应用呼吸阻抗图和肺阻抗图探讨肺心病与膈肌疲劳关系

目的 探讨,肺心病与膈肌疲劳的关系。方法 对６４例肺心病患者进行呼吸阻抗图和肺阻抗图检测,分组统计膈肌疲劳图形阳性率;并对阳悸 组和阴性一组进行肺阻抗图各参数比较。结果 （１）肺心病伴与不伴呼衰组膈肌疲劳图形阳性率分别为７５％与２１.9％;（2）肺心病伴与不伴心组膈肌疲劳图形阳性率分别为80％与46.3％;（3）膈肌疲劳阳性组与阴性组肺阻抗图各参数均值无显著性差异。结论 肺心病的呼衰、心衰与膈肌疲劳互为因果,但肺心病严重程度与膈肌疲劳不一定呈平行关系。     

膈肌疲劳与COPD呼吸衰竭

<正> 呼吸肌是肺通气的动力来源,主要由吸气肌(膈肌、肋间外肌),呼气肌(腹肌、肋间内肌)及辅助肌(胸锁乳突肌,斜方肌)三部分组成。呼吸肌与心脏一样,对维持生命同样重要,是生命过程中唯一所依赖的骨骼肌。膈肌是最重要的吸气肌,呼吸肌与其它骨骼肌一样,可以发生疲劳。呼吸肌疲劳,尤其是膈肌疲劳,可导致或加重呼吸衰竭。晚年发现膈肌疲劳是慢性阻塞性肺疾病(COPD)呼吸衰竭的重要原因。本文就膈肌疲劳与COPD呼吸衰竭有关方面作一综述如下: 一、膈肌的一般生理解剖最近的研究表明:膈肌并非由相同功能的肌纤维组成,而是因胚胎起源不同,功能不一的两块肌肉所组成:即膈肌肋部(Costal Part、边缘部)和肺肌脚部(Crurul Part、背部)两部分。膈肌肋部其纤维起源于     

体外膈肌起搏在肺心病呼吸衰竭治疗中的应用

本文报告30例肺心病所致呼吸衰竭患者,经体外膈肌起博治疗后,呼吸衰竭症状改善,PaCO_2明显下降,PaO_2上升,提示体外膈肌起博在急慢性呼衰治疗中,具有降低高碳酸血症和提高氧分压疗效。并具有无创性,操作简易等优点,为呼吸乐统疾病提供一个新的治疗手段。     

膈肌疲劳与慢性阻塞性肺疾病

膈肌是重要的呼吸肌,慢性阻塞性肺疾病(COPD)的进行性加重常伴随严重的呼吸肌疲劳,表现为膈肌功能性改变、肌力和耐力的下降。炎性细胞因子的代谢紊乱与膈肌细胞的过度凋亡引起膈肌疲劳是COPD呼吸困难的重要病理生理机制。论文围绕膈肌疲劳在COPD发病时形态与功能改变、COPD膈肌疲劳病变的发病机制及治疗进展做一综述。     

膈肌疲劳与起搏研究近展

膈肌疲劳与起搏研究近展刘刚综述吴莪如吴善审校（第三军医大学西南医院重庆６３００３８）ＲｅｃｅｎｔＰｒｏｇｒｅｓｓｉｎＳｔｕｄｉｅｓｏｆＤｉａｐｈｒａｇｍａｔｉｃＦａｔｉｇｕｅａｎｄＰａｃｉｎｇＬｉｕＧａｎｄ，ＷｕＥｒｕ，ＷｕＳｈａｎ（ＸｉｎａｎＨｏｓ...     

膈肌疲劳研究进展

慢性阻塞性肺部疾病 (ＣｈｒｏｎｉｃＯｂｓｔｒｕｃｔｉｖｅＰｕｌｍｏｎａｒｙＤｉｓｅａｓｅ ,ＣＯＰＤ)是临床上常见的一组以小气道的进行性气流阻塞为特征的疾病 ,呼吸衰竭是导致ＣＯＰＤ患者死亡的主要原因。呼吸肌是呼吸运动的动力泵 ,膈肌是最主要的呼吸肌 ,在呼吸过程     

