小儿推拿联合清肺化痰活血汤对痰热闭肺型肺炎患儿免疫功能及呼吸功能的效果观察

目的 探讨小儿推拿联合清肺化痰活血汤口服对痰热闭肺型肺炎患儿免疫功能及呼吸功能的影响。方法 选取2019年12月—2021年12月医院痰热闭肺型肺炎的患儿94例,按组间基本资料匹配原则分为对照组和观察组,每组47例。采用酶联免疫实验法检测白细胞介素-17(IL-17)、白细胞介素-10(IL-10)水平,流式细胞仪检测CD3⁺、CD4⁺水平,自动血气分析仪检测呼吸频率(RR)、动脉血氧分压(PaO₂)、(PaO₂/FiO₂)水平。评定中医证候积分。结果 护理干预后,观察组发热、咳嗽、痰壅评分、IL-17、IL-10、CD3⁺、CD4⁺、RR水平降低于对照组,差异有统计学意义(P<0.05);而PaO₂、PaO₂/Fi O₂水平高于对照组,差异有统计学意义(P<0.05)。结论 小儿推拿联合清肺化痰活血汤口服对痰热闭肺型肺炎患儿护理干预,能够有效改善患儿免疫功...     

B型脑钠肽在左心室射血分数保留的慢性阻塞性肺疾病急性加重期患者中的应用研究

目的 分析左心室射血分数(LVEF)保留的慢性阻塞性肺疾病急性加重期(AECOPD)患者血清B型脑钠肽(BNP)与动脉血氧分压[p_a(O₂)]、超敏C反应蛋白(hs-CRP)、右心室舒张末期横径(RVDD)及预后死亡的相关性。方法 回顾性分析150例LVEF保留的AECOPD患者病例资料,根据血清BNP水平分为A组(BNP≤100 pg/mL,n=82)、B组(BNP>100～400 pg/mL,n=45)、C组(BNP>400 pg/mL,n=23)。比较入院后3组患者p_a(O₂)、BNP、hs-CRP及RVDD水平。分析BNP与p_a(O₂)、hs-CRP、RVDD的相关性;采用Logistic回归分析探讨1年内死亡预测因素。统计3组患者1年内的死亡危险比(RR)。结果 B组、C组p_a(O₂)低于A组,BNP、hs-CRP、RVDD高于A组,差异有统计学意义(P<0.05); C组BNP、hs...     

中西医结合治疗对痰热壅肺型重症肺炎中医证候积分及炎症因子水平的影响

目的 探究中西医结合治疗对痰热壅肺型重症肺炎患者中医证候及炎症反应的影响。方法 选取我院2017年6月-2019年7月收治的88例痰热壅肺型重症肺炎患者,按随机数字表法分为观察组（44例）与对照组（44例）。对照组行西医治疗,观察组在西医治疗基础上联合清肺通腑汤治疗。对比两组治疗前后中医证候积分及炎症因子水平。结果 观察组治疗后咳嗽、发热、气促及痰壅积分低于对照组,WBC、IL-6及CRP水平低于对照组,差异有统计学意义（P＜0.05）。结论 清肺通腑汤结合西药在痰热壅肺型重症肺炎治疗中有助于改善患者中医证候,降低炎症因子水平,利于缓解病情,值得推广应用。     

两种氧疗方式治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的效果

目的探讨经鼻高流量氧疗(HFNC)和传统鼻导管氧疗在慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者中的临床疗效。方法将75例AECOPD合并Ⅱ型呼吸衰竭患者分为对照组(n=36)和实验组(n=39)。对照组在常规治疗基础上给予传统鼻导管氧疗,实验组在常规治疗基础上给予HFNC。比较2组的动脉血氧分压[p_a(O₂)]、动脉血二氧化碳分压[p_a(CO₂)]、血氧饱和度(SpO 2)、呼吸频率、心率、第1秒用力呼气容积(FEV₁)、用力肺活量(FVC)、痰液黏稠度、痰量的变化。结果治疗后,实验组p_a(CO₂)、呼吸频率、心率、痰液黏稠度、痰量改善程度与对照组比较,差异有统计学意义(P<0.05)。结论HFNC对AECOPD合并Ⅱ型呼吸衰竭患者的治疗效果优于传统鼻导管氧疗,可有效提高通气效率,降低呼吸频率,减少二氧化碳重复吸入。     

十五味龙胆花丸治疗痰热壅肺证临床疗效观察

目的:研究十五味龙胆花丸治疗痰热壅肺证患者的临床疗效.方法:将我院在2014年5月到2015年6月收录的100例痰热壅肺证患者,用随机分组法分为研究组和对照组,每组分别50例.对照组痰热壅肺证患者采用芩暴红止咳颗粒进行治疗,研究组痰热壅肺证患者采用十五味龙胆花丸进行治疗.对比两组痰热壅肺证患者的临床疗效.结果:研究组痰热壅肺证患者总有效率为(86.00％)明显高于对照组痰热壅肺证患者总有效率,改善状况优于对照组痰热壅肺证患者(P小于0.05).结论:应用十五味龙胆花丸治疗痰热壅肺证患者效果显著,值得在临床上推广.     

