用潮气呼吸流速容量环评价婴幼儿肺炎治疗前后肺功能变化的研究

目的 研究婴幼儿肺炎时小气道阻塞程度及肺功能损害程度。方法 运用潮气呼吸流速容量环（TBFV环）对82例婴幼儿肺炎进行治疗前后肺功能各项指标比较。结果 发现治疗后TBFV环形态有很大的变化，反映小气道功能中到达潮气呼气峰流速时的呼气量／潮气量（％V－PF）及呼出75％潮气量时的呼气流速／潮气呼气峰流速（25／PF），潮气呼气峰流速（PTEF）差异均有显著意义（P＜0．05）。反映通气功能的每公斤潮气量（TV/kg）、呼吸频率（RR）差异有显著意义（P＜0．05）。反映大气道阻塞位置与损害程度的潮气呼吸中期流速与潮气吸气中期流速之比（ME／MI）治疗前后差异无显著意义（P＞0．05）。结论 提示TBFV环可作为评价临床上婴幼儿肺炎的轻重程度，肺功能的损害程度以及观察治疗效果客观的重要依据，值得临床推广应用。     

用潮气呼吸流速容量环评价婴幼儿肺炎治疗前后肺功能变化的研究

目的研究婴幼儿肺炎时小气道阻塞程度及肺功能损害程度. 方法运用潮气呼吸流速容量环(TBFV环)对82例婴幼儿肺炎进行治疗前后肺功能各项指标比较. 结果发现治疗后TBFV环形态有很大的变化,反映小气道功能中到达潮气呼气峰流速时的呼气量/潮气量(%V-PF)及呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF),潮气呼气峰流速(PTEF)差异均有显著意义(p<0.05).反映通气功能的每公斤潮气量(TV/kg)、呼吸频率(RR)差异有显著意义(p<0.05).反映大气道阻塞位置与损害程度的潮气呼气中期流速与潮气吸气中期流速之比(ME/MI)治疗前后差异无显著意义(p>0.05). 结论提示TBFV环可作为评价临床上婴幼儿肺炎的轻重程度,肺功能的损害程度以及观察治疗效果客观的重要依据,值得临床推广应用.     

儿童肺炎支原体感染检测MBL和CRP的意义

探讨肺炎支原体（MP）感染患儿血清甘露糖结合凝集素（MBL）和C-反应蛋白（CRP）水平变化的意义。用EL／SA和速率散射比浊法分别检测患儿血清MBL和CRP水平。结果显示,57例MP感染患儿MBL水平（3．64±1．72mg／L）和CRP（21．44±15．02mg／L）比对照组（2．18±1．05mg／L和2．76±1．81mg／L）显著增高（P〈0．001）。年龄小于8岁患儿MBL水平低于年龄大于8岁患儿,其中8例反复呼吸道感染患儿MBL水平（2．02±1．21mg／L）显著低于其它患儿（3．95±1．63mg／L,P〈0．01）。患儿恢复期CRP水平明显降低。结果提示,血清MBL和CRP水平可作为监测MP感染患儿天然免疫功能的指标,动态检测有助于评价疗效。     

肺炎支原体肺炎与细菌性肺炎患儿心肌酶变化比较的意义

目的观察肺炎支原体肺炎（MPP）患儿血清心肌酶值的变化，与普通细菌性肺炎患儿心肌酶值变化水平进行比较，探讨其对心肌损害的影响程度，为心肌损害的早期诊断及治疗提供依据。方法选取普通细菌感染及肺炎支原体感染肺炎患儿各100名，进行急性期血清心肌酶值测定，与100名正常体检儿童进行对比并进行相互比较。结果肺炎急性期MP感染组与非MP感染组AST、LDH、CK—MB均明显高于正常对照组（P〈0．05），两组对比MP感染组心肌酶升高程度明显高于非支原体感染组，AST、LDH、CK—MB在两组间存在显著差异（P〈0．05）。结论细菌性肺炎与肺炎支原体肺炎急性期均有不同程度的心肌细胞损害，其中MP感染患儿血清心肌酶水平明显高于非MP感染患儿，提示MP肺炎患儿有明显心肌损害且心肌损害程度要重于非MP肺炎患儿。     

