BIPAP呼吸机治疗慢性阻塞性肺疾病并Ⅱ型呼吸衰竭疗效观察

目的探讨BIPAP呼吸机无创机械通气治疗慢性阻塞性肺疾病(COPD)并Ⅱ型呼吸衰竭的疗效。方法将80例COPD急性发作期并Ⅱ型呼吸衰竭患者随机分为2组,均予常规氧疗及药物治疗,治疗组在此基础上予BI-PAP呼吸机无创机械通气治疗。结果在治疗1 d及3 d后治疗组意识障碍程度、动脉血气、心率等明显改善(P均<0.05),对照组与治疗前比较改善不明显(P>0.05)。2组治疗7 d后疗效均明显,但是治疗组效果更显著。结论BI-PAP呼吸机是治疗COPD急性发作期并Ⅱ型呼吸衰竭快捷和有效的方法,且愈早使用愈有利。     

阻塞性睡眠呼吸暂停-慢性阻塞性肺疾病重叠综合征的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是呼吸科常见的一种疾病,以睡眠时上气道反复塌陷引起的间歇性缺氧并伴有睡眠片段化为特征。当OSAHS合并慢性阻塞性肺疾病(COPD)时称为重叠综合征,两种疾病在发生、发展上存在复杂的交互作用,严重影响患者的生活质量和预后,现对OSAHS与COPD之间相互影响及可能的机制作一综述...     

介入治疗在肺结核病及其相关疾病中的应用

结核病是全世界范围内流行的感染性疾病，特别是在发展中国家较为多见。在我国结核病患病率和致残率依然较高，本文就介入治疗在结核病及其相关疾病中的应用现状和前景作一概述。     

Effect of NADPH oxidase inhibitor apocynin on the expression of hypoxia-induced factor-1α and endothelin-1 in rat carotid body exposed to chronic intermittent hypoxia

The effects of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor apocynin on the enhanced hypoxia induced factor-1α (HIF-1α) and endothelin-1 (ET-1) expression,elevated systolic blood pressure under chronic intermittent hypoxia (CIH) condition and its action mechanism were investigated.Thirty healthy 8-week old Sprague-Dawley (SD) male rats were randomly divided into three groups (n=10 each): sham group,CIH group,and apocynin-treated CIH group.Tail artery systolic blood pressure was measured by tail-cuff method.Real-time fluorescence quantitative polymerase chain reaction (PCR) was used to detect the mRNA expression of HIF-1α and ET-1 in the carotid body,and the HIF-1α protein expression was examined by using Western blotting.The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were determined by using colorimetric method.In addition,the plasma ET-1 and HIF-1α levels were measured by using enzyme-linked immunosorbent assay.It was found that CIH exposure was associated with increased MDA levels,and apocynin-treated CIH animals showed reduction in MDA levels.Apocynin treatment prevented CIH-induced hypertension as well as CIH-induced decrease in SOD.The increases of HIF-1α and ET-1 mRNA along with HIF-1α protein expression in the carotid body,and elevated circulating HIF-1α and ET-1 levels were observed in CIH-exposed animals.Treatment with apocynin significantly decreased the ET-1 mRNA,HIF-1α protein expression and circulating HIF-1α level in CIH-exposed animals,and there was no statistically significant difference in the HIF-1α mRNA expression between CIH group and apocynin-treated group.These results indicated that apocynin alleviated CIH-induced hypertension by inhibiting NADPH oxidase,further leading to the reduced vasoconstrictor ET-1 level and oxidative stress.HIF-1α/ET-1 system signal pathway may interact with CIH-induced NADPH oxidase-dependent oxidative stress.Inhibition of NADPH oxidase activity may hopefully serve as a useful strategy for prevention and treatment of obstructive sleep apnea hypopnea syndrome-induced hypertension.     