痰热清注射液联合抗菌药物治疗痰热壅肺型慢性阻塞性肺疾病的临床疗效研究

目的 探讨痰热清注射液联合抗菌药物治疗痰热壅肺型慢性阻塞性肺疾病的临床疗效。方法 连续性选取2020年6月至2021年6月在该院就诊的痰热壅肺型慢性阻塞性肺疾病患者79例,将患者随机分为对照组42例,观察组37例,分别给予常规抗菌药物和痰热清注射液联合抗菌药物治疗,比较两组患者一般资料及治疗前后检测指标等的变化。结果 治疗后,两组患者血气分析中动脉血氧分压(PaO₂)均高于治疗前,二氧化碳分压(PaCO₂)均低于治疗前,治疗后,观察组PaO₂水平高于对照组,而PaCO₂、总胆红素(TBIL)水平低于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。采用多重线性回归进行分析,同时纳入年龄、性别和痰热清注射液干预3个因素构建回归模型,结果可见,PaCO₂线性回归模型中,年龄(β=0.002,t=0.063,P=0.950)和性别(β=-0.276,t=-0.287,P=0.775)对PaCO₂...     

宣白承气汤加减对重症肺炎(痰热壅肺型)患者中医证候积分及炎症因子水平的影响

目的探讨宣白承气汤加减对重症肺炎(痰热壅肺型)患者中医证候积分及炎症因子水平的影响。方法将我院收治的86例重症肺炎(痰热壅肺型)患者根据用药方案不同分为对照组(43例,常规西医)和观察组(43例,常规西医+宣白承气汤加减)。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,观察组咳嗽、胸闷胸痛、气喘评分、血清TNF-α、IL-6水平、EVLWI低于对照组,CI高于对照组(P<0.05)。结论宣白承气汤加减治疗重症肺炎(痰热壅肺型)患者,能降低炎症反应,改善血流动力学,减轻临床症状,效果显著。     

中医拔罐联合西药治疗社区获得性肺炎疗效观察及护理

社区获得性肺炎（0婶）是指在医院外罹患的感染性肺实质（含肺泡壁,即广义上的肺间质）炎症,包括具有明确潜伏期的病原体感染而在入院后平均潜伏期内发病的肺炎。CAP归属于祖国医学的“咳嗽”、“风温肺热病”等病证范畴,临床以身热、咳嗽、烦渴或伴气急、胸痛为主证,常见证型为风热袭肺证、痰热壅肺证、痰湿阻肺证。     

清肺通腑汤对重症肺炎痰热壅肺证患者肺功能、中医证候积分和炎症因子水平的影响

目的探讨清肺通腑汤对重症肺炎痰热壅肺证患者肺功能、中医证候积分和炎症因子水平的影响。方法选取80例重症肺炎痰热壅肺证患者,随机分为对照组与观察组各40例。对照组采用常规治疗,观察组在常规治疗的基础上采用清肺通腑汤治疗。比较2组治疗前后中医证候积分(发热、咳嗽、气促等),肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、每分钟最大通气量(MVV)]和炎症因子[白细胞计数(WBC)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平。结果治疗2周后,2组发热、咳嗽、气促积分均显著低于治疗前(P 0. 05),且观察组显著低于对照组(P 0. 05)。治疗2周后,2组FVC、FEV1、MVV均显著高于治疗前(P 0. 05),且观察组显著高于对照组(P 0. 05)。治疗2周后,2组WBC、CRP、IL-6均显著低于治疗前(P 0. 05),且观察组显著低于对照组(P 0. 05)。结论重症肺炎痰热壅肺证采用中医清肺通腑汤治疗安全有效,可改善患者症状,抑制炎性反应,增强肺功能,促进患者康复。     

