外周血血小板参数、抗凝血酶-Ⅲ表达水平在急性肺栓塞患者中的临床意义

目的 调查外周血血小板参数、抗凝血酶-Ⅲ(AT-Ⅲ)表达水平在急性肺栓塞(aute pulmonary embolism,APE)患者中的临床意义.方法 选择2018 年1月-2019 年10 月连续247 例APE 患者作为研究对象.根据人院时的血流动力学和右心室功能障碍情况,确定了高风险APE(n = 120)和低...     

慢性阻塞性肺疾病患者生活质量及相关因素研究

目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的生活质量状况及相关因素。方法以问卷形式对206例COPD患者的生活质量与人口社会学资料、疾病相关的知识、态度及健康行为习惯等进行调查分析。结果患者的生活质量总分为(64.70±14.78)(百分制),经多元逐步回归分析获知其主要相关因素是住院次数、健康行为、婚姻状况、病程、受教育程度。结论COPD患者的总体生活质量较差,尤其是那些病程长、反复住院、文化程度低、健康行为缺乏以及无配偶的患者。     

无创正压通气在COPD呼吸衰竭患者救治中撤机方法探讨

目的：探讨无创正压通气（NPPV）治疗慢性阻塞性肺疾病（COPD）并发Ⅱ型呼吸衰竭时,不同的撤机方法对临床效果的影响。方法：将63例经持续应用NPPV治疗的COPD并发呼吸衰竭的患者,达到统一制定的撤机标准后,随机分为3组,分别采用直接停用的方法（直停组）18例;逐步减少通气时间的方法（减时组）24例;逐步减少吸气压力的方法（减压组）21例。结果：直停组、减时组和减压组的撤机成功率分别为38.9%（7例）、62.5%（15例）和42.8%（9例）,减时组的撤机成功率最高（P〈0.05）。另外减时组和减压组中自动脱机的患者分别为1例和4例。结论：采用逐步减少NPPV时间的方法撤机,可以获得较高的成功率。逐步减少吸气压力的方法影响了患者的依从性,对撤机的效果产生不利的影响。     

实验性急性肺血栓栓塞症肺动脉血管重构及意义

目的：探讨急性肺血栓栓塞症肺动脉血管重构及其临床意义。方法：取栓塞3～24h后的急性肺血栓栓塞症动物模型的栓塞段肺动脉，同时取正常肺动脉设实验对照组，固定液固定后送检。结果：正常肺动脉内皮细胞完整，未见平滑肌细胞迁移，肌层平滑肌呈层状，多为收缩型；肺栓塞后，肺动脉内皮细胞脱落，中层平滑肌细胞向内皮迁移，可见较多的合成型平滑肌细胞，内皮下可见类凋亡平滑肌细胞。结论：急性肺栓塞后，栓塞段肺动脉局部发生血管重构．对肺动脉高压的产生可能起着一定作用。     

冬病夏治“天灸疗法”治疗小儿肺系疾病理论探析

对冬病夏治、天灸疗法在应用于小儿肺系疾病中的中医理论及机制、现代研究进行了探析,肯定了冬病夏治、天灸疗法在防治呼吸道疾病方面的重要作用。     

EnSite指引下心房纤颤消融治疗的临床应用

目的：评价EnSite三维立体电标测系统对心房纤颤（AF）消融的临床效果。方法：阵发性或持续性AF患者8例,男5例,女3例,年龄55～72岁。所有患者连接EnSite三维立体电标测系统,在X线和EnSite指引下构建左心房立体电标测结构图。在EnSite Navix指引下,行右肺上、下静脉和（或）左肺上、下静脉的环形隔离后,进行前庭部线性隔离。结果：所有患者均获得成功,平均随访时间为（203.29±86.52）d,无AF发作。无任何临床并发症。结论：EnSite三维立体电标测指导下的肺静脉口外环形消融是安全有效的非药物治疗AF的手段。     

Cardiac catheterization in children with pulmonary arterial hypertension

Cardiac catheterization of childhood pulmonary arterial hypertension (PAH) is used to assess the severity of the disease as well as prognosis, selection of the most adequate pulmonary vasodilators, and evaluation of effectiveness. Sudden deterioration of cardiovascular hemodynamics, however, can be easily induced by pain, patient agitation, catheter manipulation, and by vasodilator provocation tests; these could trigger a pulmonary hypertension crisis, vagotony, respiratory distress, and hemoptysis resulting in critical complications, including death. Those patients with New York Heart Association functional class IV are at an especially high risk. It is noteworthy that pulmonary arteriography is a contraindication in patients with PAH. In a review of 7218 adult patients, 76 (1.1%) serious complications, including four deaths, were reported; with regard to the pediatric patients, 29 (10.7%) out of 270 patients with complications, including one with cardiogenic shock requiring cardiopulmonary resuscitation in addition to minor complications, were reported. To prevent serious complications, basic and routine precautions, such as oxygen and concomitant transcutaneous oxygen saturation and electrocardiogram monitoring during transportation to and from the catheter laboratory, are mandatory. Furthermore, the cooperation of experienced physicians and well informed medical staff in addition to meticulous preparation, for example, calculation of prior doses of catecholamine and confirmation of the presence of emergency equipment, is required.     

儿童肺血管栓塞性疾病

近年来,儿童肺血管栓塞性疾病在临床的发生率有所增长。儿童肺栓塞跟成人不同,其临床表现无明显特异性,血流动力学不稳定少见,容易误诊漏诊,病死率较高。治疗上大部分经验来自于成人,儿科医生对本病的药物使用经验不足。该文对儿童肺栓塞的流行病学、风险因素、临床表现、诊断、治疗、预防及预后等方面的诊治进展进行综述,以提高临床医生对本病的认识,做到早诊断、早治疗,降低病死率。     

L-454,560, a potent and selective PDE4 inhibitor with in vivo efficacy in animal models of asthma and cognition

Type 4 phosphodiesterases (PDE4) inhibitors are emerging therapeutics in the treatment of a number of chronic disorders including asthma, chronic obstructive pulmonary disease (COPD) and cognitive disorders. This study delineates the preclinical profile of L-454,560, which is a potent, competitive and preferential inhibitor of PDE4A, 4B, and 4D with IC50 values of 1.6, 0.5 and 1.2 nM, respectively. In contrast to the exclusive binding of cilomilast and the preferential binding of roflumilast to the PDE4 holoenzyme state (Mg2+-bound form), L-454,560 binds to both the apo-(Mg2+-free) and holoenzyme states of PDE4. The intrinsic enzyme potency for PDE4 inhibition by L-454,560 also results in an effective blockade of LPS-induced TNFalpha formation in whole blood (IC50 = 161 nM) and is comparable to the human whole blood potency of roflumilast. The cytokine profile of inhibition of L-454,560 is mainly a Th1 profile with significant inhibition of IFNgamma and no detectable inhibition of IL-13 formation up to 1 microM. L-454,560 was also found to be efficacious in two models of airway hyper-reactivity, the ovalbumin (OVA) sensitized and challenged guinea pig and the ascaris sensitized sheep model. Furthermore, L-454560 was also effective in improving performance in the delayed matching to position (DMTP) version of the Morris watermaze, at a dose removed from that associated with potential emesis. Therefore, L-454,560 is a novel PDE4 inhibitor with an overall in vivo efficacy profile at least comparable to roflumilast and clearly superior to cilomilast.