第五届全国慢性阻塞性肺疾病学术会议纪要

由中华医学会呼吸病学分会慢性阻塞性肺疾病学组和<中华结核和呼吸杂志>编辑委员会联合举办,浙江大学呼吸疾病研究所协办的第五届全国慢性阻塞性肺疾病学术会议于2011年4月15一18日在浙江省杭州市举行.中华医学会呼吸病学分会前任主任委员刘又宁教授、中华医学会呼吸病学分会主任委员王辰教授亲临会议并作了重要发言.大会邀请了国内外相关专业的知名专家学者,就COPD患者的表型、临床表现,COPD肺血管炎症和肺动脉高压,以及COPD与OSAHS及心血管并发症等进行了专题报告和讨论.大会还收到了近百篇论文,来自全国的400余位长期从事COPD基础及临床研究工作的医务人员参加了本次会议.     

Clinical Characteristics of Hereditary Multiple Exostoses: A Retrospective Study of Mainland Chinese Cases in Recent 23 Years简

Hereditary multiple exostoses（HME） are an autosomal dominant skeletal disease with wide variations in clinical manifestations among different ethnic groups. This study investigated the epidemiology, clinical presentations, pathogenetic features and treatment strategies of HME in mainland China. We searched and reviewed the related cases published since 1990 by searching electronic databases, namely SinoMed database, Wanfang database, CNKI, Web of Science and PubMed as well as Google search engines. A total of 1051 cases of HME（male-to-female ratio 1.5：1） were investigated and the diagnosis was made in 83% before the age of 10 years. Approximately 96% patients had a family history. Long bones, ribs, scapula and pelvis were the frequently affected sites. Most patients were asymptomatic with multiple palpable masses. Common complications included angular deformities, impingement on neighbouring tissues and impaired articular function. Chondrosarcomas transformation occurred in 2% Chinese cases. Among the cases examined, about 18% had mutations in EXT1 and 28% in EXT2. Frameshift, nonsense and missense mutations represented the majority of HME-causing mutations. Diagnosis of HME was made based on the clinical presentations and radiological documentations. Most patients needed no treatment. Surgical treatment was often directed to remove symptomatic exostoses, particularly those of suspected malignancy degeneration, and correction of skeletal deformities. This study shows some variance from current literature regarding other ethnic populations and may provide valuable baseline assessment of the natural history of HME in mainland China.     

夜间胸闷伴憋气是否一定是冠心病

病例简介 患者,女,66岁,反复夜间胸闷、喘气近5年,有时伴夜间憋气,严重时可从睡眠中惊醒,醒后感胸闷不适,休息一会儿可好转。体格检查显示肥胖,双肺呼吸音清,心界不大,心音可,各瓣膜区未闻及杂音,心律齐。     

胃癌术后患者败血症并ARDS 1例及文献复习

患者48岁女性,因发热1天入院.10月前行胃癌切除术,术后予奥沙利铂＋CF方案化疗4个周期.入院前一天因＂吻合口炎,胃癌术后＂从我院消化内科出院.本次入院查体：T：40.2℃,P 102次/min,RR 22次/min,BP 105/70 mmHg,神志清楚,急性病容,双肺叩诊呈清音,未闻及干湿啰音.查血常规示三系减少（其中血小板47 G/L）,凝血功能异常（PT延长16秒,APTT延长22秒,D-二聚体阳性,达到弥散性血管内凝血诊断标准）;胸片示：左下肺炎,入院诊断：1、肺部感染,弥散性血管内溶血（DIC）;2、胃癌术后.     

肺隐球菌病14例报道及435例荟萃分析

目的 探讨肺隐球菌病的临床表现,诊断及治疗情况,以提高对该病的认识.方法 收集该院2005年1月～2010年6月确诊的14例肺隐球菌病例资料,与经筛选后的1999～2009年中国学术期刊网及PUBMED数据库收录的421例肺隐球菌病的资料共同荟萃分析,以分析其临床特点.结果 肺隐球菌病超过一半发生于无基础疾病及易感因素者,症状、影像学表现形式多样,易并发隐球菌性脑膜炎;隐球菌抗原乳胶凝结试验、CT引导下经皮肺活检及经支气管镜肺活检对诊断有重要意义,目前临床应用较少;治疗手段包括手术、抗真菌药物及联合治疗.结论 目前临床对于该病的认识不足,常误诊为肿瘤、结核及一般感染,应强调上述3种检查方法的引用.单纯手术治疗治愈率较低,且易产生并发症.