家庭氧疗加无创通气治疗慢性阻塞性肺疾病稳定期及其对运动耐量的影响

目的 观察家庭氧疗加无创通气对慢性阻塞性肺疾病(COPD)稳定期的治疗效果及对运动耐量的影响.方法 采用自身对照方法,将患者治疗前后及治疗期间的血气分析及6 min步行实验结果进行对比观察.结果 10例完成疗程的患者治疗前后血气分析及6 min步行实验结果差异均有统计学意义(均P＜0.05).结论 COPD稳定期实施家庭氧疗及无创通气治疗安全可行,效果较好.     

容积补偿法监测连续每搏无创血压的进展

无创血压是最常用的监护参数，本文介绍了连续每搏无创血压的新技术，容积补偿法的原理和应用。     

RAPID DOPPLER SCREENING TEST FOR INTERNAL CAROTID DISEASE

There is increasing evidence that only hemodynamically significant internal carotid lesions (of more than 50% diameter stenosis or occlusion) rather than minor lesions are the precursors of stroke. A Doppler test combining periorbital and direct audible interpretation of internal carotid Doppler signals was performed on 67 patients (134 internal carotids) and the results were compared with those from conventional biplane angiography. The test was 100% sensitive and had a positive predictive value of 91% for hemodynamically significant lesions. Negative predictive value for normal or less than 50% stenosis was 100%. Carotid bifurcation bruits were heard over only 25% of internal carotids with significant stenosis and nearly 60% of bruits were heard over internal carotids with minor disease. The equipment was portable and relatively inexpensive. The test could be performed by vascular technicians in less than 12 minutes with minimal patient discomfort, thus meeting most of the criteria for an ideal non-invasive screening test. (Aust NZ J Med 1986; 16: 481–485.)     

Blood pressure changes associated with tilting in normotensive subjects: Differences in response pattern as measured by oscillometry and auscultation

Three non-invasive instruments were used to measure blood pressure in the supine position and on tilting—a conventional and a random-zero sphygmomanometer, and an oscillometric device (Accutorr 1A). Twenty normotensives volunteered for the study. There was no statistically significant difference in systolic blood pressure and diastolic blood pressure measured by the conventional and random-zero sphygmomanometers in the supine position. There was a difference between these recordings and those of the Accutorr, with the Accutorr giving higher readings of systolic blood pressure (p < 0.001, analysis of variance, 95% confidence interval of the difference between the Accutorr and the random-zero was 5.1–15.7 mmHg) and lower readings of diastolic blood pressure (p < 0.0001, analysis of variance, 95% confidence interval of the difference between the Accutorr and the random-zero was –12.2––2.2 mmHg). On tilting, the Accutorr showed an increase in systolic blood pressure while the other two machines did not (p < 0.01, analysis of variance). By contrast, the Accutorr detected a smaller rise in diastolic blood pressure than with the other two instruments (p < 0.05, analysis of variance). The difference between blood pressure measurements made in the supine position by the two different techniques, auscultation and oscillometry, might be expected. However, the two different techniques do not detect the same blood pressure responses to a change in posture.     

Airway occlusion pressure at 0.1 s (P0.1) after extubation: an early indicator of postextubation hypercapnic respiratory insufficiency

Objective: To examine variables associated with postextubation respiratory distress in chronic obstructive pulmonary disease (COPD) patients. Design: Prospective, clinical investigation. Setting: Intensive care unit of a university hospital. Patients: Forty COPD patients, considered ready for extubation. Measurements and main results: We recorded, from the digital display of a standard ventilator, breathing frequency (f), tidal volume (VT) and f/VT for the respiratory pattern, airway occlusion pressure at 0.1 s (P0.1) for the respiratory drive and measured blood gases : i) before extubation, following 30 min of a 6 cm H₂O pressure support (PS) ventilation trial, ii) 1 h after extubation, at the 30th min of a face mask 4 cm H₂O PS ventilation trial. According to the weaning outcome, the patients were divided into two groups : respiratory distress, and non-respiratory distress within 72 h of the discontinuation of mechanical ventilation. The respiratory distress was defined as the combination of f more than 25 breaths/min, an increase in PaCO₂ of at least 20 % compared with the value measured after extubation, and pH lower than 7.35. We determined whether those patients who developed respiratory distress after extubation differed from those who did not. Respiratory pattern data and arterial blood gases recorded, either before or after extubation, and P0.1 recorded before extubation, were inadequate to differentiate the two groups. Only P0.1 recorded 1 h after the discontinuation of mechanical ventilation differentiated the patients who developed respiratory distress from those who did not (4.2 ± 0.9 vs 1.8 ± 0.8, p < 0.01). Conclusions: P0.1 recorded after extubation may be a good indicator of postextubation respiratory distress. Measuring P0.1 and/or the analysis of the evolution of this parameter could facilitate decisions during the period following extubation. Received: 23 March 1998 Accepted: 5 October 1998     

The retina: A window in which to view the pathogenesis of Alzheimer’s disease

Alzheimer’s disease (AD) is the most familiar type of dementia affecting elderly populations worldwide. Studies of AD patients and AD transgenic mice have revealed alterations in the retina similar to alterations which occur in the AD brain. Moreover, AD retinal pathology occurs even earlier than AD brain pathology. Importantly, non-invasive imaging techniques can be utilized for retinal observation due to the unique optical transparency of the eye, which acts as a convenient window in which preclinical pathology in the AD brain can be monitored. In this review, we overview the existing literature covering different forms of AD retinal pathology and propose a basis for the clinical application of using the retina as a window to view AD during preclinical and clinical stages.     