肺炎支原体肺炎免疫功能动态变化

肺炎支原体 (Mycoplasmapneumoni ae ,MP)是婴幼儿肺炎的主要病原之一 ,为观察患儿免疫功能的变化 ,对 4 0例确诊为MP肺炎 (MPP)的患儿进行了在急性期和恢复期外周血免疫球蛋白 (Ig)、T淋巴细胞亚群、IL 2、sIL 2R、IL 6和IL 8水平的检测 ,为MPP患儿免疫学治疗提供依据。MP IgM检测确诊为MPP感染者 :男2 1例 ,女 19例 ,2 7天～ 1岁 12例 ,1～ 3岁 2 8例。外周血免疫球蛋白 (IgG、IgA、IgM)测定采用单向琼脂免疫扩散法 ,T淋巴细胞亚群测定采用APAAP ,药盒由军事医学科学院提供 ,IL 2和sIL 2R及IL 6和IL 8检测均采用双抗…     

112例新生儿呼吸道合胞病毒肺炎肺潮气呼吸功能研究

目的探讨新生儿呼吸道合胞病毒肺炎肺功能研究变化。方法采用潮气呼吸功能测定112例,日龄15-28d的新生儿呼吸道合胞病毒肺炎的肺功能。以102例正常同日龄新生儿做对照。主要参数为：达峰时（TPTEF）,达峰时间比（TPTEF/TE）,达峰容积（VPEF）,达峰容积比（VPEF/VE）,呼吸频率（RR）,潮气量（VT/kg）,每分通气量（MV）,潮气呼吸容量环（TBFV）。结果急性期组潮气量（VT/kg）（5.98±1.32）mg/kg,分钟通气量（MV）（1.08±0.29）L/min,较恢复期（7.02±1.21）ml/kg和（1.29±0.24）l/min明显偏低（P〈0.05）;反映气道阻塞的指标TPTEF/TE,VPEF/VE分别为（33.01±4.81）%和（33.5±5.02）%低于恢复期组的（43.76±9.82）%和（45.0±10.01）%（P〈0.05）。急性期组呼吸频率（RR）为（58.42±13.01）次/分,比恢复期的（50.01±13.44）次/分明显增快（P〈0.05）。恢复期分钟通气量（mv）为（1.29±0.24）l/min,较对照组的（1.52±0.30）l/min低（P〈0.05）,有显著性意义。TBFV形态特点：临床急性期TBFV环变窄,呼吸曲线升陡,高峰提前,峰值较高,降支凹陷。结论潮气呼吸肺功能测定新生儿呼吸道合胞病毒肺炎气道病变,可作为检测新生儿呼吸道合胞病毒肺炎病程及预后较为理想的方法。     

儿童支原体肺炎的药物治疗

目的：探讨不同治疗方法对支原体肺炎患者的肺功能的影响。方法：本组39例均确诊为支原体肺炎患者,治疗组2l例在常规阿奇霉素等治疗基础上加用舒利迭治疗,对照组18例常规阿奇霉素等治疗。在治疗前、治疗后1月、2月分别检测患儿最高呼气流速（PEF）值,并分析其变化。结果：两组PEF值治疗后较治疗前明显改善,差异具有统计学意义（P〈0．01）。治疗2月后治疗组患儿PEF值较对照组改善显著,组间比较差异具有统计学意义（P〈0．05）。结论：舒利迭联合阿奇霉素治疗支原体肺炎疗效确切,并能长期改善患儿的肺功能。     

肺炎支原体感染儿童肌红蛋白和肌钙蛋白Ⅰ的分析

目的检测并比较肺炎支原体（MP）感染患儿治疗前后血清中肌红蛋白（Mb）和肌钙蛋白Ⅰ（cTn-I）的含量,以探讨其在肺炎支原体肺炎（MPP）合并心肌损害诊治中的意义。方法抽取肺炎支原体感染并有心肌损伤表现的患儿（46例）急性期和恢复期的静脉血,测定并比较其血清中Mb和cTn-I的含量变化,同时以健康儿童做为对照组。结果 MPP合并心肌损伤组患儿急性期血清中Mb和cTn-I的含量显著高于健康对照组（P〈0.01）。与急性期相比,MPP合并心肌损伤的患儿恢复期血清Mb和cTn-I的含量明显下降（P〈0.01）,但仍高于对照组（P〈0.05）。结论 MPP患儿有部分患者急性期有不同程度的心肌损害。     

