呼比(TI/TE),达峰时间(TPEF),达峰时间比(TPEF/TE),达峰容积(VPEF),达峰容积比(VPEF/VE),潮气呼吸呼气峰流速(PTEF),25%,50%或75%潮气量时呼气流速(TEF25%,TEF50%,TEF75%).同时描绘出流速-容量环(TFV curve).[结果]哮喘组治疗前VT/kg较对照组小(P＜0.05);RR较对照组增快(P＜0.05);TI、TI/TE较对照组明显缩短(P＜0.01);TPEF、TPEF/TE、VPEF、VPEF/VE较对照组明显降低(P＜0.01);PTEF较对照组明显增快(P＜0.01);TEF25%较对照组降低(P＜0.01).哮喘组治疗后TI、TI/TE仍较对照组缩短(P＜0.05);TPEF、TPEF/TE、VPEF、VPEF/VE较时照组明显降低(P＜0.01);TEF25%较对照组明显降低(P＜0.05).哮喘组治疗后RR较治疗前减慢(P＜0.05),Tl较对照组明显缩短(P＜0.01),TPEF、TPEF/TE、VPEF、VPEF/VE较治疗前明显增高(P＜0.01);PTEF较治疗前减慢(P＜0.05).哮喘组大部分婴幼儿流速容积环变窄,呼气相升支陡峭,高峰提前,降支倾斜,甚至凹向容量轴,即流速容积环呈现特征性阻塞图形.[结论]TPEF/TE、VPEF/VE可作为反映小气道阻力及流速变化的指标,反映耍幼儿哮喘的气道阻塞程度.潮气呼吸肺功能检查是耍幼儿哮喘重要的辅助诊治手段.     

Physician Risk Attitudes and Hospitalization of Infants with Bronchiolitis

Objectives: To determine whether the risk attitudes of pediatric emergency physicians are related to the likelihood that otherwise healthy infants with bronchiolitis will be admitted for inpatient care. Methods: Risk aversion and discomfort with diagnostic uncertainty were assessed among 46 pediatric emergency physicians from three hospitals participating in the Child Health Accountability Initiative. Study physicians managed 397 otherwise healthy infants ages 0 to 12 months presenting to their hospital emergency departments with bronchiolitis. Mean risk aversion and discomfort with diagnostic uncertainty scores were compared across physician gender, years of experience, and formal training in emergency medicine. Additional analyses based on infants as the analytic unit determined admission rates of physicians scoring high and low on risk attitude measures. This model was controlled for severity of illness. Results: Scores on measures of risk aversion and discomfort with uncertainty were similar for male and female physicians and for physicians who had completed pediatric emergency medicine fellowship training and those without such training. Risk aversion scores were significantly higher for physicians with 15 or more years of experience. Admission rates for infants with bronchiolitis were no higher among physicians scoring above the median on risk attitude measures. When adjusted for severity of illness, physicians' risk attitudes were not associated with admission rates. Conclusions: Recent growth in per‐capita admissions for bronchiolitis is not accounted for by physician intolerance for diagnostic uncertainty. Physician risk attitudes should be considered in the context of hospital admissions for other pediatric conditions with unclear prognoses.     

Tidal breathing flow-volume loops in bronchiolitis in infancy: the effect of albuterol [ISRCTN47364493]

Objectives  

To evaluate the effect of nebulized albuterol on tidal breathing flow-volume loops in infants with bronchiolitis due to respiratory syncytial virus.     

Clinical Significance of Sleep-Related Breathing Disorders in Patients with Implantable Cardioverter Defibrillators

The prevalence and clinical significance of sleep-related breathing disorders (SRBDs) in patients with cardiac disease and a history of life-threatening ventricular tachyarrhythmias is unclear. Forty consecutive recipients of implantable cardioverter defibrillators (ICDs) with cardiac disease and a documented history of spontaneous, life-threatening, ventricular tachyarrhythmias underwent full night polysomnography. SRBDs were diagnosed if the apnea/hypopnea index was > 10. SRBD were diagnosed in 16 of 40 patients (40%): central sleep apnea (CSA) was present in 9 of these 16 patients (56%), 8 of whom had associated Cheyne-Stoke respiration. Seven of the 16 patients with SRBD (44%) had obstructive sleep apnea (OSA). Patients with and without SRBDs were comparable with respect to left ventricular ejection fraction, NYHA classification, underlying heart disease, ICD indications, and concomitant antiarrhythmic drug and beta-blocker therapy. Patients were followed prospectively for 2 years. ICD-treated ventricular tachyarrhythmias occurred in 10 of 24 patients (42%) without SRBD, in 4 of 9 patients (44%) with CSA, and in 3 of 7 patients (44%) with OSA (NS). The numbers and circadian distributions of episodes recorded during follow-up in patients without SRBD versus with CSA or OSA were not significantly different (14 ± 25, median = 4 vs 4 ± 5, median = 2.5 vs 15 ± 15, median = 7, respectively). The 2-year mortality, which was entirely attributable to nonsudden cardiac events, was highest in patients with CSA (4/9 [44%], vs 0/7 [0%] with OSA, vs 3/24 patients (12.5%) without SRBD; P < 0.05).     

