煤工尘肺并发下呼吸道感染病原菌和耐药分析

目的 分析煤工尘肺并发下呼吸道感染病原菌和耐药情况,为临床治疗提供依据.方法 将对2009年1月至2010年lO月住院治疗的111例煤工尘肺并发感染患者分为行机械通气组(36例)和未行机械通气组(75例).两组患者均经纤维支气管镜(纤支镜)防污染毛刷取得下呼吸道标本进行病原菌分离培养鉴定及药敏试验.结果 未行机械通气组病原菌检出率为46.7%(35/75),机械通气组为88.9%(32/36),机械通气组病原菌检出率明显高于未行机械通气组,差异有统计学意义(P＜0.01).未行机械通气组检出结核杆菌3例,G-杆菌27株,G+球菌3株,真菌2株;机械通气组检出G-杆菌26株,G+球菌3株,真菌3株.行机械通气组G-杆菌耐药率(78.8%)高于未行机械通气组(47.1%),差异有统计学意义(P＜0.05).结论 煤工尘肺并发呼吸道感染的病原菌以G-杆菌为主,耐药现象严重,行机械通气组较未行机械通气组更严重.

Abstract：

Objective To investigate the composition and resistance of main pathogens isolated form Lower respiratory tract in coalminer s pneumoconiosis patients complicated with infection to provide the basis for clinical treatment. Method Coalminer's pneumoconiosis patients complicated with infection during 2009to 2010 were divided into mechanical ventilation group and non mechanical ventilation group. Specimens were obtained from lower respiratory tract by fibrobronchoscopy with protected specimen brush in patients of both groups to perform isolation, culture, identification and susceptibility test of pathogen. Result Total 111patients were enrolled, 36 of them in mechanical ventilation group and 75 patients in non mechanical ventilation group. The pathogenic bacteria detection rate of patients in mechanical ventilation group was significantly higher than that of patients in non mechanical ventilation group( 88.9% vs. 46.7%, P＜0.01). In non mechanical ventilation group, Mycobacterium tuberculosis was detected in 3 patients, and 27 strains of G- bacilli, 3 strains of G+ coccus, and 2 strains of fungus; and 26 strains of G- bacilli, 3 strains of G+ coccus, and 3 strains of fungus were detected in mechanical ventilation group. There was no significant difference in term of strains between the two groups (P＞0.05). Rate of resistance to main antibiotics of patients in mechanical ventilation group was higher than that of patients in non mechanical ventilation group. Conclusion Resistance of pathogenic bacteria isolated from lower respiratory tract was severe in coalminer's pneumoconiosis patients complicated with infection, which was higher in patients treated with mechanical ventilation than patients without mechanical ventilation. Mycobacterium tuberculosis and fungal infection and increasing resistance prompted that clinicians must attach importance to rational drug use and keep to monitoring bacterial resistance.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

等效镇痛剂量舒芬太尼和瑞芬太尼呼吸抑制作用的比较

Objective To observe the respiratory depression of sufentanil and remifentanil with target-controlled infusion under propofol sedation or not, and compare the effect of respiratory depression of the two drugs. Methods Eighty patients scheduled for elective neurosurgery were allocated into four groups by random digits table: the sufentanil group (group S), the remifentanil group (group R), the combination of sufentanil and propofol group (group SP) and the combination of remifentanil and propofol group (group RP),each group was 20 cases. The respiratory rate (RR), minute ventilation (MV),partial pressure of end-tidal carbondioxide ( PETCO2), pulse oxygen saturation (SpO2), mean arterial pressure ( MAP ), heart rate (HR), observer's assessment of alertness/sedation (OAA/S) were measured and respiratory depression was defined as one of the following end points were achieved: muscle rigidity, RR ＜ 6 beats/min, MV ＜ 3 L/min,PETCO2 ＞ 55 mm Hg ( 1 mm Hg = 0.133 kPa), SpO2 ＜ 0.90 or apnea ＞ 15 s. Results The calculated effect concentration (Ce) of sufentanil for respiratory depression were (0.46 ± 0.14) μ g/L in group S and (0.23 ±0.06) μ g/L in group SP, and Ce of remifentanil for respiratory depression were (5.22 ± 2.11 ) μ g/L in group R and (2.22 ± 1.02) μ g/L in group PP. Some respiratory parameters,such as RR,MV were decreased and PETCO2 was increased significantly as the increase of Ce. Conclusions Target-controlled infusion of equal analgesic plasma concentration of sufentanil and remifentanil can suppress spontaneous respiration significantly with the increase of plasma concentration. There will be a synergetic effect after combining with propofol, and respiratory depression will appear at lower concentration. But equal analgesic plasma concentration of the two drugs have no significant difference in the effect of respiratory depression.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