中西医结合治疗慢性支气管炎87例

目的：本文旨在探讨中西医结合治疗慢性支气管炎的疗效。方法：通过回顾总结以往治疗慢性支气管炎的经验，建立中医辨证与西医辨病相结合的辨治方案，将慢性支气管炎初诊患者辨证分为肺脾气虚痰热壅肺证、肺脾肾虚痰湿阻肺证进行辨证施治。并在中医辨证施治的同时，对肺脾气虚痰热壅肺患者，配合西医抗感染等治疗，并注重缓解期调护，提出强心畅肺的治疗新观念。结果：本方案经过对87例的治疗追踪观察，取得60．9％的临床控制率和95．4％的总有效率，且远期疗效稳定。结论：该治疗方案符合慢性支气管炎的发病规律，针对性强，疗效较好。     

中老年慢性阻塞性肺疾病临床特征与病情进展的相关性

目的 探讨中老年慢性阻塞性肺疾病(COPD)患者的临床特征与病情进展的相关性.方法 采用双盲法选取136例COPD患者作为研究对象,按病情的不同分为COPD稳定期组(n=52)、COPD急性加重期(AECOPD)组(n =44)和哮喘慢阻肺重叠综合征(ACOS)组(n =40).分析3组患者的基线资料[年龄、性别、体质...     

Systemic oxygen delivery and consumption during acute lung injury in dogs

When oxygen delivery (QO₂ = Qt × CaO₂) is reduced in healthy animals, oxygen uptake by tissues (VO₂) is maintained by an increase in the O₂ extraction ratio ((CaO₂ − CvO₂)/CaO₂) until a critical level of delivery QO₂C is reached, below which VO₂ becomes dependent on QO₂. In patients with adult respiratory distress syndrome (ARDS), VO₂ becomes dependent on O₂ delivery even at high levels of QO₂ implying a systemic O₂ extraction defect. To determine whether lung injury, or its management with positive end-expiratory pressure (PEEP) and high inspired oxygen fractions (F1O₂), might disrupt O₂ extraction by peripheral tissues, we compared the critical O₂ delivery and extraction ratio in 30 anesthetized and paralyzed dogs in four groups. One group (n = 7) received oleic acid to produce an acute lung injury (F_lO₂ = 1.0) and a second group (n = 7) was maintained with PEEP (F_lO₂ = 1.0) after receiving oleic acid. A third group (n = 8) received no oleic acid (F_lO₂ = 1.0), and a fourth group received no oleic acid and was ventilated with room air. The critical O₂ delivery was determined in each animal as QO₂ was lowered in a stepwise manner by controlled blood removal. Neither the critical QO₂ nor critical O₂ extraction ratios were different (P> .05) among oleic acid, PEEP-treated, or hyperoxic control animals. Similarly, the critical QO₂ determined from the point at which arterial lactate began to increase showed no difference among groups. Thus, neither acute lung injury produced with oleic acid nor its treatment with PEEP was associated with a peripheral O₂ extraction defect. However, a linear regression across all groups demonstrated a positive correlation between the arterial PO₂ and corresponding critical O₂ delivery (r = < P < .05). These results suggest that high arterial O₂ tensions may contribute to an impairment of peripheral O₂ extraction.     

Effects of high-volume hemofiltration on alveolar-arterial oxygen exchange in patients with refractory septic shock

BACKGROUND: High-volume hemofiltration (HVHF) is technically possible in severe acute pancreatitis (SAP) patients complicated with multiple organ dysfunction syndrome (MODS). Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in patients with refractory septic shock.METHODS: A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups: fluid resuscitation (group A, n=41), and fluid resuscitation plus high-volume hemofiltration (group B, n=48). The levels of O₂ content of central venous blood (C_cvO₂), arterial oxygen content (C_aO₂), alveolar-arterial oxygen pressure difference P_(A-a)DO₂, ratio of arterial oxygen pressure/alveolar oxygen pressure (P_aO₂/P_AO₂), respiratory index (RI) and oxygenation index (OI) were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times (0, 24, 72 hours and 7 days of treatment) in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups.RESULTS: The levels of C_cvO₂, C_aO₂ on day 7 in group A were significantly lower than those in group B (C_cvO₂: 0.60±0.24 vs. 0.72±0.28, P<0.05; CaO₂: 0.84±0.43 vs. 0.94±0.46, P<0.05). The level of oxygen extraction rate (O₂ER) in group A on the 7th day was significantly higher than that in group B ( 28.7±2.4 vs. 21.7±3.4, P<0.01). The levels of P_(A-a)DO₂ and RI in group B on the 7th day were significantly lower than those in group A. The levels of P_aO₂/P_AO₂ and OI in group B on 7th day were significantly higher than those in group A (P<0.05 or P<0.01). The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A (8.2±3.8 vs. 17.2±6.8, P<0.01).CONCLUSION: HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.     

