尿毒症患者呼吸中枢兴奋性及吸气肌力的测定

OBJECTIVE: To investigate the changes of central respiratory drive and inspiratory muscles function in patients with uremia. METHODS: We performed the measurement of forced vital capacity (FVC), maximal voluntary ventilation (MBC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal midexpiratory flow (MMEF), expiratory flow of 25 per cent of FVC (V25), lung carbon monoxide diffusing capacity (DLco), maximal inspiratory mouth pressure (MIP) and airway occlusion pressure (P0.1) in 25 patients with uremia and 20 normal subjects. RESULTS: In patients with uremia, the FVC, MBC, FEV1, PEF, MMEF and V25 which reflect the lung ventilatory function and the DLco which reflects the lung diffusing function were significantly lower than those in normal subjects. The patients' MIP which reflects inspiratory muscles strength was significantly lower and their P0.1 which reflects the central respiratory drive was significantly higher, compared with the normal subjects'. CONCLUSION: Our findings suggest that on the basis of the disorder of ventilation and diffusing function of the lungs, the inspiratory muscles function of the patients with uremia is significantly decreased and the central respiratory drive of the patients is increased.     

慢性肺心病患者最大用力吸气流量－容积曲线测定的意义

对７５例慢性肺心病患者和３１例健康成年人测定了各项肺容积和最大用力呼气流量－容积曲线（ＭＥＦＶ）及最大用力吸气流量－容积曲线（ＭＩＦＶ）。结果显示：慢性肺心病患者组肺活量（ＶＣ）、补呼气容积（ＥＲＶ）、一秒率（ＦＥＶ１．０％）和最大呼气中段流量（ＭＭＥＦ）非常显著降低（Ｐ＜０．０１），功能残气量（ＦＲＣ）、残气容积（ＲＶ）、ＲＶ／ＴＬＣ％均非常显著增高（Ｐ＜０．００１）；而最大用力吸气流量－容积曲线（ＭＩＦＶ）１５％、２５％、５０％、７５％、８５％和ＭＭＩＦ各段平均流量亦有非常显著降低（Ｐ＜０．００１）和用力吸气时间（ＦＩｔ）明显延长（Ｐ＜０．００１）。表明慢性肺心病患者不仅在最大用力呼时大小气道有严重的通气功能障碍，在最大用力吸气时各段吸气流量亦均有显著降低和吸气时间延长     

Pulmonary function changes following surgical correction for pectus excavatum

Ｐｅｃｔｕｓｅｘｃａｖａｔｕｍｉｓｔｈｅｍｏｓｔｆｒｅｑｕｅｎｔａｎｔｅｒｉｏｒｃｈｅｓｔｗａｌｌｄｅｆｏｒｍｉｔｙａｎｄｉｓｐｒｏｄｕｃｅｄｂｙｐｏｓｔｅｒｉｏｒｄｅｐｒｅｓｓｉｏｎｏｆｔｈｅｓｔｅｒｎｕｍａｎｄｌｏｗｅｒｃｏｓｔａｌｃａｒｔｉｌａｇｅ Ｉｔｏｃｃｕｒｓｍｏｒｅｃｏｍｍｏｎｌｙｉｎｂｏｙｓｂｙａｌｍｏｓｔａ 4∶ 1ｒａｔｉｏ Ｔｈｅｓｔｅｒｎｕｍａｎｄｃｏｓｔａｌｃａｒｔｉｌａｇｅｔｈａｔａｒｅａｎｇｌｅｄｐｏｓｔｅｒｉｏｒｌｙｍａｙｄｅｃｒｅａｓｅｔｈｅｃｈｅｓｔｖｏｌｕｍｅ,ｒ…     

不同地区青年耐寒锻炼前后肺通气功能的变化

目的 研究来自不同地区青年耐寒锻炼前后肺通气功能的变化.方法 选取驻哈尔滨某部当年入伍的新兵,分为两组;Ⅰ组为来自寒区的新兵50人(吉林省吉林地区),Ⅱ组为来自非寒区的新兵50人(河南信阳);按照新兵训练大纲进行耐寒锻炼,分别于锻炼前和锻炼后60天测定受试者的肺通气功能.并比较吸烟者和非吸烟者肺通气功能指标.结果 训练前,Ⅰ组新兵的25%呼气流速(FEF25%)、50%呼气流速(FEF50%)和75%呼气流速(FEF75%)3项肺通气功能指标均高于Ⅱ组新兵,且有显著性差异(P<0.05);而其他肺通气功能指标两组间无显著性差异(P>0.05).训练后60天,两组新兵的肺通气功能指标均显著高于训练前(P<0.01,P<0.05),而两组间比较各项指标均无显著性差异.在训练前和训练60天后,新兵小气道功能的部分指标吸烟组和非吸烟组比较有显著性差异(P<0.05).结论 寒冷气候对来自非寒区的新兵训练前小气道功能有一定影响,而经过耐寒锻炼60天后,来自寒区和非寒区新兵的肺通气功能均显著提高,增强了新入伍战士对寒冷环境的适应能力.同时长期大量吸烟对小气道功能有一定损害.     