早期肠内营养对高血压性脑出血患者医院获得性肺炎的影响

目的 探讨早期肠内营养(EN)对重症高血压性脑出血患者医院获得性肺炎(HAP)的临床价值.方法 将140例重症高血压性脑出血患者按随机数字表法分成治疗组和对照组,治疗组(70例)术后48 h开始EN支持.对照组(70例)术后第2天开始全胃肠外营养(TPN)支持.观察两组HAP发生率、HAP持续时间、肺部二重感染发生率、呼吸机使用率、呼吸机使用时间以及HAP病死率.结果 治疗组HAP发生率、肺部二重感染发生率、呼吸机使用率分别为30.0%(21/70)、12.9%(9/70)、35.7%(25/70),显著低于对照组的47.1%(33/70)、27.1%(19/70)、47.1%(33/70)(P＜0.05);治疗组HAP持续时间、呼吸机使用时间分别为(6.4±2.3)、(6.4±0.5)d,显著短于对照组的(15.6±2.1)、(11.4±0.3)d(P＜0.01或＜0.05).治疗组HAP病死率(8.6%,6/70)显著低于对照组(18.6%,13/70)(P＜0.05).结论 早期EN不仅能有效降低重症高血压性脑出血患者HAP和肺部二重感染的发生率,还可以降低呼吸机使用率,缩短呼吸机使用时间,最终缩短了HAP的治疗时间,降低了HAP的病死率.

Abstract：

Objective To investigate the clinical value of early enteral nutrition (EN) on hospital acquired pneumonia (HAP) in postoperative patients with severe hypertensive cerebral hemorrhage.Methods One hundred and forty postoperative patients with severe hypertensive cerebral hemorrhage were divided into treatment group (70 cases) and controll group (70 cases) by random digits table. The treatment group was given EN from the second day after operation, while the control group was given total parenteral nutrition (TPN). The incidence and duration of HAP,the incidence of superinfection,the percent and duration of mechanical ventilation and the mortality rate of HAP was observed. Results The incidence of HAP, superinfection and using mechanical ventilation in treatment group [30.0% (21/70), 12.9% (9/70),35.7%(25/70)] were significantly lower than those in control group [47.1%(33/70) ,27.1%(19/70) ,47.1%( 33/70 )] (P ＜ 0.05 ). The duration of HAP and using mechanical ventilation in treatment group[(6.4 ± 2.3 ),(6.4 ± 0.5 ) d] were significantly lower than those in control group [( 15.6 ± 2.1 ), ( 11.4 ± 0.3 ) d] (P ＜ 0.01or ＜ 0.05 ). The mortality rate of HAP in treatment group was significantly lower than that in control group [8.6% (6/70) vs. 18.6% (13/70),P ＜0.05]. Conclusion Early EN not only effectively decreases the incidence of HAP and superinfection,but also decreases the incidence of mechanical ventilation, shortens the duration of mechanical ventilation and decreases the mortality rate of HAP.     

