阻塞性睡眠呼吸暂停综合征患者的血氧饱和度和肺功能变化

目的分析阻塞性睡眠呼吸暂停综合征（OSAHS）患者及OSAHS合并慢性阻塞性肺病（COPD）亦称重叠综合征患者的饱和度和肺功能变化特点。方法对经过多导睡眠图（PSG）、肺功能仪检查的60例患者进行回顾性分析。结果OSAHS患者与重叠综合征患者的呼吸暂停低通气指数（AHI）、最长呼吸暂停时间（LAT）、最低脉氧饱和度（LSaO2）、平均脉氧饱和度（MSaO2）与COPD患者均有明显差异;而且重叠综合征患者肺通气功能受损严重。结论重叠综合征患者的姐氧饱和度下降和肺通气功能受损比COPD患者显著,对夜间缺氧明显的COPD患者及时检测多导睡眠图,便于及早发现老年人OSAHS的发生。     

吸烟对COPD患者肺功能的影响

目的探讨吸烟与慢性阻塞性肺疾病（COPD）病因及肺功能受损严重程度间的关系。方法对我院住院的1013名有肺功能测定记录中肺功能异常的134例缓解期COPD患者进行研究,调查吸烟与COPD患者肺功能的关系。按2002年中华呼吸学会制定的标准进行COPD诊断与严重程度分级。结果肺功能异常134例中、轻度异常49例（36.6%）,中度44例（32.8%）,重度41例（30.6%）。在肺功能轻度异常的患者中,不吸烟人数为20人（40.8%）,吸烟人数为29人（59.2%）。在肺功能中度异常患者中,不吸烟人数为7人（17.1%）,吸烟人数为34人（82.9%）。表明吸烟者较不吸烟者肺功能更差,吸烟者较不吸烟者FEV1/FVC更低,RV%增加,TLC增加。结论吸烟与COPD发病有着密切的关系,吸烟人群中重度COPD发病人数明显增多。因此对于COPD患者应该加强戒烟教育。     

未诊断呼吸系疾病人群中慢性阻塞性肺疾病患病率调查

目的了解未诊断过呼吸系疾病的人群中慢性阻塞性肺疾病（COPD）的患病率以及吸烟对其影响。方法分析471例非呼吸系疾病者肺功能及病史,以第一秒用力呼气容积／用力肺活量（FEV。／FVC）〈70％作为COPD诊断标准。结果吸烟和非吸烟组年龄无统计学差异（P〉0．05）,吸烟组的各项通气指标占预计值的百分比均显著低于非吸烟组（P〈0．01）。符合COPD诊断标准的有20例,占该人群的4．25％;吸烟组患病率为8．02％,明显高于非吸烟组（2．27％,P〈0．01）;在无临床症状人群中,COPD患病率为3．12％,其中吸烟者达到6．34％,而非吸烟者为1．45％,两者有显著差异（P〈0．01）;咳嗽组和气闷组符合COPD诊断标准的分别为21．74％和6．45％。按照COPD严重度分级,Ⅰ级4例,Ⅱ级11例,Ⅲ级5例。结论未诊断过呼吸系疾病人群中,存在一定比例的COPD,吸烟者中比例更高。早期进行肺功能检查,可有效减少COPD的漏诊和误诊。     

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阻塞性通气功能障碍是指由于气道阻塞造成的通气障碍。表现为第1秒用力呼气容积(FEV1)及其与用力肺活量(FVC)的比值FEV1/FVC%显著下降,而FVC可在正常范围或轻度下降,其他肺功能指标如最大通气量(MVV)、最大呼气中期流量(MMEF)、用力呼气50%肺活量(FEF50%)等肺通气指标也常常显著下降。其中在阻塞性通气功能下降的早期常常表现为小气道病变,肺功能表现为MMEF、FEF50%及FEF75%显著下降。上气道梗阻性疾病的肺功能有特征性的改变。阻塞性肺疾病包括慢性阻塞性肺疾病、哮喘、细支气管炎、纤毛运动障碍等,肺功能检查对其诊断有重要的指导意义。     

结节病患者的气流阻塞及其影响因素分析

目的探讨结节病患者的气流阻塞及其影响因素。方法回顾性分析我院18年来收治的31例结节病患者的临床资料,比较肺功能正常者（A组）、阻塞性通气功能障碍者（B组）和非阻塞性肺功能异常者（C组）的肺功能、影像学、纤维支气管镜下表现、支气管肺泡灌洗液（BALF）细胞学、血清血管紧张素转换酶抑制剂（ACEI）水平的差异。结果B组患者FEV1%与小气道功能指标较A组和C组显著降低。B组和C组的肺内网状结节纤维影出现比例显著高于A组。三组患者纤支镜下改变、支气管肺泡灌洗液的细胞学、ACEI水平等比较均差异无显著性。结论结节病患者可出现阻塞性通气功能障碍,小气道及其周围肺组织病变导致的气道结构改变可能与气流阻塞关系密切。     