无创通气治疗慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭的临床研究

目的 探讨应用无创双水平正压通气(BiPAP)呼吸机治疗慢性阻塞性肺疾病(COPD)并发Ⅱ型呼吸衰竭的临床应用价值.方法 将56例COPD急性加重并发Ⅱ型呼吸衰竭患者随机分为观察组和对照组,观察组应用BiPAP+常规综合治疗,对照组常规综合治疗.观察2组治疗后血气分析结果、呼吸频率、心率、辅助呼吸肌动用评分、气管插管率、病死率.结果 观察组治疗后PO2明显升高,PCO2明显降低,pH明显改善,呼吸频率、心率、辅助呼吸肌动用评分下降;对照组各指标无改善.观察组气管插管率、住院病死率与对照组相比显著降低,差异均有统计学意义(均P＜0.05).结论 对COPD并发Ⅱ型呼吸衰竭患者,在常规药物治疗的基础上,给予BiPAP呼吸机辅助通气治疗可以提高疗效,缓解呼吸肌疲劳,降低气管插管率及病死率.     

中药穴位贴敷治疗无创正压通气相关性腹胀的临床效果

〔摘 要〕 目的：探究中药穴位贴敷治疗无创正压通气（NPPV）相关性腹胀的临床疗效,并观察其对患者血气分析指标 的影响。方法：选取眉山市中医医院 2019 年 11 月至 2020 年 11 月收治的 NPPV 合并相关性腹胀患者 106 例为研究对象,随 机数字表法分为观察组（53 例）及对照组（53 例）,对照组患者实施常规治疗方案,观察组患者在对照组基础上实施中药 穴位贴敷治疗。观察两组患者的总有效率、上机不同时间段腹胀发生率及治疗前后的动脉血氢离子浓度指数（pH）、动脉血 氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。结果：观察组患者的治疗总有效率为 96.23 %,显著高于对照组的 81.13 %, 差异具有统计学意义（P ＜ 0.05）;治疗后,两组患者的 PaO2 较治疗前显著增高,pH、PaCO2 显著下降,且观察组 PaO2 指 标高于对照组,pH、PaCO2 低于对照组, 差异具有统计学意义（P ＜ 0.05）;观察组患者上机后 24 h、48 h、72 h 腹胀发生 率分别为 11.32 %、5.66 %、3.77 %,均低于对照组的 26.42 %、20.75 %、15.09 %,差异具有统计学意义（P ＜ 0.05）。结论： 中药穴位贴敷治疗 NPPV 合并腹胀疗效理想,可显著改善患者的血气分析指标,且随着上机时间的延长,腹胀发生率呈显著 下降趋势。     

Biomarkers of liver fibrosis: clinical translation of molecular pathogenesis or based on liver-dependent malfunction tests

BACKGROUND: Fibrosis is the excessive deposition and histological redistribution of extracellular matrix (ECM) in the tissue as consequence of chronic liver damage. It leads to progressive liver insufficiency, portal hypertension and ultimately to cirrhosis and primary liver cell carcinoma. There is a strong demand for reliable, organ- and disease-specific, non-invasive biomarkers of fibrosis and fibrogenesis to replace or to complement the invasive method of needle biopsy, which is afflicted with a high degree of sampling error. METHODS: A systematic literature search was performed using electronic databases and reference lists of relevant publications to ascertain studies with non-invasive biomarkers of liver fibrosis. RESULTS: Two classes of serum biomarkers can be differentiated: Class I markers are those, which reflect ECM turnover (fibrogenesis and fibrolysis) and/or fibrogenic cell changes, mainly of hepatic stellate cells, which are the dominant profibrogenic cell type in liver. They are mostly cost intensive, single laboratory tests and derive from the translation of fibrogenic mechanisms into clinical application. Examples are procollagen peptides, hyaluronan, and laminin. Class II biomarkers are based on algorithmic evaluation of commonly observed functional alterations of the liver that do not necessarily reflect ECM metabolism and/or fibrogenic cell changes. About 20 numerical scores or indices are reported for parameters, which are mostly routine laboratory tests and frequently multiparametric (panels). Among them fibrotest, hepascore, ELF-score have reached limited clinical application. CONCLUSIONS: Up to now the impact of both classes of biomarkers for diagnosis and monitoring of fibrosis, fibrogenesis, and fibrolysis is limited. They cannot replace needle biopsy but some of them might be complementary in follow-up studies. Innovative methods like proteomics and glycomics to establish fibrosis-specific serum protein and glycosylation patterns, respectively, might have a high potential for diagnosis and monitoring of fibrogenesis.