慢性阻塞性肺疾病患者肺血气分析与糖尿病的相关性研究

目的 明确慢性阻塞性肺疾病(COPD)患者肺血气分析与糖尿病之间的关系对临床研究的意义.方法 选择COPD稳定期患者125例,其中合并糖尿病患者69例(试验组),单纯COPD患者56例(对照组),对两组患者进行血气分析以及肺功能指标的检测.结果 对照组患者肺通气功能指标用力肺活量(FVC)、肺活量(VC)、第1秒用力呼气容积(FEV1)、用力呼气中期流速(PEF)(25%～75%)、肺一氧化碳弥散量(DLCO)及肺一氧化碳弥散量实测值占预计值的百分比(DLCO/PRED)显著高于试验组,两组比较差异有统计学意义(P<0.05).试验组动脉血氧分压(PaO2)为(61.23±8.34)mmHg(1mmHg=0.133 kPa),较对照组的(72.34±9.32)mmHg有明显的降低趋势(P<0.05),而两组动脉血二氧化碳分压(PaCO2)比较差异无统计学意义[(45.34±6.43)mmHg比(44.89±4.98)mmHg,P>0.05].结论 COPD合并糖尿病会导致患者肺通气功能和弥散功能受到一定的损害,在临床治疗中应当注意合理调整治疗方法.

Abstract：

Objective To study the correlation of blood gas analysis and diabetes mellitus in chronic obstructive pulmonary disease(COPD)patients and its clinical significance.Methods One hundred and twenty-five patients with stable phase COPD patients including 69 cages with COPD combined with diabetes mellitus(experimental group),56 patients with COPD alone(control group).The blood gas analysis and pulmonary function were detected.Results The simple pulmonary function forced vital capacity(FVC),vital capacity(VC),forced expired volume in one second(FEV1),peak expiratory flow (PEF)(25%-75%)and the diffusion function parameters diffusion capacity for carbon monoxide of the lung (DLCO),DLCO/PRED in control group were significantly higher than those in experimental group(P<0.05).Arterial partial pressure of oxygen(PaO2)was lower in experimental group than that in control group[(61.23±8.34)mm Hg(1 mm Hg=0.133 kPa)vs.(72.34±9.32)mm Hg,P<0.05],while there was no significant difference in partial pressure of carbon dioxide in artery(PaCO2)between two groups[(45.34±6.43)mm Hg vs.(44.89±4.98)mm Hg,P>0.05].Conclusion COPD combined with diabetes mellitus may lead to some damage in lung function and diffusion function,it should be noted in the clinieal treatment of reasonable adjustments in treatment.     

阻塞型睡眠呼吸暂停低通气综合征患者抑郁情绪和高敏C反应蛋白的变化

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者抑郁情绪和高敏C反应蛋白(hs-CRP)的改变及相关关系.方法 选择OSAHS患者54例(OSAHS组)和健康对照者30例(对照组),使用抑郁自评量表(SDS)和采用速率散射比浊法分别评估受试者的抑郁情绪状态和测定其血清hs-CRP水平.结果 OSAHS组患者SDS评分和hs-CRP水平分别为(48.8±12.7)分、(3.3±0.7)mg/L,均高于对照组的(36.3±6.3)分、(1.4±0.4)mg/L(P＜0.01).SDS评分和hs-CRP水平与睡眠呼吸暂停低通气指数(AHI)呈正相关(r=0.636、0.628,P<0.01);与平均血氧饱和度(MSa02)(r=-0.509、-0.614,P<001)、最低血氧饱和度(LSaO-2)(r=-0.607、-0.512,P<0.01)呈负相关;SDS评分与hs-CRP水平呈正相关(r=0.536,p<0.01).SDS评分与AHI、hs-CRP和LSaO2呈直线回归关系(F=33.31,P:0,002).结论 OSAHS患者存在抑郁情绪障碍和hs-CRP水平增高,且与OSAHS病情程度相关;血清hs-CRP水平增高是OSAHS抑郁障碍高发的原因之一.

