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。     

呼吸训练对脊柱侧弯妊娠病人产后肺功能的影响

脊柱侧弯合并妊娠是较少见的妊娠合并症,脊柱侧弯病人常因胸廓畸形而导致严重的限制性呼吸功能障碍[1,2],继而可引发心功能不全,并随妊娠进程逐渐加重,导致围产期发生严重心肺并发症,威胁母儿健康,甚至导致母婴死亡[3]。目前尚无有效的防治措施,因此,改善肺功能成为病人产后重要的治疗内容。呼吸训练能够有效改善肺功能不全病人的呼吸功能[4-7],故本研究拟观察深慢缩唇呼气训练对脊柱侧弯的妊娠病人术后肺功能的影响。1对象与方法1.1对象选择2007年—2011年我院收治的25例妊娠合并     

体描法与一口气法测定正常人和COPD病人FRC的比较

[目的]探讨慢性阻塞性肺疾病(COPD)病人是否能采用弥散一口气法测定功能残气量.[方法]同时用体积描记法和弥散一口气法测定32例健康人,23例COPD病人的胸腔气量(TGV)或功能残气量(FRC)及肺总量(TLC)或肺泡量(VA)等肺容量指标.[结果]正常组用两种方法测量FRC差异无显著性(P>0.05)而TLC差异有显著性(P<0.01).而在COPD组两方法比较FRC、TLC差异均有极显著性(P<0.01).[结论]对于正常人可采用弥散一口气法粗略估算FRC,但不能作为实测值.而COPD病人不能采用弥散一口气法测定FRC.     

健康教育对重度脊柱侧弯病人围术期肺功能的影响

[目的]探讨健康教育对重症脊柱侧弯病人围术期肺功能改善的意义。[方法]对37例重度脊柱侧弯患儿术前实施健康教育,尤其呼吸功能的锻炼指导,于健康教育前后进行肺活量(VC)、肺容量(TLC)、用力肺活量(FVC)、最大通气量(MVV)检测。[结果]健康教育后,VC、TLC、FVC、MVV较教育前改善明显(P<0.01)。[结论]健康教育能够使重度脊柱侧弯患儿在短时间内改善肺功能,从而提高对脊柱矫形术的耐受力,更好地预防和减少术后呼吸功能不全的发生。     

健康教育对重度脊柱侧弯病人围术期肺功能的影响

[目的]探讨健康教育对重症脊柱侧弯病人围术期肺功能改善的意义。[方法]对37例重度脊柱侧弯患儿术前实施健康教育,尤其呼吸功能的锻炼指导,于健康教育前后进行肺活量（VC）、肺容量（TLC）、用力肺活量（FVC）、最大通气量（MVV）检测。[结果]健康教育后,VC、TLC、FVC、MVV较教育前改善明显（P〈0.01）。[结论]健康教育能够使重度脊柱侧弯患儿在短时间内改善肺功能,从而提高对脊柱矫形术的耐受力,更好地预防和减少术后呼吸功能不全的发生。     

脉冲振荡法与体积描记法测定气道阻力的对比分析

目的 探讨新兴的脉冲振荡技术(IOS)和传统的体积描记技术测定气道阻力(Raw)的相关性,为新技术新方法的标准化应用与推广提供依据。方法 分别对217例受试者用两种方法同期进行Raw的测定,然后对结果进行比较分析。结果 两种方法测定的Raw呈现显著正相关(P<0.01),其中体积描记法测定的Raw与脉冲振荡法测定的中心Raw(R20)实测值之间差异无统计学意义(P>0.05),而与总的Raw(R5)等实测值之间差异有统计学意义(P<0.01)。结论 用脉冲振荡法与公认的体积描记法测定的Raw结果一致,且方法简便、配合容易、价格低廉、信息全面、判读直观,是对传统肺功能检查技术的一个极好的补充手段,值得大力推广应用。     