脊柱侧凸患者肺功能影响因素的分析及临床意义

目的 对脊柱侧凸患者术前肺功能指标影响因素进行回顾性研究.方法 选取108例脊柱侧凸患者为研究对象,对患者术前肺功能参数相关因素进行分析.结果 脊柱侧凸患者Cobb角与VC、FVC、FEVl、PEF、FEF25-75、MMEF及MVV等肺功能参数的实测值占预计值的百分比呈显著负相关;与MV及FEVI/FVC无相关性;CS患者的肺功能损害程度较IS组严重;Cobb角≥90°组、顶椎位于T4-T8组、年龄<10岁组及受累椎体数目7个组的侧凸患者肺功能损害程度远高于其余相应组别的患者.结论 脊柱侧凸患者术前肺功能主要影响因素为侧凸发病年龄、侧凸畸形Cobb角、侧凸发生的部位及侧凸累积节段.发病年龄小、大角度、长节段的先天性胸弯(尤其是顶椎区位于T8以上)患者其肺功能损害程度将会明显加重.     

阻塞性睡眠呼吸暂停低通气综合征患者肺功能的变化

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者肺功能的变化。方法对经多导睡眠图监测（PSG）确诊的142例OSAHS患者（OSAHS组）及52例体检健康者（对照组）,分别行肺通气功能[检测指标包括潮气量（VT）、每分通气量（MV）、最大肺活量（VCMAX）、补呼气量（ERV）、用力肺活量（FVC）、1秒用力呼气容积（FEV1）、1秒率（FEV1／FVC）、最大分钟通气量（MVV）、用力呼气峰流量（PEF）和75％用力呼气容积流量（FEF75）、50％用力呼气容积流量（FEF50）、25％用力呼气容积流量（FEF25）]测定及比较,并作呼吸暂停低通气指数（AHI）及体重指数（BMI）与上述指标的相关性分析。结果OSAHS组患者肺通气功能指标ERV、VCMAX、FVC、FEV1、FEF50、MV、MVV均较对照组显著下降（均P〈0．01）。OSAHS组患者AHI与MV、ERV、VCMAX、FVC、MVV呈负相关（r=-0.321～-0．244,均P〈0．01）;BMI与ERV、VCMAX、FVC、MVV、MV呈负相关（r==-0．375～-0205,P〈005或0．01）。与FEV1／FVC呈正相关（r=0．385,P〈001）。结论OSAHS患者存在肺功能损害,损害程度与BMI及AHI有关,需要引起重视。     

支气管哮喘发作期中医辨证回顾性调查报告

目的：了解哮喘的证型分布和四诊信息出现的频率，考证现代医学指标与证型的相关性，为支气管哮喘中医辨证现场调查和前瞻性研究提供依据。方法：通过对112份支气管哮喘（发作期）住院病例的回顾性调查，重点收集中医证型、四诊信息及检查指标等数据，对数值变量进行t检验，方差不齐时采用t'检验，多因素处理采用Logistic回归分析。结果：112例支气管哮喘痰热蕴肺证占哮喘4个证型的83．93％。第1秒用力呼气容积、第1秒用力呼气容积百分比、最大呼气中段流量、最大呼气流率、75％肺活量最大呼气量、50％肺活量最大呼气量及肺纹理增粗与痰热蕴肺主有统计学意义。结论：证型分布呈极度偏态，大多集中在痰热蕴肺证；肺纹理增粗、肺功能指标与痰热蕴肺证有一定相关性。     

糖尿病患者肺功能损害的特征及机制研究进展

糖尿病(diabetes mellitus,DM)在中国具有很高的发病率,因肺脏具有广泛的微血管循环和丰富的结缔组织,导致其更易受到慢性高血糖的病理影响,从而可能成为DM的"靶器官".近年来的研究表明,DM患者存在肺功能的改变,主要表现为限制性通气功能障碍和弥散功能障碍.DM患者具有更低的用力肺活量(forced vi...     