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Objective To study the changes of serum high-sensitivity C-reactive protein (ha-CRP) and depression in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS),and investigate the relationship between them.Methods Thirty healthy volunteers (control group) and 54 OSAHS patients (OSAHS group) were recruited for the study.The level of serum hs-CRP was determined by scatter rate nephelometry,and the state of depression was assessed by self-rating depression scale (SDS).Results The level of serum hs-CRP and SDS score were higher in OSAHS group than those in control group [(48.8 ± 12.7) scores vs.(36.3 ± 6.3) scores,(3.3 ±0.7) mg/L vs.(1.4 ± 0.4) mg/L](P＜0.01).SDS score and the level of serum hs-CRPwere positively correlated to apnea-hypopnea index(AHI) (r = 0.636,0.628 ;P<0.01) and negatively related to the MSaO2 (r =-0.509,-0.614;P <0.01) and LSaO2 (r =-0.607,-0.512;P <0.01).The level of serum hs-CRP was positive correlation to SDS score (r = 0.536,P<0.01).SDS score was related to the AHI,the level of serum hs-CRP and LSaO2 in multiple linear regression(F= 33.31,P = 0.002).Conclusion Depression is correlated to AHI and the level of serum hs-CRP in patients with OSAHS.     

高频喷射通气对单肺通气患者氧化应激反应的影响

目的 研究高频喷射通气(HFJV)对单肺通气患者氧化应激反应的影响.方法 择期行食管癌根治术患者45例,按随机数字表法分为双肺通气组(A组)、单肺通气组(B组)、单肺通气时非通气侧给予HFJV(驱动压力1 kg/cm2,频率100次/min)组(C组),每组15例.分别于开胸前(T0),单肺通气后(A组于开胸后)30 min(T1)、90 min(T2)、150 min(T3),手术结束时(T4)测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、一氧化氮(NO)浓度.结果 T2～T4时B、C组SOD活性[B组:(47±10)、(37±9)、(41±7)kU/L;C组:(58±12)、(51±11)、(49±9)kU/L]低于A组[(78±8)、(75±7)、(79±6)kU/L](P＜0.05),T1～T4时B、C组MDA、NO浓度高于A组(P＜0.05);T3时C组SOD活性明显高于B组(P＜0.05),T1～T4时C组MDA浓度及T2～T4时NO浓度低于B组(P＜0.05).结论 HFJV能在一定程度上抑制单肺通气患者的氧化应激反应.

Abstract：

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用

Objective To observe the application of cesarean section and vaginal delivery in parturient term pregnancy with fetal distress. Methods One hundred and six cases of parturient term pregnancy with fetal distress were selected, SO cases of cesarean section as group A, 56 cases of vaginal delivery as group B, newborn outcome and condition of the large maternal cervix data when fetal distress between two groups were compared. Results The neonatal asphyxia rate was 14.0% (7/50) in group A and 16.1 % (9/56 ) in group B, there was no significant difference between two groups (P＞0.05); the rate of the large maternal cervix data in delitescence in group A was higher than that in group B [54.0% (27/50) vs. 26.8% (15/56) ](P＜ 0.05); the rate of the large maternal cervix data in active stage deceleration phase in group A was lower than that in group B [4.0%(2/50) vs. 23.2%(13/56)](P＜0.05). Conclusion Cesarean section and vaginal delivery in parturient term pregnancy with fetal distress can get a good neonatal outcomes, maternal clinical condition should select the appropriate surgical approach, and effort to reduce cesarean section rates.     