血清BUN、D-D、Lac、sCHE水平对重症肺炎生存预测价值

目的探讨血清尿素氮(BUN)、D-二聚体(D-D)、血乳酸(Lac)、胆碱酯酶(sCHE)水平对重症肺炎患者生存状况的预测价值。方法选取2014年4月至2019年6月本院收治的224例重症肺炎患者作为研究对象,根据入院后30 d生存状况分为生存组(152例)、死亡组(72例)。对比2组不同入院时间血清BUN、D-D、Lac、sCHE水平、急性生理与慢性健康(APACHEⅡ)评分、多器官功能障碍综合征(MODS)评分,分析各血清指标与APACHEⅡ、MODS评分关联性及对重症肺炎生存状况的预测价值。结果血清D-D、Lac、BUN与APACHEⅡ、MODS评分呈正相关,sCHE与APACHEⅡ、MODS评分呈负相关(P<0.05);入院第7 d,BUN AUC值(0.810)>sCHE(0.808)>D-D(0.780)>Lac(0.777);随访30 d后,以ROC曲线最佳截断值分为低危组、高危组,血清BUN、D-D、Lac、sCHE高危组、低危组生存曲线对比有显著差异(P<0.05)。结论血清BUN、D-D、Lac、sCHE水平在重症肺炎患者中呈异常表达,可为临床预测生存状况提供一定的数据支持。     

Experimental critical care in ventilated rats: effect of hypercapnia on arterial oxygen-carrying capacity

We have previously demonstrated an increased arterial o2-carrying capacity in normal ventilated dogs subjected to both acute and prolonged exogenous hypercapnia. In the present study, we tested if arterial hypercapnia, during controlled ventilation, can increase 02-carrying capacity also in rats.

Twenty young male Sprague Dawley rats were anesthetized (60 mg/kg pentobarbital), tracheostomized, intubated, and one femoral vein and artery were cannulated. Anesthesia and paralysis were maintained using 15 mg/kg/h pentobarbital intravenously, and 2 mg/kg/h vecuronium bromide. The fluid balance (5 mL/kg/h saline), normothermia, and minute volume were maintained. The mean arterial blood pressure and heart rate were continuously monitored. Experiments included the following: (1) a control group, ventilated with normoxic air for 150 minutes (n = 5); (2) mild hypercapnia, a group of eight rats ventilated with normoxic air for 30 minutes and then ventilated with a mixture of normoxic air at 60 mm Hg C0₂ (8 kPa) for 1 hour; and (3) severe hypercapnia, a group of seven rats were treated exactly as in group II, except a 90 mm Hg (12 kPa) C0₂ during hypercapnia. Gas-exchange profile, arterial hemoglobin (Hb) concentration, arterial Hb-oxygen saturation (Hb-O₂), and arterial O₂ content were periodically determined during normocapnia and 1 hour of hypercapnia.

Exposures to mild and severe hypercapnia, in rats with maintained ventilation, significantly reduced the arterial O₂ content by 20% and 33%, respectively, without significant changes in the arterial Hb concentration (−2%). Severe hypercapnia generated a significant reduction of −14% in the PaO₂, but not in PaO₂/F_i0₂ ratio.

Rats subjected to controlled ventilation and permissive hypercapnia, unlike dogs and perhaps humans, show no augmentation of Hb concentration. Hypercapnia in rats also provokes much stronger Bohr effect than in dogs. Hypercapnia-induced Bohr effect in rats is accompanied with extreme desaturations of Hb-O₂, and substantial reduction in the 0₂-carrying capacity. We speculate that the strong hypercapnia-induced Bohr effect in rats may prevent hypoxia at the tissue level. However, to maintain a stable oxygen-carrying capacity in rats used for pulmonary critical care studies with hypercapnia, we suggest to use hyperoxia, with or without a mild hypothermia.     