Study of pulmonary functions in tea industry workers in North Bengal

This study was intended to compare pulmonary function parameters in tea garden factory workers who are on chronic exposure to tea dust with tea garden plantation workers on the basis of dynamic ventilatory pulmonary function tests. The pulmonary function tests done on 128 subjects included 64 tea garden factory workers and 64 tea garden plantation workers. In tea factory workers the values of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in first 0.75 second (FEV0.75), FEV1/FVC%, peak expiratory flow rate (PEFR) were found significantly lower (p < 0.001) than those of tea garden plantation workers. It may be concluded that pulmonary functions are more affected in tea factory workers than those of tea plantation workers.     

65例煤矽肺患者肺功能4年随访观察

目的：探讨煤矽肺患者肺功能随时间推移的变化情况，并比较I、Ⅱ期矽肺病人肺功能损害变化情况。方法：监测65例煤矽肺患者4年中VC（肺活量）、FVC（用力肺活量）、FEV1（一秒钟用力呼气容积）、MMEF（最大呼气中期流速）、V50、V25（50％、25％肺活量时的最大呼气流量）的变化情况。结果：反应大气道功能的指标下降程度相对较轻。其中VC基本正常，FVC和FEV1在4年内呈轻度异常，并均逐年下降；反应小气道功能的MMEF、V50、V25在检测时已经明显下降，尤以V25为甚。并逐年下降；I、Ⅱ期矽肺病人肺通气功能各项指标测定值随矽肺类别的上升而下降，两组间有显著性差异。结论：矽肺患者的肺功能监测指标均低于正常，并呈进行性下降趋势；Ⅱ期矽肺病人肺通气功能较I期显著下降。     

吸烟对小气道影响的探讨

本文报告吸烟对小气道的影响,用最大呼气流速-容量曲线的方法对60名健康人和60名吸烟人进行检测,其结果显示吸烟组各项指标均低于健康组,其差异高度显著性(P<0.001)。本文对60名吸烟者作了进一步分析,把吸烟≤10年,11～20年、≥20年,分为三组进行比较,其结果证实吸烟年数愈长,小气道功能损害愈大,各项检测相比差异均有显著性(P<0.05及0.025)。说明最大呼气流速-容量曲线对小气道疾病的检测有高度的敏感性,重复性强。因此是早期诊断呼吸道疾病和保健检查的重要方法。     

河北省正常人群肺功能检测分析

目的探讨河北省正常人群肺功能的生理预计值及其不同生活环境、年龄、身高、体重等因素与肺功能的关系.方法2002年8～10月对进行过基础体检并确定为正常的1 587名不同年龄段人群采用便携式肺功能仪进行肺容量及肺通气量检测,分析不同地域、年龄、性别、身高、体重等因素对肺功能的影响.结果检测的各项肺功能指标城乡之间差异无显著性(P＞0.05);不同性别之间差异有显著性(P=0.000);多数肺功能指标在男12～16岁、女12～14岁为肺功能增长突增期,肺活量(VC)、用力呼气肺活量(FVC)、一秒量(FEV1)26岁达到高峰并维持到34岁左右,然后呈逐渐下降趋势;最高呼气流速(PEF)、25%用力呼气流速(FEF25%)可持续增长到34～44岁其后呈下降趋势(均P＜0.01);FEF50%、FEF75%等18岁为高峰随后随年龄增长逐渐下降(P＜0.01).身高、体重与各项肺功能指标均有相关性,但身高的影响大于体重.结论年龄、身高、体重与各项肺功能均有相关性,肺功能随年龄的增长而发生变化,青少年期、成年期、中老年期应有不同的生理预计值;本研究为正常人群肺功能值提供了一个参考值.     

Ventilatory Tests and Pulmonary Conductance in Hospitalized Patients

In a series of 49 patients, including individuals with varying lung pathology and some older patients with no lung disease, the usual excellent correlation between first-second forced expiratory volume and maximum breathing capacity was found (coefficient of correlation=0.88). The first-second forced expiratory volume and maximum mid-expiratory flow rate were also seen to be closely related (coefficient of correlation=0.87). The relationship between these ventilatory tests and direct mechanical measurements of pulmonary resistance, however, was not as striking. Reduction in pulmonary compliance not due to loss or removal of pulmonary tissue did not affect the interrelationships between these tests. First-second forced expiratory volume, expressed as a percentage of the predicted vital capacity, was more closely related to the expression “% of predicted maximum breathing capacity” than the first-second forced expiratory volume, expressed as a percentage of the actual vital capacity (p<.05).     