肺炎支原体肺炎患儿血清细胞因子、高敏C反应蛋白、总免疫球蛋白及补体C的检测及其临床意义

目的 探讨检测肺炎支原体肺炎(MPP)患儿血清白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α、高敏C-反应蛋白(hs-CRP)、总免疫球蛋白(Ig)、补体C的临床意义.方法 选择61例MPP患儿(观察组)和60例健康儿童(对照组)为研究对象,IL-6、IL-8采用酶联免疫吸附试验方法测定,TNF-α采用γ放射免疫计数器检测,hs-CRP、总Ig、补体C采用速率散射比浊法测定.结果 观察组血清IL-6为(109.31±54.72)ng/L、IL-8为(128.19±65.87)ng/L、血清hs-CRP为(34.13±19.21)mg/L、总Ig为(12.62±5.51)g/L、补体C为(2.98±0.97)g/L,与对照组的(67.23±32.18)ng/L、(31.78±8.91)ng/L、(1.62±1.34)g/L、(6.71±3.65)g/L、(1.46±0.45)g/L比较均显著上升,差异有统计学意义(P＜0.05或＜0.01);两组血清TNF-α水平差异无统计学意义(P＞0.05).结论 IL-6、IL-8、hs-CRP、总Ig及补体C在小儿MPP中起重要作用,检测IL-6、IL-8、hs-CRP、总Ig及补体C的变化对判定病情和预后有一定的临床应用价值.

Abstract：

Objective To investigate the clinical significance of serum interleukin (IL)-6,IL-8,tumor necrosis factor (TNF)- α, high-sensitivity C-reactive protein (hs-C RP), total immunoglobulin (Ig) and complement C levels in children with mycoplasma pneumoniae pneumonia (MPP). Methods Sixty-one cases of children with MPP (observation group) and 60 healthy children (control group) were selected. The serum IL-6 and IL-8 levels were tested by enzyme linked immunosorbent assay(ELISA) method; the serum TNF-α level was tested by γ radioimmunoassay (RIA) counter; the serum hs-CRP, total Ig and complement C levels were tested by rate nephelometry method. Results The serum IL-6 concentration was (109.31 ±54.72) ng/L, IL-8 concentration was (128.19 ±65.87) ng/L, hs-CRP concentration was (34.13 ± 19.21) mg/L, total Ig concentration was (12.62 ± 5.51) g/L and complement C concentration was (2.98 ± 0.97) g/L in the observation group, and they were higher than those in the control group [(67.23 ±32.18) ng/L, (31.78 ±8.91) ng/L, (1.62 ±1.34) g/L, (6.71 ±3.65) g/L, (1.46 ±0.45) g/L]. The differences were significant (P ＜ 0.05 or ＜ 0.01). The serum TNF- t level between two groups had no significant difference (P＞ 0.05). Conclusions The serum cytokines IL-6 and IL-8, hs-CRP, total Ig and complement C play an important role in MPP. It has important significance to detect the serum cytokines IL-6 and IL-8, hs-CRP, total Ig and complement C levels in children with MPP.     

三种通气模式对慢性阻塞性肺病患者机械通气撤机过程的应用比较

目的比较压力支持通气（PSV）、同步间隙指令通气（SIMV）、神经调节辅助通气（NAVA）三种通气模式在慢性阻塞性肺病（COPD）机械通气患者撤机过程的优缺点。方法根据通气模式的不同,将60例COPD患者随机分为PSV组（n=20）、SIMV组（n=20）和NAVA组（n=20）,比较三组患者的撤机成功率、失败率、再插管率、撤机时间、撤机后并发症、撤机后ICU停留时间等。结果①三组患者一般资料无明显差异（P〉0．05）;（2）NAVA组撤机成功率均比PSV组、SIMV组明显增高（P〈0．05）;撤机失败率和48h内重新气管插管率均比PSV组、SIMV组明显降低（均P〈0．05）;而撤机时间、撤机后ICU停留时间均比PSV组、SIMV组明显缩短（均P〈0．05）;（3）PSV组和SIMV组在撤机时间、撤机成功率、失败率、48h内重新气管插管率、撤机后ICU停留时间方面比较差异均无统计学意义（P〉0．05）;④三组在撤机后严重并发症如死亡、肺部感染、肺不张的发生率差异均无统计学意义（P〉0．05）。结论NAVA模式在COPD患者撤机过程较SIMV、PSV模式更接近生理,撤机成功率更高．更有利于患者的预后。     