渐进性康复训练对重度脊柱侧弯矫形术后患者肺功能和生活质量的影响

目的探讨渐进性康复训练对重度脊柱侧弯矫形术后患者肺功能和生活质量的影响。方法选取本院收治的符合纳入标准的84例重度脊柱侧弯矫形术后患者作为研究对象,采用随机数字表法分为对照组和实验组,每组42例。对照组在治疗期间接受重度脊柱侧弯矫形术后护理常规护理、心理护理及常规康复训练;实验组在对照组基础上,根据患者手术时间和评估患者耐受程度进行渐进性康复训练。采用脊柱侧凸社会生活质量调查问卷观察两组患者出院时、出院后1月、出院后6个月生活质量变化情况;出院时、出院后1月、出院后6个月监测两组患者肺活量(VC)、肺活量占预计值的百分比(VC%)、最大通气量(MVV)和最大通气量占预计值的百分比(MVV%),观察两组患者肺功能变化情况。结果 (1)出院时,两组患者社会生活质量调查问卷得分、VC、VC%、MVV和MVV%值比较,差异无统计学意义(P0.05);(2)生活质量、VC、VC%、MVV和MVV%值随时间的推移变化明显,出院后1月、出院后6个月数据比较,实验组患者明显优于对照组,差异均有统计学意义(P0.05)。结论渐进性康复训练在重度脊柱侧弯矫形术后患者中运用,它遵循了循序渐进康复功能锻炼和患者耐受原则,使患者更容易接受,提高了训练依从性,改善了患者肺功能和生活质量,帮助患者回归社会,将手术的效果发挥到最佳。     

婴幼儿喘息性支气管炎患者肺功能残气量的测量和临床观察

目的 探讨婴幼儿喘息性支气管炎患者肺功能残气量(FRC)的改变.方法 应用Vmax26肺功能仪和六氟化硫冲洗法,对38例婴幼儿喘息性支气管炎患者进行FRC检测.根据患儿年龄与体质量选择合适的面罩和死腔减径管,由经过培训的专门人员操作.检查当天患儿口服10%水合氯醛0.5 ml/kg,入睡后取去枕仰卧位检测,反复测量2次,取2次结果的平均值.最终测量结果与35例无呼吸系统疾病、无哮喘病史且2周内无呼吸道感染史的婴幼儿(对照组)进行比较.结果 婴幼儿喘息性支气管炎患者测量过程顺利,测得FRC为(0.0252±0.0051)L/kg,对照组FRC(0.0171±0.0033)L/kg,喘息性支气管炎患儿FRC显著增高(P＜0.01).结论 应用Vmax26婴幼儿肺功能仪和六氟化硫冲洗法为患儿测量FRC,操作安全、方便,患儿无不适.婴幼儿喘息性支气管炎患者FRC较无呼吸道系统疾病婴幼儿增高,为喘息性支气管炎的诊断、病情观察与疗效判断提供一定的量化指导依据.     

SARS患者康复期肺功能的变化

目的了解严重急性呼吸综合征(SARS)患者康复期肺功能的特征性及其变化规律。方法对26例SARS患者出院后每隔3个月进行1次肺功能检查，分析康复期肺功能各指标的意义。结果SARS患者发病后第3～6个月肺功能主要表现为限制性通气功能障碍和弥散功能障碍。不同时间段(3～6个月、6～9个月、9～12个月、12～15个月、15～17个月)的用力肺活量(FVC)、1秒用力呼气容积(FEV1.0)、功能残气量(FRC)和残气容积(RV)差异均无显著性，但随康复时间的延长而逐渐增加；同时FEV1.0／FVC变化不大；而肺总量(TLC)和肺一氧化碳弥散量(DLCO)在不同时间段均有不同程度的好转。结论SARS患者发病后肺功能的损害主要表现为限制性通气功能障碍和弥散功能障碍，但随康复时间的延长两者均逐渐恢复。     

糖尿病肾病患者的肺功能变化

目的探讨2型糖尿病肾病患者的肺功能改变及其意义。方法 90例2型糖尿病肾病Ⅲ～V期患者,每期各30例;对照组为30例健康体检者。采用美国森迪斯大型肺功能仪测定肺通气及肺弥散功能,比较糖尿病肾病不同分期的肺功能变化。结果 2型糖尿病肾病患者肺通气及肺弥散功能均有变化。与对照组相比,糖尿病肾病患者的DLCO、DLCO(%)、DLCO/VA、DLCO/VA(%)等肺弥散功能指标随病期的进展呈依次递降(P<0.05),除Ⅲ期外,与对照组的差异均有统计学意义(P均<0.01);Ⅲ、Ⅳ、Ⅴ期之间两两比较,差异亦有统计学意义(P<0.05或P<0.01)。与对照组相比,Ⅲ、Ⅳ、Ⅴ期患者的VC、VC(%)、FEV1、FEV1(%)等通气功能指标呈依次递降(P<0.05);其中Ⅳ期的VC(%)、FEV1(%)显著低于对照组(P均<0.01);V期的VC、VC(%)、FEV1、FEV1(%)显著低于对照组(P<0.05或P<0.01)。结论 2型糖尿病肾病患者存在肺功能的损害,且糖尿病肾病越严重,肺弥散和通气功能损害越明显。     