76例上气道阻塞临床分析

目的探讨上气道阻塞的认识和早期诊断。方法回顾分析2004年1月-2007年4月确诊为上气道阻塞的76例病例的临床及病理学特点。结果本组患者呼吸道淀粉样变19例；复发性多软骨炎23例；肿瘤25例，结核8例；临床表现为咳嗽46例；呼吸困难36例；声嘶43例、略痰29例；肺功能检查56例，其中27例（48．21％）表现为阻塞性通气功能障碍，14例（25％）表现为混合性通气功能障碍；有70例纤维支气管镜或喉镜检查，有明显阳性发现者67例，约占95．71％，其中气管、支气管壁增厚和／或狭窄者35例，占50％；异常气管内结节或新生物32例，占45．71％；76例中60例进行病理学检查：刚果红染色阳性者16例；符合复发性多软骨炎5例；肿瘤25例；支气管黏膜慢性炎10例。讨论肺功能测定、纤支镜检查可用于诊断和评估上气道阻塞。肺功能与纤支镜检查，有助于上气道阻塞的诊断与评估，并可用于病情的随访。     

接尘职工肺通气功能检查结果分析

目的了解粉尘接触职工肺通气功能损害情况和肺功能障碍类型,为粉尘职业病的防治和劳动能力鉴定提供依据。方法分别于2010年3月及2014年3月对酒钢公司接触粉尘的职工进行肺功能检测,对比分析两次检查结果。结果 2014年接尘职工的FVC、FEV1、FEV1/FVC%、FVC%PRED、PEF50%PRED显著低于2010年,FEV1%PRED显著高于2010年,差异均有统计学意义(P0.01)。2010年及2014年的检测结果均显示,不同接尘年限职工的肺功能指标差异均有统计学意义(FVC%PRED除外,P0.01)。2014年接尘职工肺功能异常率(24.89%)显著高于2010年(16.08),差异有统计学意义(P0.01);两次检测的肺功能障碍类型构成比较差异无统计学意义(P0.05),均以阻塞型肺功能异常为主。结论随着接尘年限的增加接尘职工的肺通气功能显著下降,职工的肺通气功能异常率升高,肺通气功能异常主要以阻塞型通气障碍为主。     

慢性阻塞性肺疾病与肺癌的相关性

以人群为基础的研究、肺癌筛查、流行病学调查、病例对照研究、以及生物学机制研究等都发现慢性阻塞性肺疾病（chronicobstructivepulmonarydisease,COPD）与肺癌之间存在特殊的相关性。在吸烟人群中,肺功能异常以及CT检测到肺气肿是肺癌及其最终预后的重要危险因素。     

健康体检老年人心电图异常特征分析

目的观察老年人健康体检心电图的特征及相关因素,以明确老年人定期进行心电图检查的重要性。方法随机选取2010年1月-2013年6月参加健康体检的500例老年人,对其进行心电图检测,然后进行统计学分析。结果500例老年人中心电图异常总检出182例,总检出率为36．4％;男性和女性心电图异常检出率分别为39．2％和33．6％,男性检出率明显高于女性,差异有统计学意义（P〈0．05）。ST—T异常表现者在心电图异常者中占比最高（44．51％）,其次为传导阻滞（18．68％）及早搏（9．89％）等,且随年龄增大,所占比例呈现上升趋势（P〈0．01）：心电图异常特征与年龄、性别具有相关性。结论老年健康体检时进行心电图检测可以及早发现心电图异常者,老年人进行定期心电图检查对早期发现心血管疾病非常必要。     

