慢性阻塞性肺疾病患者肺动脉扩张与肺功能的相关性分析

目的探讨慢性阻塞性肺疾病患者(COPD)肺动脉扩张与肺功能的关系。方法随机选择2016年11月至2018年11月广州市胸科医院收治的104例慢性阻塞性肺疾病肺动脉扩张患者作为研究组。另选取同期我院收治的慢性阻塞性肺疾病肺动脉正常患者104例作为对照组,两组均接受肺功能检查,指定同一名高年资、高职称医务人员按照仪器设备相关延期完成两组肺功能检测,具体项目包括呼气峰流速(PEF)、第一秒用力呼气容积(FEV1)/用力肺活量(FVC)、FEV1、每分钟最大通气量(MVV)、MVV/预计值%等。结果研究组PEF、MVV、FEV1/FVC、FEV1等各项肺功能指标检测值均显著低于对照组,差异有统计学意义(P 0. 05)。结论慢性阻塞性肺疾病患者肺动脉扩张与肺功能具有显著相关性,即肺动脉扩张患者肺功能相关指标检测值较低。     

全身性呼吸操对老年COPD患者急性发作期肺功能的影响

目的:探讨全身性呼吸操对老年COPD患者急性发作期肺功能的影响.方法:将40例慢性阻塞性肺疾病(COPD)患者随机分为观察组和对照组各20例,观察组采用全身性呼吸操进行锻炼,对照组采用常规锻炼.在入院时及出院前分别测定两组患者肺功能,对两组肺功能指标值用力肺活量(FVC)、第一秒用力呼气量(FEV1)、最大随意通气量(MVV)及第一秒用力呼气量占用力肺活量之比值(FEV1/FVC)进行统计学比较.结果:出院时观察组肺功能指标FEV1、MVV和FEV1/FVC与对照组比较,差异有统计学意义(P<0.05).结论:全身性呼吸操对急性发作期COPD患者的肺功能有明显改善.     

慢性阻塞性肺疾病患者呼吸肌强度与肺功能的关系

目的:探讨慢性阻塞性肺疾病(COPD)患者的呼吸肌强度及其与肺功能的关系。方法:测定30例COPD患者犤男5例,女15例,平均年龄(72+3)岁犦的呼吸肌力犤最大吸气压(MIP)、最大±呼气压(MEP)犦和肺功能犤用力肺活量(FVC)、第1秒用力呼气量(FEV1)、第1秒用力呼气量占第1秒用力呼气量百分比(FEV1/FVC),最大通气量(MVV)犦,计算各个对象实测值占其预计值百分比,并计算呼吸肌力与肺功能的相关性。结果:COPD患者呼吸肌强度和肺功能均明显低于其预计值(慢阻肺患者的MIP仅占其预计值的(56±11)%,MEP仅占预计值的(46±11)%,肺功能仅达到预计值的48%～71%;COPD患者的呼吸肌力与其肺功能指标呈显著相关。结论:COPD患者肺功能减退与其呼吸肌强度衰弱密切关联,改善呼吸肌状态有利于提高COPD患者的呼吸功能。     

水疗对痉挛型双瘫儿童肺功能的影响

目的观察痉挛型双瘫的脑瘫患儿肺功能特点及水疗对其肺功能的影响作用。方法痉挛型双瘫患儿30例,按照自主意愿分为水疗组和对照组。水疗组患儿进行水疗加常规康复训练,对照组患儿只进行常规康复训练。所有患儿治疗前及治疗2个月后进行肺功能测试。水疗组患儿还记录其在水中最长憋气时间。结果所有患儿测量肺活量（VC）、补呼气量（ERV）、深吸气量（IC）、用力肺活量（FVC）、第1秒用力呼气量（FEV1）、每分钟最大通气量（MVV）、峰流速（PEF）测定值均显著低于预计值（P=0.000）,1秒率（FEV1/FVC）测定值与预计值相比无显著性差异（P=0.141）。治疗后,所有患儿VC、FVC、FEV1、FEV1/FVC、MVV、PEF测定值及上测定值占预计值的百分比、最长发声时间较治疗前改善（P〈0.05）。对照组治疗后ERV、IC测定值及测定值占预计值的百分比较治疗前略有提高,但无显著性差异（P〉0.05）;水疗组此两值治疗前后比较有显著性差异（P〈0.05）。组间比较,两次测定VC、ERV、IC、FVC、FEV1、FEV1/FVC、MVV、PEF值占预计值的百分比之差、最长发声时间的差值均有显著性差异（P〈0.05）。水疗组的患儿治疗后,水中最长憋气时间显著延长（P=0.000）。结论痉挛型双瘫患儿的肺功能降低。康复训练能改善患儿肺功能,结合水疗效果更好。     