血栓弹力图评价急性创伤患者早期血小板功能的改变

目的用血栓弹力图(TEG)血小板图分析急性创伤后血小板抑制功能的改变。方法用TEG检测51例急诊创伤患者及48例健康人全血血小板二磷酸腺苷(ADP)抑制率及花生四烯酸(AA)抑制率,并用logistic回归分析创伤患者的高危风险因素。结果创伤患者平均二磷酸腺苷(ADP)抑制率(%)为85.9(38.4,97.6)、平均花生四烯酸(AA)抑制率(%)为44.7(26.4,59.1),健康人平均ADP抑制率(%)为4.4(0,18.1)、平均AA抑制率(%)为0.7(0,3.03),创伤组与健康人对照组血小板抑制率差异有统计学意义(P0.01)。以ADP抑制率是否大于75%为cut off值,患者碱缺失(BD)6 m Eq/L(OR=3.21,95%CI:1.45~9.31)和6 h内至少输注血浆200 m L(OR=4.9,95%CI:0.89~28.8)为患者的高危风险因素;以ADP抑制率是否大于90%为cut off值,患者收缩压70 mm Hg(OR=12.4,95%CI:1.8~91.4)和患者6 h内至少输注红细胞悬液2 U(OR=8.7,95%CI:1.8~46.5)为患者的高危风险因素。结论创伤患者血小板AA及ADP抑制率明显升高,血小板活化功能降低;血制品输注增加创伤患者风险。     

Left ventricular function in asthmatic children chronically treated with theophylline evaluated by exercise Doppler echocardiography

To evaluate the chronic effects of theophylline on cardiac function, M-mode and pulsed Doppler derived variables were measured at rest and the suprasternal continuous wave Doppler measurement of ascending aortic flow was used during treadmill exercise testing. Subjects consisted of 13 children with stable asthma (mean 11.7±2.2 years) who were treated with theophylline for at least one year and 16 age-matched, untreated normal volunteers. In the resting state, the chronic administration of theophylline seemed to produce a slight increase in percent fractional shortening, outflow peak velocity and atrial contribution to ventricular filling in the asthmatic children as compared to normals, but these changes were not statistically significant. The asthmatic children showed significantly lower values than the controls in exercise induced changes in the peak velocity, stroke index and cardiac index, but not in the heart rate. Therefore, chronic administration of theophylline appears to have a minimal effect on resting cardiac function, but a possibly deleterious effect on the cardiac response to exercise testing.     

Pulmonary function and spinal characteristics: their relationships in persons with idiopathic and postpoliomyelitic scoliosis

OBJECTIVE: To identify what influence the various features of spinal deformity have on pulmonary function in persons with idiopathic and the postpoliomyelitic scoliosis. DESIGN: Prospective, cohort, observational study with clinical and radiologic evaluations. SETTING: Hospital-based rehabilitation units. PATIENTS: Forty-four patients with idiopathic scoliotis and 16 with postpoliomyelitic scoliotis. Each group was divided into subgroups: normal and abnormal pulmonary function. INTERVENTION: Clinical and radiologic evaluation of spinal deformity, full pulmonary functional test and respiratory muscle strength were performed. Presence of dyspnea on exertion and low back pain (LBP) was recorded. MAIN OUTCOME MEASURES: Pulmonary function: spirometry, lung volume test, and diffusing capacity. Respiratory muscle strength: maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Presence of dyspnea on exertion (DOE), and LBP were also recorded. Characteristics of spinal deformity: direction of convexity, uppermost vertebra, number of involved vertebrae, Cobb angle, the apical vertebra, degree of rotation at the apical vertebra, type of scoliotic curve, and presence of balanced spine and pelvic obliquity. Chi-square analyses and Mann-Whitney U test for between-groups comparisons. Spearman's rho correlation coefficient to determine the existence and magnitude of a relationship. RESULTS: We found significant differences between the idiopathic and postpoliomyelitis groups in the degree of rotation at the apical vertebra, MIP, average percentage of predicted vital capacity, residual volume/total lung capacity, presence of double or triple curves, pelvic obliquity, and DOE. Between the idiopathic scoliotis subgroups we found significant differences in the uppermost vertebra and number of vertebrae in the scoliotic curve. Between the subgroups of the postpoliomyelitis group were significant differences in the location of the apical vertebra and the uppermost vertebral body of scoliotic curve. In the idiopathic group, pulmonary function was mostly related to scoliotic angle, number of vertebrae in the scoliotic curve, location of the uppermost vertebra, and the patients' age; MIP and MEP were negatively related to the scoliotic angle and degree of rotation of apical vertebra. In the postpoliomyelitis group, pulmonary function was mostly related to scoliotic angle, kyphotic angle, location of the uppermost vertebra of the scoliotic curve, and age. CONCLUSION: No single factor can predict the severity of impairment in scoliotic patients' pulmonary function. In both groups, severity of pulmonary impairment was related to the combined features of the spinal deformity. However, uppermost vertebra, scoliotic angle, and patient's age may play important roles influencing pulmonary function in both groups.     