前列地尔对肺心病心衰患者内皮素、心钠素的影响

目的 了解前列地尔对肺心病心衰患者血浆内皮素、心钠素的影响及PaO2、PaCO2,心功能的变化。方法 使用放免法测定40例慢性肺心病心衰患者静滴前列地尔前后血浆内皮素、心钠素浓度 ,同时检测PaO2、PaCO2 及观察心功能变化。结果 肺心病心衰患者的血浆内皮素 ,心钠素浓度显著高于健康组 ( p<0.001) ,静滴前列地尔后血浆内皮素、心钠素显著降低(t=3.82和3.75,p均<0.001) ,36例血气显著改善(p<0.01～0.001) ,39例心衰改善。结论 血浆内皮素、心钠素参与肺心心衰的发生与发展 ,前列地尔能够降低血浆内皮素、心钠素 ,改善血气 ,纠正心衰。     

肺炎患儿膈肌疲劳的诊断研究

目的探讨电阻抗呼吸图仪对肺炎惠儿膈肌疲劳的诊断价值。方法用2K—V1型智能电阻抗呼吸图仪分别测定126例肺炎患儿和60例正常小儿的膈肌功能,并根据其一维图中胸腹运动曲线的变化及二维图中M值与a角度的变化判断其膈肌疲劳的程度。结果126例患儿中98例有膈肌疲劳,其中68例为I型膈肌疲劳,30例为Ⅱ型膈肌疲劳。Ⅰ型膈肌疲劳患儿M值为（46．1±8．4）％,α角为（136．7±12．0）°;Ⅱ型膈肌疲劳M值为（17．2±3．2）％,α角为（48．2±9．5）°;对照组M值为（4．3±1．0）％,α角为（31．7±5．2）°（P〈O．01）。膈肌疲劳的程度与临床诊断呼吸衰竭呈高度相关,与年龄的大小呈负相关。结论电阻抗呼吸图仪可作为肺炎膈肌疲劳的临床诊断方法,膈肌疲劳与肺炎患儿呼吸衰竭有相关性。     

美托洛尔在治疗慢性肺心病心力衰竭中的应用

目的　研究与分析选择性β1受体阻滞剂美托洛尔(倍他乐克)对慢性肺心病心力衰竭(心衰)患者的病 死率、住院率及耐受性方面的疗效。方法　44例重度慢性肺心病心衰患者随机分成两组:对照组20例,给予常规治 疗加维生素B15～60mg/d;治疗组24例,给予常规治疗加倍他乐克6.25～100mg/d,随访1年。结果　随访1年时, 治疗组与对照组对比,在所有预设的病死率研究终点上均明显降低,总死亡数为2例对4例;因心衰恶化死亡数为1 例对3例。另外,与对照组对比,倍他乐克治疗组心衰恶化患者住院率下降64%(P<0.01),患者的心功能(NYHA 分级)改善更明显,不良反应轻微。结论　倍他乐克治疗重度慢性肺心病心衰患者,可降低住院率,改善心功能状态而 且具有良好的耐受性。     

肺源性心脏病呼吸衰竭病人行无创呼吸机治疗的护理

总结30例肺源性心脏病呼吸衰竭病人行无创呼吸机辅助治疗的护理,包括心理护理、上机前准备、使用中的生活护理、饮食护理、呼吸道管理、呼吸机的监测、病情观察、出现并发症后的护理等.     

Severity of fatigue is related to functional limitation and health in patients with chronic obstructive pulmonary disease

Fatigue is one of the most prevalent symptoms in patients with chronic obstructive pulmonary disease (COPD). In research as well as in clinical practise, fatigue and its influence on functioning and health has not been in focus. The aim of this study was to compare fatigue, functional limitations owing to fatigue and health between patients with COPD and individuals from the general population to assess the differences between patients experiencing no, moderate and severe fatigue. Patients with COPD (n = 151) and individuals from the general population (n = 95) answered questions about fatigue, the Fatigue Impact Scale and the Medical Outcomes Survey Short Form‐36. The patients with COPD reported a higher frequency, longer daily duration and more severity of fatigue compared with individuals from the general population as well as more functional limitations and worse health. The patients who reported severe fatigue had more functional limitations and worse health compared with patients reporting moderate fatigue. These results indicate that fatigue severity should be screened for during the nursing care process with purpose to reduce the symptom burden.     