188例矽肺患者肺功能损伤的临床观察

对188例I、Ⅱ期矽肺患者用力肺活量(FVC)、一秒用力呼气量(FEV1)、一秒用力呼气量占用力肺活量百分比(FEV1/FVC)、最大通气量(MVV)、残气/肺总量比值(RV/TLC)等肺功能指标进行数据分析。随着矽肺临床分期的升高,部分肺功能指标测定值(FVC、FEV1、FEV1/FVC)均下降,I期和Ⅱ期相比,差异均有显著性,P0.05。而对I、Ⅱ期矽肺患者MVV、RV/TLC的测定比较,结果没有明显差异。在评估矽肺患者肺功能损伤的指标中,FVC、FEV1、FEV1/FVC,3项指标比较可靠。     

脊髓损伤患者的肺功能变化

目的探讨脊髓损伤患者肺功能变化的特点及影响因素。 方法共分析86例脊髓损伤患者的肺功能指标，比较颈髓损伤（48例）及胸腰髓损伤（38例）患者的肺活量(VC)、用力呼气肺活量(FVC)、最大通气量(MVV)、1秒钟最大呼气量(FEV1.0)预测百分比（分别记作VC%,FVC%,MVV%,FEV1.0%）间的差异；并应用多元逐步回归分析研究患者性别、年龄、病程、体重指数、损伤部位（颈髓或胸髓损伤）、ASIA感觉/运动评分以及残损分级与脊髓损伤患者VC，FVC，MVV及FEV1.0间的相关性。 结果颈髓和胸腰段脊髓损伤患者VC%，FVC%，MVV%及FEV1.0%均有不同程度下降，以颈髓损伤患者各项肺功能指标的下降幅度较为显著（P＜0.01）；多元逐步回归分析显示，影响VC，FVC，MVV及FEV1.0的主要因素包括损伤部位、运动评分和性别。 结论脊髓损伤患者（特别是颈髓损伤患者）均存在不同程度通气功能障碍；ASIA运动评分是影响脊髓损伤患者肺功能的主要指标之一。     

轻中度青少年特发性脊柱侧凸患者肺功能研究

目的:研究轻中度青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者肺功能特征。方法:选取68例AIS患者作为AIS组,20例健康青少年作为正常对照组,采用肺功能仪测定研究对象用力肺活量(FVC)、FVC预计值(FVC pred)、FVC占预计值百分数(FVC pred%)、第1秒用力呼气量(FEV1)、FEV1预计值(FEV1 pred)、FEV1占预计值百分数(FEV1 pred%)、FEV1占FVC百分数(FEV1/FVC%)。结果:AIS组FEV1 pred%、FEV1/FVC%分别为(85.60±11.60)、(88.40±6.84),对照组分别为(93.20±9.39)、(91.00±3.13),AIS组FEV1 pred%、FEV1/FVC%均低于正常对照组,差异有显著性意义。不同侧凸类型、不同性别AIS患者FVC pred%、FEV1 pred%、FEV1/FVC%差异无显著性意义。患者年龄与FVC、FVC pred、FEV1、FEV1 pred正相关,患者Cobb角与肺功能指标无关。结论:轻、中度AIS患者存在肺功能障碍,患者肺功能与年龄正相关,与侧凸类型、性别、Cobb角没有相关性。     