婴幼儿肺炎支原体感染免疫状态及临床分型

目的探讨婴幼儿肺炎支原体（MP）感染的临床分型及其感染后免疫状态的改变。方法通过测定患儿血清MP特异性抗体IgM（MP—IgM）及冷凝集试验（CAT），确诊128例婴幼儿为MP感染，并进行细胞免疫体液免疫的检测，结合临床表现及辅助检查进行临床分型。结果患儿临床表现多样化，大致可分为5型，肺炎型62例（48．4％），败血症型31例（24．2％），结核型16例（12.5％），脑膜脑炎型11例（8．6％），上感型8例（6．2％）。同时发现MP感染患儿急性期外周血辅助T细胞（CD4）与白细胞介素6（IL-6）、白细胞介素8（IL-8）、肿瘤坏死因子α（TNF—α）水平呈高度负相关，（P〈0.01），抑制T细胞（CD8），与IL-6、IL-8、TNF—α呈高度正相关（P〈0．01）。结论1、MP感染临床表现多样化，故早期诊断较困难，及早做出诊断采取针对性治疗，以减少病灶迁延及多个脏器损害极为重要。2、免疫损伤在本病的发病机理中却起了一定作用。     

呼吸道感染患者肺炎支原体抗体检测结果分析

目的研究肺炎支原体（MP）感染发病率与患者年龄、性别和季节的关系。方法用被动凝集法检测呼吸道感染患者血清中肺炎支原体抗体（MP-Ab）,并对2010年患者MP-Ab检测结果进行分析。结果5年检测结果阳性率为30．10％;男、女性患者阳性率分别为30．74％、36．12％,差异有统计学意义（P〈0．05）;各年龄组差异有统计学意义（P〈0．001）,3～14岁阳性率最高;季节发病率差异无统计学意义;阳性滴度〉1：640的患者占10．18％。结论MP感染逐年增加,3～14岁儿童为高危人群,女性感染机会高于男性,全年均可发病;大多患者预后良好。     

Non-invasive measurement of total respiratory compliance and resistance in cats

We adapted non-invasive techniques developed for human infants to measure total respiratory system compliance (Crs) and resistance (Rrs) in 21 healthy cats. The animals breathed through a face mask attached to a respiratory circuit and measurements were taken of changes in lung volume and airway pressure during brief occlusions of the airway at different lung volumes. The slope of the plot of change in volume against airway pressure yielded the multiple occlusion Crs with a mean (+/-95%CI) value of 6.8 (6.3-7.3) ml/cm H2O. In 12 animals measurements were made by the single breath technique in which occlusion was made early in expiration and on release, a plot of the subsequent relaxed expiratory flow and volume yielded the time constant (taurs), Crs and Rrs with mean (+/-95%CI) values of 0.27 (0.22-0.31) s, 7.0 (6.1-7.8) ml/cm H2O, and 38.7 (33.7-43.6) cm H2O/l/s, respectively. Rrs was significantly correlated inversely with forced expiratory flow at resting lung volume (V'maxFRC).     

The total compliance of the respiratory system during the first year of life

Respiratory system compliance (Crs) was measured in 34 spontaneously breathing infants during the first year of life. An occlusion technique was used whereby several expiratory occlusions were performed at different lung volumes within the tidal range. The airway opening pressure generated during a plateau after occlusion was related to the volume included above the end-tidal level by a regression equation. The slope of this equation represented the compliance of the infant's respiratory system; the intercept was significantly different for preterm (-0.5 ml) and post-term (-5.5 ml) infants and may represent the difference between end-expiratory lung volume during tidal breathing and the relaxed functional residual capacity. The values for respiratory system compliance were similar to those previously reported for infants during muscle relaxation. As a function of body length, Crs = 1.58 X length3.13 X 10(-4) ml . kPa-1. The technique described is simple to apply and is independent of oesophageal pressure measurements.     