Bioelectrical impedance analysis in estimating nutritional status and outcome of patients with chronic obstructive pulmonary disease and acute respiratory failure

Objective: To evaluate bioelectrical impedance analysis (BIA) in estimating the nutritional status and outcome of patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) in comparison with measurements of anthropometric parameters and plasma levels of visceral proteins Design: Retrospective study Setting: A ten-bed intensive care unit (ICU) in a university teaching hospital Patients: 51 COPD patients with ARF in whom BIA data, anthropometric parameters, and measurements of visceral proteins were available Measurements and results: BIA results in patients requiring mechanical ventilation (MV) vs. those who did not showed lower active cell mass (ACM; 37.5 ± 6.5 % vs. 42.4 ± 7.2 % body weight, P = 0.01) and a higher extra-/intracellular water volume ratio (ECW/ICW; 1.25 ± 0.2 vs. 1.04 ± 0.2, P = 0.0001), suggesting a more severe alteration in the nutritional status among those on MV. Anthropometric data showed the opposite results, since body weight, body mass index (BMI), triceps skinfold thickness (TSF), and fat mass were significantly higher in the invasively ventilated patients, whereas middle-arm muscle circumference (MAMC) did not differ between the two groups. The marked inflation of the extracellular compartment (ECW, ECW/ICW) that was well shown by BIA in the invasively ventilated patients presumably lead to inaccurate anthropometric results (overestimation of TSF and fat mass, and erroneous measure of MAMC). A higher death rate (38 % vs. 0 %, P = 0.01) was observed in the patients with ACM depletion (ACM ≤ 40.6 % body weight, n = 26) than in those without ACM depletion (n = 25). Low albumin level ( < 30 g/l) was associated with increased mortality (33 % vs. 7 %, P = 0.04), but the differences in the other biological and anthropometric parameters (prealbumin and transferrin levels, body weight, BMI, TSF, MAMC, fat mass, and fat-free mass) were not associated with mortality Conclusion: This study suggests that the decrease in BIA-derived ACM is a good indication of malnutrition and of poor outcome in COPD patients with ARF. Received: 2 July 1999 Final revision received: 10 February 2000 Accepted: 1 March 2000     

黄芪治疗慢性肺心病心力衰竭102例临床观察

目的 :观察黄芪注射液治疗肺源性心脏病 (肺心病 )心力衰竭的疗效。方法 :10 2例患者随机分为治疗组和对照组 ,2组常规综合治疗相同 ,治疗组加用黄芪注射液 4 0 m g静滴 ,每日 1次 ,疗程 10～ 14日。治疗前后分别进行动脉血气分析、血液流变学检查并观察临床疗效。结果 :治疗组与对照组比较 ,治疗组显效率和总有效率明显优于对照组 (P均 <0 .0 5 )。结论 :黄芪治疗慢性肺心病心衰能明显提高临床疗效 ,是一种行之有效的治疗方法。     

中度稳定期慢性阻塞性肺疾病疲劳与多维度指标的关系

目的 探讨中度稳定期慢性阻塞性肺疾病(慢阻肺)患者疲劳与营养指标、生活质量指标、炎症指标、精神情绪指标的关系。方法 采用前瞻性研究,根据一般疲劳定义,从慢阻肺患者中随机选取中度稳定期慢阻肺疲劳患者30例(疲劳组)与中度稳定期慢阻肺非疲劳患者26例(非疲劳组)。收集两组一般资料、营养指标、生活质量指标、炎症指标、精神情绪指标,并进行比较。结果 两组性别、年龄、吸烟指数等方面差异无统计学意义(均P>0.05);与非疲劳组相比,疲劳组白蛋白、血红蛋白、体重指数、第1秒用力呼气容积占预计值的百分比(percent predicted forced expiratory volume in one-second, FEV1%)、6 min步行距离(6-minute walk distance, 6MWD)均显著降低(P<0.05),慢性阻塞性肺疾病评估测试(chronic obstructive pulmonary disease assessment test, CAT)评分、C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PC...     

综合护理干预在慢性肺源性心脏病合并心力衰竭治疗中的应用效果

目的探讨综合护理干预在慢性肺源性心脏病合并心力衰竭治疗中的应用效果。方法选择100例慢性肺源性心脏病合并心力衰竭患者按是否愿意接受综合护理干预分为2组。对照组患者给予常规护理,实验组患者加施综合护理干预,比较2组患者干预前后1 s用力呼气容量、左室射血分数、6 min步行距离、生活质量、并发症与护理满意度等。结果 2组患者干预后FEV1与LVEF水平组间比较存在显著性差异(P0.05);2组患者干预后6 min步行距离与心衰生活质量水平组间比较存在显著性差异(P0.05);实验组患者心律失常发生率明显低于对照组,存在显著差异(P0.05);实验组患者并发症总发生率显著性低于对照组(P0.05);实验组患者护理满意度显著性优于对照组(P0.05)。结论综合护理干预在慢性肺源性心脏病合并心力衰竭治疗中的应用效果显著,可提高患者满意度。