300例大气道阻塞病变的肺功能分析

目的探讨大气道阻塞的肺功能表现,为临床早期筛查大气道阻塞病变提供依据。方法选择2004年1月-2015年12月在我院确诊为大气道阻塞疾病的患者300例,通过对其病因、临床特点、肺功能检查结果等进行回顾性分析,总结大气道阻塞的肺功能表现,并对常规和脉冲振荡法测定肺通气功能的指标进行相关分析。结果肺功能检查结果:所有病例中F-V曲线异常者243例(81%),表现为阻塞性肺通气功能障碍者181例,限制性肺通气功能障碍者22例,混合性肺通气功能障碍者19例,正常78例;IOS检查结果:呼吸总阻抗(Zrs增高、共振频率(Fres)、中心气道阻力(Rc)及周边气道阻力(Rp)明显增高的患者分别占76.33%、87.34%、84.67%及84.00%;频谱分析图:264例(88%)患者的X曲线呈弓背抬高或平台样改变;两种检查方法中F-V曲线与R-X曲线形态异常的阳性率比较(81%vs88%),差异有统计学意义(P=0.017);常规肺功能参数与IOS指标相关性分析结果:FEV1%、FEV1/FVC%与Fres、R5、R5-R20、Rp、Rc均呈负相关,与X5呈正相关(P均0.05),其中FEV1%与Fres的相关性最强,r=-0.547,其次为X5,r=0.523。结论肺功能检查可早期发现大气道阻塞病变,F-V曲线特征及脉冲震荡检查对诊断大气道阻塞有重要的临床意义。     

沈阳市不同职业人群脂肪肝的流行现状分析

目的探讨不同职业人群脂肪肝的流行现状。方法纳入6992名健康体检者为研究对象,职业来源包括2家医院的医护人员、3家银行的职员、3个工厂的工人及机关干部,所有研究对象均接受彩超检查。结果 6992名研究对象中,其中男性3662例,女性3330例,男女之比为1.10∶1。年龄（18～92）岁,平均年龄（40.00±11.34）岁,男女之间年龄差异无统计学意义。超声检出脂肪肝1593例（22.8%）,经性别及年龄调整后沈阳市脂肪肝的患病率为21.2%,男性为18.4%,女性为4.4%,男女之间脂肪肝的患病率差异有统计学意义（χ2=667.88,P〈0.001）。不同职业脂肪肝的患病率经年龄及性别调整后相应为：医护人员为18.6%,银行职员为20.3%,机关干部为17.6%,工人为28.7%,工人组明显高于其他3组,差异有统计学意义。男性患者发病高峰在（30～49）岁（41.4%）,女性患者随着年龄的增长逐渐增长。多元回归分析显示：性别、年龄、体重指数BMI、腰围、收缩压、血脂异常、血尿酸、空腹血糖及职业与脂肪肝相关。结论沈阳市脂肪肝的发病率高于南方城市。工人脂肪肝的患病率显著高于医护人员、银行职员及机关干部。脂肪肝的发病率与性别、年龄、代谢综合征及职业相关。     

Lung function and long-term exposure to cement dust

In a cross-sectional epidemiological survey a selected group of former and present cement factory workers and a random sample of the corresponding urban population underwent dynamic spirometry. Based upon life experience the subjects were grouped into four occupational categories. Three hundred and one men were grouped as cement factory workers, 649 were grouped as blue collar workers, 218 as white collar workers and 102 men had predominantly been occupied in farming, forestry and fishing. On the average the investigated men had spent more than 75% of their total occupational life in their main occupational category. Each occupational category was further subdivided according to smoking habits and in all categories the well-known association between tobacco consumption and decrease in ventilatory capacity was found. White collar workers, who smoke less and had experienced better housing conditions throughout life had better ventilatory lung function than any of the other three occupational categories. No significant differences in lung function between cement factory workers and other blue collar workers with comparable smoking habits could be demonstrated by use of the maximal midexpiratory flow (MMEF), or any other of the calculated indices from the dynamic spirometry, when standardized for age, height and body weight.     

Respiratory effects of occupational exposure to tobacco dust.

The ventilatory capacities of 195 tobacco factory workers exposed to tobacco dust and 190 Libyan men not exposed to tobacco dust were measured. In both groups, the forced vital capacity (FVC) and forced expiratory volume in 1 s were found to be correlated with age, stature, sitting height and body surface area. Those exposed to tobacco dust have decreased ventilatory capacity values as compared with age-matched unexposed workers. The duration of exposure to tobacco dust does not appear to have any significant effect on the ventilatory function. There was no significant difference in the lung function test values between the smokers and nonsmokers in both groups. The flow-volume curves were constructed for the unexposed and exposed groups of workers. At 25% FVC, in the group exposed to tobacco dust, there was a decrease in air flow by 20.8% as compared to age-matched normal unexposed Libyans. This indicates that the small airways are affected by exposure to tobacco dust. Flow-volume curves are useful in the assessment of lung function status.     

Lung function in the absence of respiratory symptoms in overweight children and adolescents

OBJECTIVE:

To describe lung function findings in overweight children and adolescents without respiratory disease.