比例辅助通气对撤机阶段慢性阻塞性肺疾病合并呼吸衰竭患者通气参数的影响

目的 观察比例辅助通气(PAV)与压力支持通气(PSV)对撤机阶段慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者通气参数的影响.方法 COPD合并呼吸衰竭患者15例,所有患者均为气管插管并接受机械通气支持1周以上者,在治疗过程中病情稳定准备撤机.随机选用PAV和不同水平的PSV[PSV水平为10 cm H2O(PS10)和PSV水平为15 cm H2O(PS15),1 cm H2O=0.098 kPa]辅助通气60 min,应用PAV前采用最小平方拟合法(LSF)测定患者的呼吸系统弹性阻力(Ers)和气道阻力(Rrs),设置容量辅助(VA)和流量辅助(FA),辅助比例为80%.观察患者在不同通气条件下通气参数及动脉血气分析的变化.结果 与低水平PSV(PS10)时相比,高水平PSV(PS15)与PAV时的潮气量显著增加[(443±12)ml与(532±34)ml、(464±23)ml,P<0.05];PAV时的呼吸频率与气道峰压稍高于PS10时,但差异无统计学意义.PAV支持后,患者的气道闭合压由PS10时的(5.70±0.25)cm H2O降至(4.53±0.25)cm H2O(P<0.05),气道压力及吸气触发压力时间乘积也显著降低[由(0.42±0.04)cm H2O降至(0.32±0.03)cm H2O,P<0.05];而氧合指数与动脉血二氧化碳分压均得到明显改善,与PS15时相近.PAV时的浅快呼吸指数较PS10时无明显改变.结论 PAV通过采用正反馈调节机制,成比例地提供同步辅助,显著减少COPD呼吸衰竭患者的自主吸气做功,改善人机同步性.     

适应性支持通气对COPD及支气管哮喘合并呼吸衰竭患者呼吸力学的影响

目的探讨适应性支持通气(ASV)对慢性阻塞性肺疾病(COPD)及支气管哮喘合并呼吸衰竭患者呼吸力学的影响。方法选择需要行机械通气的呼吸衰竭患者共21例,随机分为两组,分别行常规通气模式容量控制通气(CMV)/压力支持通气(PSV)+同步间歇指令通气(SIMV)和ASV进行机械通气,记录两种模式下的各项呼吸力学参数。结果全部患者均成功脱机,呼吸频率明显降低、潮气量(VT)明显升高(P<0.05),气道峰压(PIP)和吸气阻力(R)下降显著(P<0.05),静脉顺应性(Cstat)逐渐增加(P<0.05)。ASV通气患者的上机时间明显缩短(P<0.05)。结论ASV可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量,降低呼吸频率,而对血流动力学和生命体征没有影响,并能缩短上机时间,明显优于常规通气。     

不同治疗方法对晚期慢性阻塞性肺疾病呼吸衰竭患者预后的影响

目的探讨晚期慢性阻塞性肺疾病(COPD)患者临床缓解期最佳的治疗方法。方法将47例晚期COPD患者分为三组:A组为不能或不接受家庭氧疗和家庭无创正压通气(NPPV)者;B组为出院后在医生指导下进行长期家庭氧疗者;C组为能在医生指导下进行长期家庭NPPV加长期家庭氧疗,且能很好耐受者。回顾性对比分析三组患者1年内再住院率、再插管率及病死率。结果B组患者1年内的再住院率、再插管率及病死率较A组分别降低了38.4%、17.3%和18.0%,而C组患者较B组患者又降低了8.0%、35.3%和29.4%,三组患者的再住院率、再插管率及病死率比较,差异均有统计学意义(P<0.05)。结论长期家庭氧疗和长期家庭NPPV能显著降低晚期COPD患者的再住院率、再插管率和病死率,长期家庭氧疗加长期家庭NPPV治疗效果最好。     