Ventilatory standards for clinically well aboriginal adults.

OBJECTIVE: To obtain reference standards for ventilatory function of clinically well Australian Aboriginal adults. DESIGN: A cross-sectional assessment of the population of a North Queensland Aboriginal community. SETTING: A specialist clinical and public health service. The measurements were made with the cooperation of the local primary health care centre. PARTICIPANTS: The 288 study subjects included over 70% of Aboriginal adults residing in an isolated Cape York community. Those with known respiratory disease, abnormal chest x-ray findings, positive loose cough sign, abnormal lung signs or inability to perform the ventilatory tests satisfactorily were excluded; 229 persons (80%) remained for analysis. Smoking was prevalent in both men (85%) and women (76%). As in most other studies producing reference values for lung function, smokers were not excluded. MAIN OUTCOME MEASURES: Age, standing height in bare feet and sitting height were recorded. Ventilatory measurements included forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and maximum mid-expiratory flow (MMEF) which is also known as the forced expiratory flow (FEF 25%-75%). RESULTS: Standing height, age and sex were the major determinants of ventilatory function. Sitting height was not a good predictor. Ventilatory values differed significantly from those expected for Europeans: Aboriginal lung volumes were much smaller (by about 25%) and fell much faster with age. The age-related decrease in lung function was less in smokers. CONCLUSION: The smoking effect may reflect the operation of differential survival or other selective factors and has been noted in some other ethnic groups. Although previous studies have yielded some ventilatory function data on Aborigines, we report the first population-based reference values expected for clinically well adults. The information will be useful to clinicians and public health workers.     

戈壁气候对新兵肺通气功能的影响

目的了解戈壁气候对人体肺通气功能的影响。方法选择健康新兵15名分别于进入戈壁地区第1周、3个月、9个月进行肺通气功能检查,项目包括潮气量(VT)、用力肺活量(FVC)、一秒用力呼出量/用力肺活量比值(FEV1%)、每分钟最大通气量(MVV)等,采用SPSS10.0统计软件对相关数据进行自身前后对照研究,统计方法采用one-way ANOVA。结果在第1周、3个月、9个月三个时间段,VT均显著高于正常预计值(100.0%),三者之间比较无显著性差异;第1周时FVC、FEV1%高于正常预计值并明显高于3个月及9个月时(P<0.01),而3个月与9个月时已恢复至基线水平,其间差异没有显著性(分别为P=0.92、P=0.22);第1周MVV高于正常预计值并明显高于3个月及9个月时(P<0.01),3个月与9个月时亦高于正常预计值,其间差异没有显著性(P=0.23)。结论进入戈壁环境初期,人体肺通气功能发生明显变化;3个月后FVC、FEV1%基本恢复正常,9个月后MVV稍高于正常预计值,而VT仍持续高水平。     

Spirometry and flow-volume curve in patients with obstructive sleep apnea

OBJECTIVE: To assess the prevalence of spirometric abnormalities in obstructive sleep apnea (OSA) patients and its clinical utility in diagnosing OSA. METHODS: We conducted an observational study between March 2006 and March 2007 at King Khalid University Hospital on consecutive patients presenting with suspected OSA. Spirometric indices of forced expiratory volume in 1 second (FEV1)/forced expiratory volume (FVC), maximum mid-expiratory flow (MMEF)75/25, peak expiratory flow (PEF), forced expiratory flow (FEF)50, and forced inspiratory flow (FIF)50 were analyzed for 138 patients with OSA. Expiratory and inspiratory flow volume curves were examined for the presence of fluttering of the upper airway (saw-tooth sign) and signs of upper airway obstruction defined as a FEF(50)/FIF(50) >1. Patients with flow-volume curve abnormalities were compared with patients who did not show any abnormalities. RESULTS: Saw-tooth sign was present in 12.3% and the ratio of FEF(50)/FIF(50) >1 was found in 26.1% of OSA patients. Obstructive sleep apnea patients who had these abnormalities did not differ from patients who did not have them with regard to age, body mass index, apnea-hypopnea index (AHI), desaturation index and other spirometric indices. The presence of saw-tooth sign and FEF(50)/FIF(50) >1 was not related to the severity of AHI CONCLUSION: Spirometric abnormalities are not common in OSA patients not known to have underlying chronic lung diseases. Saw-tooth sign and FEF(50)/FIF(50) >1 are not useful in predicting OSA.     