P（v-a）CO 2/C（a-v）O 2 ratio在休克复苏中的临床应用进展

静脉-动脉二氧化碳分压差/动脉-静脉氧含量差[P（v-a）CO₂/C（a-v）O₂ ratio]通过计算氧的消耗量和二氧化碳的生成量的比率获得,其本质是反映机体呼吸商。在无氧代谢时只有CO₂的产生,却无O₂的消耗,此时呼吸商趋向无限大。因此,当机体存在无氧代谢时,可出现P（v-a）CO₂/C（a-v）O₂ ratio增高。近来,应用P（v-a）CO₂/C（a-v）O₂ ratio作为识别机体是否存在无氧代谢的指标在休克复苏中受到广泛关注。     

ARDS患者肺泡动脉氧分压差与死腔分数检测在病情判断和短期预后评估中的应用价值

目的　研究急性呼吸窘迫综合征（ARDS）患者肺泡动脉氧分压差[P(A-a)O2]和死腔分数（VD/VT）在病情判断和短期预后评估中的应用价值。方法　收集2018年7月～2020年7月咸阳市第一人民医院84例急诊ARDS患者作为研究对象,根据ARDS病情将84例患者分为A组（轻度,28例）,B组（中度,30例）及C组（重度,26例）。比较三组急诊患者入院后P[(A-a)O2]和VD/VT水平,记录28天病死率,分析[P(A-a)O2]和VD/VT判断急诊ARDS病情程度和死亡风险的价值。结果　A,B,C三组VD/VT水平依次为0.49±0.07,0.54±0.10,0.59±0.08;P（A-a）O2（mmHg）水平依次为160.67±56.32,234.45±80.98,348.29±135.74。C组患者VD/VT和P(A-a)O2水平显著高于A,B两组,B组VD/VT和P(A-a)O2水平显著高于A组,差异均有统计学意义（F=9.381,26.389,均P<0.05）。84例患者中死亡28例,28天病死率为33.33%。P(A-a)O2判断重度ARDS的AUC为0.794（SE=0.071,95%=0.655～0.934）,敏感度和特异度分别为0.769和0.690。入院4天时VD/VT预测ARDS死亡的AUC为0.824（SE=0.066,95%=0.694～0.953）,敏感度和特异度分别为0.857和0.607。结论　P(A-a)O2, VD/VT与急诊ARDS病情程度和28天病死率相关,P(A-a)O2有助于判断病情程度,而入院4天时VD/VT水平对预测ARDS死亡准确性较高。     

脱嘌呤/脱嘧啶核酸内切酶1在氧化应激介导大鼠肺微血管内皮细胞损伤中的调控作用

目的探讨脱嘌呤/脱嘧啶核酸内切酶1（APE1）在过氧化氢（H₂O₂）介导的大鼠肺微血管内皮细胞（PMVECs）氧化应激中的调控作用。 方法分离培养大鼠PMVECs并分成4组：对照组（未加H₂O₂）及各剂量H₂O₂组（终浓度分别为50、100、200 μmol/L的H₂O₂）。在H₂O₂刺激细胞24 h后检测细胞增殖活性、细胞内活性氧水平及APE1蛋白表达,同时检测100 μmol/ml的H₂O₂刺激细胞24、48、72 h后APE1蛋白表达并比较。另外利用慢病毒载体转染构建APE1过表达PMVECs,将其分成对照组（未加H₂O₂）,H₂O₂组（终浓度为100 μmol/L的H₂O₂）,H₂O₂+空载体转染组（100 μmol/L的H₂O₂刺激慢病毒空载体转染的细胞）及H₂O₂+APE1转染组（终浓度为100 μmol/L的H₂O₂刺激APE1过表达细胞）,并在24 h检测细胞活性氧水平及细胞增值情况。 结果不同剂量组H₂O₂刺激细胞24 h后,四组间细胞增殖活性、活性氧的水平和APE1蛋白表达相对值差异均有统计学意义（F = 80.238、445.608、547.566,P均< 0.001）。在100 μmol/L的H₂O₂刺激细胞0、24、48和72 h后,APE1蛋白表达相对值的比较有统计学意义（F = 422.324,P < 0.001）,且随时间增加APE1表达也逐渐下降[（0.781 ± 0.043）、（0.611 ± 0.026）、（0.407 ± 0.014）、（0.272 ± 0.013）,P均< 0.05]。在转染慢病毒载体后,H₂O₂组活性氧水平明显高于对照组[（86.4 ± 1.2）vs.（56.4 ± 0.9）,P < 0.05];而H₂O₂ + APE1转染组细胞活性氧水平较H₂O₂组显著下降[（66.8 ± 1.0）vs.（86.4 ± 1.2）,P < 0.05],细胞增殖活性明显增加[（0.209 ± 0.001）vs.（0.153 ± 0.001）,P < 0.05]。 结论H₂O₂刺激可导致APE1蛋白表达下降,而上调APE1表达可增加细胞增殖活性,并抑制活性氧的产生。因此,APE1可能具有减轻H₂O₂介导的大鼠PMVECs氧化应激反应的作用。