老年超重患者心脏手术后机械通气潮气量的研究

目的探讨两种方法设置老年超重患者心脏手术后机械通气潮气量的临床效果。方法采用随机数字表法将解放军总医院2014年1-6月在全身麻醉下行心脏开胸手术后返回监护室的老年患者141例分为研究组和对照组,研究组(73例)采用8ml/kg×标准体质量来设置潮气量,对照组(68例)采用8ml/kg×实际体质量来设置潮气量。比较两组患者的潮气量、机械通气时间、并发症发生情况,术后返回监护室行机械通气后15min和拔除气管插管后20min的动脉血气指标,以及需再次调节潮气量设置的具体情况。结果研究组初始潮气量小于对照组,需再次调整潮气量参数的患者比例少于对照组(P0.01);返回监护室机械通气15 min后,研究组二氧化碳分压(PaCO2)高于对照组(P0.01);拔除气管插管后20min,研究组pH值小于对照组(P0.01);对照组中需要再次调整潮气量者的体质量及初始潮气量均明显大于未调整者(P0.05),调整后的潮气量明显小于调整前(P0.01);两组患者均未发生肺损伤、低氧血症及高碳酸血症等并发症。结论根据标准体质量设置潮气量可有效降低老年超重患者过度通气的风险并取得较好的通气效果,同时能减轻医护人员工作量,为临床工作的改进提供了有益的尝试。     

Increased Tidal Volume Variability in Children is a Better Marker of Opioid-Induced Respiratory Depression than Decreased Respiratory Rate

OBJECTIVE: During opioid administration, decreasing respiratory rate is typically used as a predictor of respiratory depression. Prior to opioid-induced apnea, progressively irregular breathing patterns have been noticed. We hypothesize that opioid administration to children will increase tidal volume variability (TV(var)) and that this will be a better predictor of respiratory depression than a decrease in respiratory rate. METHODS: We recruited 32 children aged 2-8 years scheduled to undergo surgery. During spontaneous ventilation, flow rates and respiratory rates were continuously recorded, while remifentanil was infused at stepwise increasing doses each lasting 10 min. The infusion was continued until the patient showed signs of respiratory depression. Flow data from each dose was used to calculate tidal volumes, from which TV(var) was calculated. The respiratory rate and TV(var) during the last (D(last)), second to last (D-2), and third to last (D-3), administered doses were compared to those during baseline (fourth to last dose). We chose a threshold of TV(var) increase and compared it to a decrease in respiratory rate below 10 breaths per min as predictors of respiratory depression. RESULTS: Compared to baseline, the TV(var) increased by 336% and 668% during D(-2) and D(last), respectively, whereas respiratory rate decreased by 14.3%, 31.7%, and 55.5% during D(-3), D(-2), and D(last), respectively. A threshold increase in TV(var) of 150% over baseline correctly predicted respiratory depression in 41% of patients, compared to a drop in respiratory rate correctly predicting 22% of patients. CONCLUSIONS: TV(var) increases as children approach opioid-induced respiratory depression. This is a more useful predictor of respiratory depression than a fall in respiratory rate because the TV(var) increase is 10 times the drop in respiratory rate. A TV(var) increase also correctly predicts respiratory depression twice as often as decreased respiratory rate and is independent of age-related alterations in physiologic respiratory rates.     

应用彩色多普勒自动心输出量测量法测量主动脉瓣返流量的临床研究

目的　应用彩色多普勒自动心输出量测量 (automated cardiac flow measurement,ACM)方法 ,定量测量主动脉瓣关闭不全患者的返流量 ,并评价其临床应用价值。方法　应用 ACM法测量主动脉瓣口返流量、返流分数并与常规超声参数和部分手术结果进行对比研究。结果　应用 ACM直接法和间接法测得的返流量之间具有良好的相关性 (r=0 .94 ,y=0 .0 5 1.0 5 x,P<0 .0 0 1) ;应用 ACM法测得的返流量与左室内径 (L VD)、返流束长度 (ARL )、左室面积 (L VA)、返流面积 (ARA)、返流面积与左室面积比值 (ARA/L VA)之间具有良好的相关性 ;应用 ACM法测得返流分数对瓣膜功能的评价与手术结果相一致。结论　 ACM技术是测量主动脉瓣返流量的一种简便、快速、较为准确的无创性定量方法。     

孟鲁司特治疗毛细支气管炎前后患儿血清半胱氨酰白三烯的测定

目的：探讨孟鲁司特钠（顺尔宁）对呼吸道合胞病毒（RSV）毛细支气管炎患儿血清中半胱氨酰白三烯（Cys-LTs）的影响。方法：将60例4～18个月的RSV毛细支气管炎患儿随机分为顺尔宁治疗组（30例）和常规治疗组（30例）,常规治疗组仅给予综合治疗,而顺尔宁治疗组在综合治疗的基础上加用孟鲁司特口服,用法为4mg每晚1次口服。于治疗前和治疗后检测血清中CysLTs水平。结果：治疗前,RSV毛细支气管炎两组CysLTs水平均明显高于正常组（P〈0.05）,同时CysLTs水平较常规治疗组显著下降（P〈0.05）,常规治疗组患儿血清CysLTs水平仍高于正常组（P〈0.05）。结论：顺尔宁可降低RSV毛细支气管炎患儿血清中CysLTs水平,在RSV毛细支气管炎的抗炎机制中起重要作用,推测RSV毛细支气管炎患儿口服孟鲁司特有可能达到早期干预,从另一条途径减少哮喘的发病。     

肺癌患者血清VEGF含量测定及临床意义

目的探讨血清血管内皮生长因子在肺癌诊断、预后及疗效观察中的意义.方法用双抗夹心ELISA方法测定50例肺癌患者血清的VEGF水平,另用40名健康人作对照.用SPSS 10.0统计软件包进行统计分析.结果肺癌患者血清VEGF水平显著高于健康人(P<0.001);晚期肺癌(Ⅲ期、Ⅳ期)患者血清VEGF水平高于早期肺癌(Ⅰ期,Ⅱ期)患者,差异有显著性(P<0.01),有淋巴结转移者高于无淋巴结转移者(P<0.05).结论血清VEGF可能成为肺癌的一个新的肿瘤标志物,用于肺癌的诊断和动态监测病情进展、预后判断.