呼吸操锻炼对脊柱侧弯患儿术前肺功能的影响

目的 :探讨对小儿脊柱侧弯患者术前进行呼吸操锻炼的可行性和有效性。方法 :对 35例脊柱侧弯且肺功能障碍的患儿术前 1周实施组合的呼吸操锻炼 ,观察比较锻炼前后肺功能的变化。结果 :锻炼后患儿肺活量 (VC)、肺容量 (TLC)、用力肺活量 (FVC)、最大通气量 (MVV)较锻炼前明显改善 (P <0 .0 1) ,术后血氧饱和度 97%。结论 :术前进行呼吸操锻炼能在近期改善患儿肺功能 ,提高对脊柱矫形手术的耐受力 ,对预防和减少术后呼吸功能不全的发生有积极作用。     

Age-dependent changes in regional diastolic function evaluated by color Doppler myocardial imaging: a comparison with pulsed Doppler indexes of global function.

The goals of this study were to evaluate possible normal age-related changes in regional myocardial relaxation as detected by color Doppler myocardial imaging (CDMI) velocities and to compare the extent of any such changes with age-induced changes in global diastolic function. In 80 healthy subjects (aged 21 to 72 years, equally subdivided by decades) the mitral flow velocities in early diastole (E) and atrial contraction (A) were recorded as were the velocities of left ventricular (LV) motion of early (EDV) and late diastole (LDV) in the 16 standard LV segments, and their ratios were calculated. In healthy persons younger than 40 years, all segments showed an EDV/LDV ratio > 1, whereas in healthy persons aged 40 years or older the mean EDV of all segments decreased, and the mean LDV increased, resulting in a significant decrease of the mean EDV/LDV ratio with age. Values of EDV/LDV ratios were higher than E/A ratios (P <.0001), but their changes with age correlated well with each other (r = 0.805). With increasing age, an EDV/LDV ratio <1 was observed more often in basal segments (P <.001, compared with mid and apical segments) and less often in segments of anteroseptal and posterior walls viewed from the parasternal window. The presence of >50% segments with an EDV/LDV ratio <1 was associated with an E/A ratio <1. Regional diastolic function indexes as evaluated by CDMI changed with increasing age in a heterogeneous way and influenced global diastolic function parameters.     

Cardiovascular changes in pregnancy evaluated by two-dimensional and Doppler echocardiography.

During pregnancy significant cardiovascular changes occur. To study these anatomic and physiologic changes we performed two-dimensional and Doppler echocardiography in 28 women during the third trimester (34.4 +/- 1.9 weeks) of pregnancy and then again after delivery (7.8 +/- 2.2 weeks). Fourteen nonpregnant age- and sex-matched subjects served as controls. Left ventricular diastolic and systolic dimensions were similar among pregnant, postpartum, and control subjects. Left atrial area as determined by two-dimensional echocardiography was significantly larger during pregnancy (16.7 +/- 4.0 cm2) compared with measurements postpartum (13.8 +/- 3.1 cm2) and with controls (15.5 +/- 3.5 cm2) (p less than 0.01). Doppler study showed that the ratio of early diastolic flow velocity to late diastolic flow velocity (E/A max) and E/A integral were lower among pregnant subjects (1.3 +/- 0.3, 2.0 +/- 0.5) compared with postpartum subjects (1.6 +/- 0.4, 2.5 +/- 1.5) and controls (1.9 +/- 0.5, 3.0 +/- 0.8) (p less than 0.05). Heart rate was higher among pregnant subjects (84 +/- 10 beats/min) compared with postpartum subjects (70 +/- 16) and controls (69 +/- 13) (p less than 0.05). In summary, in pregnant subjects during late third trimester left ventricular chamber dimensions were similar to these postpartum measurements in control subjects; however, the left atrium is dilated during pregnancy. Although there are significant alterations in Doppler-derived left ventricular diastolic parameters during the third trimester, increased heart rate and a dilated left atrium may explain these findings.     