METHODS:

This was a cross-sectional study involving male and female overweight children and adolescents in the 8-18 year age bracket, without respiratory disease. All of the participants underwent anthropometric assessment, chest X-ray, pulse oximetry, spirometry, and lung volume measurements. Individuals with respiratory disease were excluded, as were those who were smokers, those with abnormal chest X-rays, and those with an SpO₂ = 92%. Waist circumference was measured in centimeters. The body mass index-for-age Z score for boys and girls was used in order to classify the individuals as overweight, obese, or severely obese. Lung function variables were expressed in percentage of the predicted value and were correlated with the anthropometric indices.

RESULTS:

We included 59 individuals (30 males and 29 females). The mean age was 11.7 ± 2.7 years. Lung function was normal in 21 individuals (35.6%). Of the 38 remaining individuals, 19 (32.2%), 15 (25.4%), and 4 (6.7%) presented with obstructive, restrictive, and mixed ventilatory disorder, respectively. The bronchodilator response was positive in 15 individuals (25.4%), and TLC measurements revealed that all of the individuals with reduced VC had restrictive ventilatory disorder. There were significant negative correlations between the anthropometric indices and the Tiffeneau index in the individuals with mixed ventilatory disorder.

CONCLUSIONS:

Lung function was abnormal in approximately 65% of the individuals evaluated here, all of whom were overweight. Obstructive ventilatory disorder and positive bronchodilator response predominated.     

Evaluation of breathlessness in asbestos workers. Results of exercise testing

We studied 120 asbestos-exposed workers seeking compensation for asbestos-related ventilatory impairment who were referred to us for evaluation of their complaint of dyspnea. We reviewed history, chest radiographs, pulmonary function studies, and exercise tests. The workers were 59.9 +/- 9.5 (mean +/- SD) yr of age and their first asbestos exposure had been 34.4 +/- 10 yr prior to the study; 63% were smokers, 19% were ex-smokers, and 18% were nonsmokers. Chest radiographs were normal in 4%, showed only pleural disease in 35%, only parenchymal diseases in 5%, and pleuroparenchymal disease in 56%. Restrictive pulmonary function abnormalities were present in 25% of the workers, and obstructive abnormalities were present in 27%. Because the impairment of one of several organ systems (i.e., ventilatory, cardiac, pulmonary vascular, or peripheral circulatory) may limit exercise performance, we designed an exercise test score in an attempt to identify the system causing the limitation. No abnormal limitation was detectable in half (49.2%) of the subjects. Only 26% had a ventilatory limitation, which was much more frequent in smokers (32%) than in nonsmokers (9%) (p less than 0.05). Unexpectedly, rather more (37%) had a cardiac rather than a ventilatory limitation. We conclude that the complaint of dyspnea in these asbestos-exposed workers was usually not caused by a ventilatory dysfunction.     

狼疮性肾炎患者肺功能损害特征及其相关因素分析

目的　探讨狼疮性肾炎患者肺功能损害的特征及其相关因素。方法　测定 40例狼疮性肾炎患者的肺容量、通气功能、小气道功能、弥散功能和血红蛋白、BUN及血压。结果　肺活量 (VC)、残气容积与肺总量之比值 (RV/TLC)、第一秒肺活量 (FEV1)、最大通气量 (MVV)、一氧化碳弥散量 (DLCO)、每升肺泡通气量之CO弥散量 (DLCO/VA)与对照组比较 ,差异有显著性 (P <0 .0 5 ) ,其中 30 %的患者呈现肺气肿现象 ,30 %的患者肺通气功能减低 ,小气道阻塞和可疑小气道阻塞者高达 6 0 % ,更有高达 85 %的患者弥散功能减退 ;相关因素分析表明 ,DLCO与TLC明显正相关关系 (r =0 .42 ,P <0 .0 5 )。结论　狼疮性肾炎患者肺功能损害以弥散功能减退为主 ,限制性通气障碍与阻塞性通气障碍并存 ,且以限制性通气障碍为主要发展趋势 ,与其他结缔组织疾病一样弥散功能障碍先于肺X线表现 ,但其呼吸困难症状几乎与弥散功能同步出现 ,则与其他结缔组织疾病有所不同     

Chronic respiratory disease in hemp workers. A follow-up study, 1967-1974.