主动呼吸训练联合肺功能康复训练对老年肺癌患者行胸腔镜术后肺功能及肺部感染的影响

目的探讨主动呼吸训练联合肺功能康复训练对老年肺癌患者行胸腔镜术后肺功能及肺部感染的影响。方法选取行胸腔镜手术的老年肺癌患者135例,按随机数字表法分为2组:对照组67例予以肺功能康复训练,研究组68例予以主动呼吸训练联合肺功能康复训练。比较2组肺功能指标[用力肺活量(FVC)、第1秒用力呼吸量(FEV1)、第1秒用力呼吸量与用力肺活量的比值(FEV1/FVC)、最大通气量(MVV)、呼吸频率(RR)]、血气指标[动脉血氧分压(PaO 2)、动脉血二氧化碳分压(PaCO 2)]及肺部感染率。结果干预前2组FVC、FEV1、FEV1/FVC、MVV、RR比较,差异无统计学意义(P>0.05);与干预前比较,2组干预后FVC、FEV1、FEV1/FVC、MVV均显著升高,RR均显著减慢,差异均有统计学意义(均P<0.05);与对照组比较,研究组干预后FVC、FEV1、FEV1/FVC、MVV均显著升高,RR显著减慢,差异均有统计学意义(P<0.05)。干预前2组PaO 2、PaCO 2比较,差异无统计学意义(P>0.05);与干预前比较,2组干预后PaO 2均显著升高,PaCO 2均显著降低,差异均有统计学意义(均P<0.05);与对照组比较,研究组干预后PaO 2显著升高,PaCO 2显著降低,差异均有统计学意义(均P<0.001)。与对照组比较,研究组干预后肺部感染率显著降低,差异有统计学意义(χ2=4.353,P=0.037)。结论主动呼吸训练联合肺功能康复训练应用于老年肺癌患者行胸腔镜术后可增强患者肺功能、改善血气指标、降低肺部感染发生率。     

康复干预对气道高反应性患者肺功能的影响

目的探讨康复干预对轻、中度气道高反应性患者肺功能的影响。 方法轻、中度气道高反应性患者60例,随机分为对照组30例和观察组30例,对照组采用常规药物治疗,观察组在常规药物治疗的基础上增加呼吸功能训练、适宜的有氧运动训练和心理指导等。应用肺功能仪检测2组患者治疗前和治疗2,4,8周后的用力肺活量（FVC）、第一秒用力呼气量（FEV1.0）、用力呼气50%流速（FEF50）、用力呼气中期流速（MMEF）。 结果治疗2,4,8周后,观察组的FVC实测值占预计值的百分比（FVC%）、FEV1.0实测值占预计值的百分比（FEV1.0%）、FEF50实测值占预计值的百分比（FEF50%）、MMEF实测值占预计值的百分比（MMEF%）均明显高于对照组（P<0.05）。 结论对气道高反应性患者采用呼吸功能训练等措施早期干预,可明显改善肺功能,延缓或防止发展成为慢性阻塞性肺疾病（COPD）。     

慢性阻塞性肺病患者呼吸功能及相关神经电生理研究初探

目的　初步研究慢性阻塞性肺病 (COPD)患者肺功能及其相关神经电生理指标 ,并探讨二者之间的关系。方法　对 5 0例COPD患者进行肺功能及膈神经运动传导 (PNC)检测 ,以 3 0例因其他原因就诊并无呼吸系统疾患的患者作为对照。肺功能检测主要包括最大通气量 (MVV)、一秒率 (FEV1/FVC % )和残气容积 (RV/TLC % )。PNC检测是在胸锁乳突肌后缘中点用电刺激膈神经 ,于第 7～ 8肋间和剑突处记录膈肌复合动作电位(dCMAP)。结果　①COPD患者肺功能各项指标均为异常 ,MVV、FEV1/FVC %和RV/TLC %分别为(4 9.6± 18.8) %、(62 .5± 16.4) %和 (5 4.1± 8.0 ) %。② 2组PNC潜伏期比较 ,差异无统计学意义 ;dCMAP波幅比率比较 ,差异有统计学意义 ,即COPD患者的dCMAP波幅比率明显减低。结论　COPD患者dCMAP波幅比率减低可能与肺功能减退有一定关系 ,通过PNC检测可能为肺功能异常者提供膈肌功能障碍的信息。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.