双水平无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究

目的研究无创正压通气(NIPPV)在慢性阻塞性肺疾病(COPD)合并呼吸衰竭中的疗效。方法将65例COPD合并呼吸衰竭患者纳入研究。随机分为标准治疗组(A组,33例),接受常规药物等治疗;NIPPV治疗组(B组,32例),在常规药物治疗的同时,立即应用面罩以双水平正压(BiPAP)模式行NIPPV。比较两组动脉血气分析结果、呼吸频率、心率、插管率、病死率及住院时间等观察指标。结果B组治疗后2~3 h及24 h血气分析中的pH值、PaCO2、PaO2均较入院时改善且差异有统计学意义(P<0.05),而A组与入院时比较差异无统计学意义;其中理论插管率治疗组(5/33)较A组(13/32)低且差异有统计学意义(P<0.05);理论住院时间B组较A组短且差异有统计学意义(P<0.05)。结论BiPAP模式行NIPPV可迅速改善COPD合并呼吸衰竭患者的血气情况,减少插管率与住院时间,是治疗呼吸衰竭的有效手段。     

布地格福联合无创正压通气治疗AECOPD合并呼吸衰竭效果及安全性

目的 探讨布地格福吸入气雾剂联合无创正压通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者临床效果及安全性。方法 以102例AECOPD合并呼吸衰竭患者为研究对象,随机分为观察组与对照组。观察组患者在基础治疗基础上给予无创正压通气联合布地格福吸入气雾剂治疗,对照组患者仅给予无创正压通气治疗。治疗前及治疗2周后,测定患者血清白细胞介素-6(IL-6)和C反应蛋白(CRP)水平,以及第1 s用力呼气容积(FEV1)、用力肺活量(FVC)及1 s率(FEV1/FVC),记录患者治疗期间不良反应发生情况。结果 治疗前,观察组和对照组患者FEV1、FVC、FEV1/FVC、血清CRP与IL-6水平差异均无统计学意义(P均＞0.05)。治疗2周后,观察组和对照组患者FEV1、FVC、FEV1/FVC、血清CRP与IL-6水平较治疗前均有所提高(P均＜0.05);治疗2周后,观察组患者FEV1/FVC为(0.66±0.02)% ,高于对照组的(0.60±0.10)%(t=9.90,P=0.030)。治疗2周后,观察组患者血清CRP和IL-6水平分别为(39.29±12.50)mg/L、(17.00±6.36)pg/mL,均低于对照组的(60.97±13.52)mg/L、(36.03±9.74)pg/mL,(t=-5.35、-10.31,P均＜0.05)。结论 无创正压通气联合布地格福吸入气雾剂治疗可显著改善AECOPD合并呼吸衰竭患者肺功能和血清炎性因子水平,且安全性较高,值得临床推广应用。     

适应性支持通气与间歇性气道正压通气对老年COPD合并呼吸衰竭患者呼吸力学的影响

目的对比适应性支持通气(ASV)与间歇性气道正压通气(SIMV)对慢性阻塞性肺疾病(COPD)合并呼吸衰竭老年患者呼吸力学的影响。方法 96例COPD合并呼吸衰竭患者纳入本次研究。应用自身对照研究方法,对比ASV和SIMV模式参数,包括心率(HR),血压,中心静脉压(CVP)和血气指标等。结果 ASV组患者呼吸频率、潮气量及呼吸道压力峰值均小于SIMV组(P0.01),每分通气量差异无显著性(P0.05)。ASV组PaO_2及pH值均显著高于SIMV组(P0.01)。结论 ASV通气模式可显著改善COPD合并呼吸衰竭患者的临床症状。     