Many soft-hemp workers with more than 20 years' exposure to dust have chronic respiratory symptoms and obstructive lung function loss. During 7 years of follow-up, these workers had significantly higher occurrences of chronic cough and phlegm and dyspnea than control subjects and a significantly larger annual decline of forced expiratory volume in 1 second (FEV1.0) than control subjects, with a particularly marked difference between 20- to 44-year-old nonsmoking controls and hemp workers. We believe that deterioration of lung function among hemp workers begins before the age of 45 and that it continues even if further exposure to dust ceases. Textile workers should be advised to avoid further exposure to dust at a time when their ventilatory lung function (in the absence of effects of acute exposure) is sufficient to prevent future development of disabling function loss.     

Pulmonary hypertension and respiratory failure in the development of right ventricular hypertrophy in patients with chronic obstructive airway disease

The high incidence of right ventricular hypertrophy in patients with chronic obstructive pulmonary disease is a well-known fact. In clinical medicine according to our present status of thinking, severe impairment of ventilatory function and pulmonary hypertension are the two essential prerequisites for right ventricular involvement. To investigate this accepted assumption we studied 51 patients with chronic obstructive pulmonary disease, while they were in a remission period. The patients were subjected to clinical examination, chest roentgenography, spirometry, blood gas examination, electrocardiography, vectorcardiography, echocardiography, and right heart catheterization. The majority of the patients with significantly compromised ventilatory function and abnormal blood gases had right ventricular hypertrophy with elevation of the pulmonary artery pressure. Two subgroups of patients could be distinguished: One included 15 patients (29.4% of all patients) with normal pulmonary artery pressure and evidence of right ventricular hypertrophy. In this subgroup are included 10 patients (19.6% of all patients) showing mild ventilatory impairment and mild hypoxaemia. The second subgroup consisted of 5 patients (9.8% of all patients) with elevated mean pulmonary artery pressure at rest and right ventricular hypertrophy showing relatively mild ventilatory impairment and moderate hypoxaemia. Two conclusions could be drawn: (1) the pulmonary artery pressure at rest could be normal despite the evidence of right ventricular hypertrophy, and (2) a mild ventilatory impairment does not exclude an elevated pulmonary artery pressure or the development of right ventricular hypertrophy in patients with chronic obstructive pulmonary disease.     

肺淋巴管平滑肌瘤病九例临床和病理分析

目的 探讨肺淋巴管平滑肌瘤病(pulmonary lymphangionleiomyomatosis,PLAM)的临床和病理特征,提高临床诊治水平.方法 对广州呼吸疾病研究所确诊的9例PLAM患者的临床特点、影像学表现、肺功能及病理学检查进行分析并结合文献复习.结果 9例PLAM患者均为育龄期妇女(20～50岁),临床症状表现为呼吸困难(8/9)、咳嗽(6/9)、咯痰(2/9)、咯血(2/9)、胸痛(3/9)、自发性气胸(6/9)、乳糜胸(3/9)、乳糜性腹腔积液(2/9).胸部X线检查4例表现为双肺弥漫性网状结节影,2例表现为液气胸,2例表现为胸腔积液,1例表现为多发肺小囊状透光区及肺大疱,1例无异常.高分辨率CT具有特征性变化,9例双肺均可见多发小囊状影,直径2～20 mm,壁较薄.2例腹部CT于腹主动脉前可见多个肿大的淋巴结.6例患者进行了肺功能检查,3例通气功能正常,1例呈中度阻塞性通气功能障碍,1例呈重度混合性通气功能障碍,1例呈极重度混合性通气功能障碍,其中1例支气管舒张试验阳性.4例肺弥散功能下降.4例(4/9)经纤维支气管镜肺活检,5例(5/9)经胸腔镜活检,全部经病理确诊.病理学检查显示不同成熟度平滑肌细胞在细支气管壁、肺泡壁、淋巴管壁和血管壁周围增生,肺实质呈囊性变.结论 PLAM表现不典型,易被漏诊、误诊,应提高对本病的认识.     

Langzeitbeobachtungen bei Fluorwasserstoffexposition

Some time after an aluminium factory was opened, a high percentage of its workers developed symptoms of dyspnea, wheezing, coughing, and expectoration. The symptom pattern varied: some complaints began on the job, others during the night after work. The aluminium was processed by electrolysis, causing fluoride-containing gases to escape in high concentrations. A screening examination of the workers confirmed a high incidence of chest complaints; an increased histamine reactivity in the bronchial tree was also found, with no marked deterioration in lung function. Some of the workers were hospitalized; indication of a slight, reversible bronchial obstruction was found, though diffusion was apperently not impaired. Exactly how fluorides interact in the bronchial-tree is unknown. There is the possibility that a preexistent chronic obstructive lung disease becomes a predisposing factor for these reactions; this, however, is not confirmed. Such symptoms among the workers could be controled if working conditions were improved and job applicants were screened more selectively.