小潮气量和传统潮气量机械通气治疗小儿重症肺炎的疗效对比分析

目的：对比分析小潮气量和传统潮气量机械通气治疗小儿重症肺炎的疗效。方法：对2013年6月至2015年6月在我院进行接治的100例小儿重症肺炎进行研究,将患儿随机分为对照组和观察组,各50例,对照组的患儿采用传统潮气量,潮气量为10~12 mL/kg;观察组的患儿采用小潮气量,潮气量为6~8 mL/kg,对治疗过程中两组患儿临床参数的变化进行对比分析。结果：观察组患儿的机械通气时间明显多于对照组(t=11.0770,P=0.0000),观察组患儿的病死率明显高于对照组(χ2=5.4825,P=0.0192),治疗过程中,两组患儿的平均气道压(Paw)、吸入氧浓度(fraction of inspiration O2,FiO2)、高呼吸末正压(positive end expiratory pressure,PEEP)、吸气峰压(peak inflating pressure,PIP)等临床各指标的变化无明显差异(P>0.05),观察组与对照组存活患儿的反复呼吸道感染发生率无明显差异(χ2=0.0624,P=0.8028)。结论：对重症肺炎患儿进行机械通气时,传统潮气量的治疗效果优于小潮气量。     

肺炎支原体BALB/c小鼠支气管肺泡灌洗液中IFN-γ、IL-4、IL-5、IL-10表达和气道阻力的变化

目的通过建立肺炎支原体(MP)感染BALB/c小鼠的模型,探讨MP感染后小鼠支气管肺泡灌洗液(BALF)中炎性因子(IFN-γ和IL-4、IL-5和IL-10)的含量变化及其对气道阻力的影响。方法 50只BALB/c小鼠随机分为MP感染组(MP组)和PBS对照组(N组),每组25只,分别于接种后第3d、7d、14d、21d和30d从各组中取5只鼠,取肺脏制作病理切片,HE染色观察病理组织学变化;RT-PCR对模型进行鉴定;ELISA试剂盒检测BALF中IFN-γ、IL-4、IL-5和IL-10含量;同时用肺功能仪测定各组小鼠肺的吸气阻力、呼气阻力和顺应性。结果 MP感染小鼠后IFN-γ、L-4、IL-5和IL-10的含量较N组明显升高(0.05);吸气阻力、呼气阻力较N组增加(0.05),顺应性降低较N组增加(0.05),第7天时达高峰,随后下降30天恢复正常。结论 MP感染BALB/c小鼠后气道阻力增加、顺应性降低,炎性因子过表达。     

高呼气末正压加小潮气量治疗急性呼吸窘迫综合征

目的：评价高呼吸末正压（PEEP）加小潮气量治疗急性呼吸窘迫综合征（ARDS）的临床疗效和安全性。方法：选择2009年3月至2011年6月在中煤三建总医院重症监护病房（ICU）收治的30例ARDS患者,采用高PEEP加小潮气量（6ml／kg）及其它对症措施治疗。结果：30例患者经治疗动脉血气氧分压（PaO2）和氧合指数（PaO2／FiO2）均明显改善,治疗第2—5天动脉血氧分压（PaO2）改善最明显,第4、5天氧合指数（PaO2／FiO2）改善最为明显。患者均无气压伤发生,无心律失常发生,心率和平均动脉压无明显变化。中心静脉压随呼气末压增高而偏高,但对平均动脉压无显著影响。结论：高PEEP加小潮气量可增加肺泡气体交换,改善氧合。减少呼吸机相关性肺损伤。     

Evaluation of the end-expiratory lung volume as an indirect index of bronchial constriction in asthma

The purpose of this study was to evaluate the merits of the end expiratory lung volume as an indirect ventilatory index of bronchial obstruction and to show an application of continuous monitoring of lung volume in asthmatic patients. The accuracy of the external measurements (IS) of functional residual capacity (FRC) was controlled by comparing them with the helium measurements (DS) obtained during nine methacholine tests (IS = 0.06 + 1.065 DS in litres: R2 = 0.99). Seven asthmatics (18-48 yr) were monitored by measuring rib cage and abdominal perimeter variations. This was done in basal condition, after methacholine-induced bronchoconstriction and after bronchodilation by either salbutamol or oxytropium bromide inhalation. All the subjects were investigated on two separate days and were their own control. Bronchoconstriction produced a significant increase (p less than 0.01) of tidal volume (VT: + 67%), external minute ventilation (VE: + 58%), mean inspiratory flow (VT/TI: + 78%) and FRC (+ 26.5%) while frequency (f) and fractional inspiratory time (TI/TT) fluctuated non significantly. In the group of seven tested subjects, there was a significant correlation (p less than 0.01) between forced expiratory volume in one second (FEV1) and VE, FEV1 and VT/TI, FEV1 and FRC. However, the individual regression line showed a significant relationship only between FEV1 and FRC (R2 = 0.80 +/- 0.04). We therefore conclude that the variation of the end expiratory level can be chosen as an indirect index of bronchoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS)     