应用本顿视觉保持测验评估非医学指征剖宫产儿童的认知功能特征

目的：探讨非医学指征剖宫产儿童在本顿视觉保持测验中的视知觉、视觉记忆、视觉结构能力等认知特征,分析剖宫产对儿童神经心理的影响,为控制人为剖宫产率提供理论支持.方法：于2003-09/10整群选取广州市几所小学三、四年级儿童作为调查对象.共发放自编的“分娩情况和一般家庭情况”调查问卷727份,回收663份,根据回收问卷中分娩方式情况,筛查出非医学指征性剖宫产儿童63例,作为剖宫产组,选择与剖宫产组儿童年龄、性别、学校、班级及家庭一般情况无显著性差异的正常阴道分娩儿童156人作为对照组.应用国内修订版本顿视觉保持测验对两组儿童的视觉记忆保持能力、视觉结构能力和延迟记忆能力进行测试,该测验的测具包括无意义的图卡片C、D、E式各10张,分为4种测验方法,A法、B法为每一图卡片呈现10 s或5 s后让被试默画,C法为让被试临摹图卡片,D法为每一图卡片呈现10 s后间隔15 s再让被试默画,本测试采用C式B法,D式C法和E式D法,采用个别施测方式,分别记录两组儿童测验的正确分（每一图卡根据全或无的原则记1或0分,总分范围0～10之间）及错误次数（错误类型分为遗漏、变形、持续、旋转、位置错误和大小错误6个范畴）,基本资料进行两组间的成组t检验.结果：所有调查对象全部进入结果分析,无脱落.本顿视觉保持测验结果显示剖宫产儿童在E式D法测验中的得分低于对照组（P＜0.05）;在D式C法中“位置”错误类型的出现次数多于对照组（P＜0.05）,在E式D法中“位置”和“变形”错误类型的出现次数较对照组明显偏高（P＜0.05）.结论：剖宫产儿童的视觉空间结构能力及视觉延时回忆能力存在缺陷,视空间工作记忆、视觉结构与视觉统和功能不足.     

应用本顿视觉保持测验评估非医学指征剖宫产儿童的认知功能特征

目的:探讨非医学指征剖宫产儿童在本顿视觉保持测验中的视知觉、视觉记忆、视觉结构能力等认知特征,分析剖宫产对儿童神经心理的影响,为控制人为剖宫产率提供理论支持。方法:于2003-09/10整群选取广州市几所小学三、四年级儿童作为调查对象。共发放自编的“分娩情况和一般家庭情况”调查问卷727份,回收663份,根据回收问卷中分娩方式情况,筛查出非医学指征性剖宫产儿童63例,作为剖宫产组,选择与剖宫产组儿童年龄、性别、学校、班级及家庭一般情况无显著性差异的正常阴道分娩儿童156人作为对照组。应用国内修订版本顿视觉保持测验对两组儿童的视觉记忆保持能力、视觉结构能力和延迟记忆能力进行测试,该测验的测具包括无意义的图卡片C、D、E式各10张,分为4种测验方法,A法、B法为每一图卡片呈现10s或5s后让被试默画,C法为让被试临摹图卡片,D法为每一图卡片呈现10s后间隔15s再让被试默画,本测试采用C式B法,D式C法和E式D法,采用个别施测方式,分别记录两组儿童测验的正确分(每一图卡根据全或无的原则记1或0分,总分范围0～10之间)及错误次数(错误类型分为遗漏、变形、持续、旋转、位置错误和大小错误6个范畴),基本资料进行两组间的成组t检验。结果:所有调查对象全部进入结果分析,无脱落。本顿视觉保持测验结果显示剖宫产儿童在E式D法测验中的得分低于对照组(P<0.05);在D式C法中“位置”错误类型的出现次数多于对照组(P<0.05),在E式D法中“位置”和“变形”错误类型的出现次数较对照组明显偏高(P<0.05)。结论:剖宫产儿童的视觉空间结构能力及视觉延时回忆能力存在缺陷,视空间工作记忆、视觉结构与视觉统和功能不足。     

彩色多普勒超声心动图诊断肺动脉吊带1例

病例男,6个月,主因咳嗽伴喘憋加重3天就诊。胸片：两肺纹理增重,右下伴有薄片状模糊阴影,印象：右下支气管肺炎。胸部CT增强扫描：右肺动脉正常起源于主肺动脉,正常左肺动脉起始处未见其开口,左肺动脉主干发自右肺动脉主干远端,走行于气管和食管之间,压迫气管。诊断：肺动脉吊带（主气管）,