两种肺保护通气模式在重症创伤性湿肺通气策略中的比较

目的 比较两种肺保护通气模式在重症创伤性湿肺时施行肺保护通气策略中的临床意义.方法 将92例重症创伤性湿肺患者按随机数字表法分为适应性支持通气（ASV）组和压力型同步间歇指令通气（P-SIMV）＋压力支持通气（PSV）组,每组46例,比较两组患者机械通气后30 min的心率、平均动脉压（MAP）、pH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaC O2）、每分钟通气量、潮气量、总呼吸频率、气道峰压、平均气道压、气道闭合内压、肺顺应性.结果 机械通气后30 min,两组患者心率、MAP、pH值、PaO2、PaCO2、平均气道压、气道峰压、气道闭合内压比较差异均无统计学意义（P＞0.05）,但ASV组潮气量、每分钟通气量、总呼吸频率、肺顺应性均较P-SIMV＋PSV组明显改善[（692.6±38.6） ml比（558.5±25.6） ml、（8.9±1.7）L比（7.8±1.6）L、（16.3±3.3）次/min比（21.3±3.2）次/min、（42.15±5.28） ml/cmH2O（1 cmH2O=0.098 kPa）比（39.15±5.47） ml/cmH2O],差异均有统计学意义（P＜0.01或＜0.05）.结论 对于重症创伤性湿肺患者在施行肺保护通气策略时,ASV可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量、增加肺顺应性、降低呼吸频率,而对血流动力学和生命体征无明显影响.     

慢性阻塞性肺疾病并发呼吸衰竭相关危险因素分析

目的 探讨慢性阻塞性肺疾病(COPD)并发呼吸衰竭相关危险因素和预后因素.方法 对2005年3月至2008年2月收治的110例COPD患者的临床资料进行回顾性分析,根据是否发生呼吸衰竭分为呼吸衰竭组(40例)和非呼吸衰竭组(70例).结果 呼吸衰竭组每年急性发作次数、尿酸、总蛋白、白蛋白、体重指数与非呼吸衰竭组比较差异有统计学意义[分别为(5.54±1.16)次/年比(2.75±0.78)次,年、(283.75±72.49)mmol/L比(359.87±41.50)mmol/L、(58.77±1.54)g/L比(63.95±2.04)g/L、(36.15±1.08)g/L比(36.96±1.48)g/L、(20.33±0.99)kg/m2比(21.16±1.36)kg/m2](P<0.01);COPD分度、院内感染、酸碱平衡紊乱两组比较差异有统计学意义(P<0.05或<0.01).呼吸衰竭死亡患者和好转患者动脉血氧分压比较差异无统计学意义(P>0.05),pH值、动脉血二氧化碳分压、血钠、血氯比较差异有统计学意义(P<0.01).结论 COPD并发呼吸衰竭相关危险因素多.     

尼可刹米结合无创正压通气对慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者动脉血气指标的影响

目的 探讨针对慢性阻塞性肺疾病(COPD)急性加重期伴呼吸衰竭患者采取尼可刹米结合无创正压通气治疗对其动脉血气指标的影响。方法 采用随机数表法将本院2017年10月—2019年10月收治的83例COPD急性加重期伴呼吸衰竭患者分为对照组42例、观察组41例。对照组予以尼可刹米治疗,观察组在对照组基础上结合无创正压通气联合治疗。对比分析2组临床疗效、1秒用力呼气量(FEV1)、用力肺活量(FVC)、1秒用力呼气量/用力肺活量比值(FEV1/FVC)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)及动脉血氧饱和度(SaO2)。结果 观察组治疗总有效率92.68%,较对照组(69.05%)高(χ2=7.448,P=0.006);观察组治疗后FVC(2.16±0.27)L、FEV1(2.94±0.36)L、FEV1/FVC(55.39±4.22)%,均高于对照组的(1.64±0.29)L、(2.27±0.43)L、(49.71±4.39)%,差异均有统计学意义(P＜0.01);观察组治疗后PaO2(90.73±7.11)mmHg、SaO2(93.13±5.75)%,均高于对照组的(86.42±7.20)mmHg、(87.10±6.12)%,且PaCO2(41.14±5.17)mmHg,低于对照组的(48.89±5.22)mmHg,差异均有统计学意义(P＜0.01)。结论 针对COPD急性加重期伴呼吸衰竭患者采取尼可刹米结合无创正压通气治疗,能够有效改善患者肺功能,调节动脉血气指标,值得推广。