体描箱评价脊柱侧弯幼儿的肺功能变化

背景：肺功能检查是脊柱侧弯矫正前评价手术风险的重要手段,寻找一种简便、有效的检测肺功能评估方法是低龄儿童脊柱侧弯手术时机选择及治疗效果评价的迫切要求。 目的：应用体描箱评价脊柱侧弯幼儿的肺功能变化。 方法：纳入脊柱侧弯患儿31例,健康对照幼儿50例。采用德国耶格公司生产的婴儿体描箱进行肺功能指标检测,包括潮气量、分钟通气量、达峰容积比、达峰时间比、潮气呼气峰流速、25%,50%,75%潮气量时的潮气呼气流速、呼吸频率、功能残气量及有效气道阻力。 结果与结论：脊柱侧弯组患儿功能残气量明显低于健康组(P < 0.01),有效气道阻力明显高于健康组(P < 0.01),分钟通气量、潮气呼气峰流速及75%潮气量时的潮气呼气流速均明显低于健康组(P < 0.05)。提示功能残气量、有效气道阻力是体描箱测定的经典指标,脊柱侧弯患儿功能残气量明显减低,气道阻力明显增高。体描箱可作为检测低龄脊柱侧弯患儿肺功能的重要手段。     

Lung function abnormalities in cystic fibrosis and changes during growth.

Static lung volumes (VC, TLC, FRC, RV), elastic recoil pressure of the lungs (Pst(1) at 100, 90, and 60% of TLC), static lung compliance [Cst(1)], specific airway conductance at FRC level (Gaw/TGVex), forced expiratory volume in the first second (FEV1), maximal expiratory flows (Vmax.) at 25 and 50% of VC and at 60% of TLC, and "upstream" airway conductance (Gus) at 60% of TLC were studied in 28 patients with cystic fibrosis, 5 to 25 years old, over a period of 1 to 5 years. The data were compared individually with normal values, related to body height in the form of regression equations and expressed in percentage of predicted values. From the indices assessing airway function, Vmax. at low lung volumes, Gus at 60% TLC, RV and RV/TLC were the functional parameters most consistently abnormal. Among the indices characterizing lung elasticity, Pst(1) at 60% TLC was the most abnormal. Generally, the values of the majority of lung function indices [VC, TLC, FRC, Pst(1)] declined during growth. Vmax. at all lung volumes and Gus at 60% TLC did not deteriorate with growth probably due to the great abnormality of these parameters already in young patients. It was also observed that lung function did not change significantly over a period of 1 to 5 years corresponding to a 10 cm increase in body height. However, over that period, lung function improved in some of the subjects, did not change in over 50% of the cases and deteriorated in the others.     

Positive expiratory pressure (PEP-mask) physiotherapy improves ventilation and reduces volume of trapped gas in cystic fibrosis

To investigate the lung function during positive expiratory pressure (PEP) physiotherapy in cystic fibrosis, the resistance tube of the PEP-mask was inserted into the expiratory outlet of our lung function equipment. This enabled us to measure a variety of lung function variables, while the lung function equipment functioned as a PEP-mask. We studied 12 patients and found that during PEP-mask physiotherapy functional residual capacity (FRC) increased significantly (p less than 0.02). There was a decrease of washout volume (WOV) (p less than 0.05), lung clearance index (WOV/FRC) (p less than 0.001) and volume of trapped gas (p less than 0.05), whereas total lung capacity, vital capacity, tidal volume and residual volume did not change significantly. It is concluded that in cystic fibrosis PEP-mask physiotherapy evens the intrapulmonary distribution of the ventilation and opens up regions, that are otherwise closed off. The results support the clinical observation that PEP-mask physiotherapy increases the transcutaneous tension of oxygen and the expectoration of sputum.