Prediction equations for spirometric parameters in Mexican adult population

BACKGROUND: Our objective was to develop prediction equations for spirometric parameters that included the following: forced vital capacity (FVC); 1st-sec forced expiratory volume (FEV1); FEV1/FVC ratio; peak expiratory flow (PEF); maximal expiratory flow 50% FVC (VF50) and maximal expiratory flow 75% FVC (VF75); maximal mid-expiratory flow (FEF25-75), and forced late expiratory flow rate (FEF75-85) in a sample of adult Mexican population of both sexes. Age and height variables were utilized. METHODS: Spirometric studies were carried out, observing the international recommendations and norms in force and effected under basal conditions and post-bronchodilator. Linear regression equations were generated based on gender, age, and height. For each spirometric parameter, we selected a linear model. Studies were carried out with spirometry that was in agreement with quality criteria recommended by the American Thoracic Society (ATS). Bronchodilatator administration allowed for elimination of subjects with subclinical bronchial hyperreactivity RESULTS: We studied 436 patients with normal clinical radiographic and pulmonary function, with negative smoking and age range between 17 and 63 years; 206 were females and 230, males. Linear regression equations obtained had direct linear correlation with height and inverse linear correlation with age; in addition, equations had a determination coefficient equal to or less than those reported by authors recommended by the ATS. CONCLUSIONS: Equations obtained in this study possessed the quality required for application in adult Mexican population exposed or not to occupational and environmental contaminants.     

The effect of passive smoking on pulmonary function during childhood

Passive smoking, especially of maternal origin, is known to influence adversely the development of children''s pulmonary function. In this study, the effect of parental smoking on the pulmonary function of 360 primary school children aged 9-13 (mean 10.8±0.7) years was investigated. Information on parental smoking history was collected using a questionnaire, and spirometric measurements were performed on the children.
All spirometric indices were lower in children who had been passively exposed to parental tobacco smoke than those not exposed. The percentage of households in which at least one parent smoked was 81.5%. This figure was significantly lower for mothers (27.5%) than for fathers (79%). Paternal smoking was associated with reduced levels of forced expiratory flow between 25-75% of vital capacity, peak expiratory flow, and flow rates after 50% and 75% of vital capacity expired (p<0.05). Maternal smoking did not have statistically significant adverse effects on children''s pulmonary function. This result might be due to the low occurrence of either pre- or post-natal smoking among mothers and confirms that, in our population, the main target group for anti-tobacco campaigns should be fathers.


     

手术内固定与非手术外固定治疗创伤性连枷胸的效果比较

目的 比较手术内固定与非手术外固定在治疗创伤性连枷胸为主的全身多发伤中的疗效。方法 对60例以创伤性连枷胸为主的全身多发伤患者的临床资料进行回顾性分析,比较手术组（手术内固定治疗,n=32）和非手术组（非手术外固定治疗,n=28）患者的临床疗效。结果 手术组患者平均住院时间、平均住ICU时间和平均机械通气时间均显著短于非手术组(P<0.05),胸壁畸形、肺部炎症、肺不张和呼吸功能衰竭等并发症发生率均显著低于非手术组(P<0.05)。出院后6个月,手术组患者肺功能指标包括深吸气量、用力肺活量、第一秒用力呼气量、最大呼气流量、肺总量和最大呼气中段流量均显著高于非手术组(P<0.05)。结论 对存在复合伤的连枷胸患者行手术内固定可减少连枷胸引起的并发症,有良好的短期和长期疗效。     

肺癌病人最大呼吸流速容量曲线及弥散功能变化的意义

目的了解肺癌患者肺功能最大呼吸流速容量曲线(MEFV)变化的意义及其变化与气道阻力(Raw)、用力肺活量(FVC)测定相关性。观察放/化疗后弥散功能和肺CT的改变。方法测定36例肺癌患者的MEFV、Raw及弥散功能,并对其间的相关性进行分析。结果发现肺癌病人存在FVC、FEV1、PEF、V!50、V"25下降,且这种下降在放/化疗后更明显,PEF、V#50下降与吸/呼气的气道阻力呈负相关,与FVC呈正相关。肺癌患者在放/化疗后1、2年Dlco、Co减少,CT所见存在28.57%肺间质病变。结论肺癌病人肺功能表现可有阻塞性通气功能障碍,当气道阻塞严重时,PEF、V$50、V%可同时下降,说明PEF的下降可与小气道的阻塞有关,V50下降也可与用力大小有关。DLco可与CT一样作为敏感指标观察放/化疗后肺间质的损害。