Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection

ObjectiveOnly approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort.MethodsPatients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group.ResultsA total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group.ConclusionsPost-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.     

Phospholamban p.Arg14del Cardiomyopathy: A Japanese Case Series

Phospholamban p.Arg14del is reported to cause hereditary cardiomyopathy with malignant ventricular tachycardia (VT) and advanced heart failure. However, the clinical courses of Japanese cardiomyopathy patients with phospholamban p.Arg14del remain uncharacterized. We identified five patients with this variant. All patients were diagnosed with dilated cardiomyopathy (DCM), developed end-stage heart failure and experienced VT requiring implantable cardioverter defibrillator discharge. Four patients survived after implantation of a left ventricular assist device (LVAD), while one patient who refused LVAD implantation died of heart failure. Based on the severe course of the disease, we propose genetic screening for phospholamban p.Arg14del in DCM patients.     

Chylous Ascites Due to Hyperthyroidism and Heart Failure

Chylous ascites (CA) is the accumulation of fluid with a high triglyceride content in the peritoneal cavity. Only two cases in the literature have reported CA with hyperthyroidism. A 28-year-old previously healthy woman presented with gradual-onset abdominal swelling, exertional dyspnea, and diarrhea. Hyperthyroidism and heart failure were diagnosed using laboratory investigation and echocardiography. Ultrasonography revealed a large amount of ascites. The ascitic fluid was milky with elevated triglyceride levels. Treatment with anti-thyroid therapy and diuretics improved all symptoms, and the free triiodothyronine (T3) level normalized after five days. Hyperthyroidism and heart failure should be considered as reversible causes of CA.     

Empagliflozin in the treatment of heart failure and type 2 diabetes mellitus: Evidence from several large clinical trials

Heart failure coexists with type 2 diabetes mellitus, which seriously affects the clinical treatment and prognosis. At present, the treatment for patients with established heart failure and type 2 diabetes mellitus is usually combined with two treatment strategies for heart failure and type 2 diabetes mellitus. Recently, increasing studies showed that empagliflozin, a sodium-glucose co-transporter-2 inhibitor, has a positive effect on the treatment of patients with established heart failure and type 2 diabetes mellitus. Here, we summarize the latest and current understanding of the management for patients with established heart failure and type 2 diabetes mellitus and further present contemporary treatment options, sodium-glucose co-transporter-2 inhibitor, for these particular populations.     

重组人脑利钠肽治疗顽固性心力衰竭的临床价值分析

目的 探讨重组人脑利钠肽治疗顽固性心力衰竭的临床价值。方法 选取医院顽固性心力衰竭患者84例（2018年7月—2020年7月）,依照随机投掷法分为两组各42例,对照组采用常规治疗,观察组在此基础上采用重组人脑利钠肽治疗,比较两组患者治疗前后的心功能变化、疗效、心指数（cardiac index,CI）及氨基端前B型钠尿肽（N-terminal pro-B type natriuretic peptide,NTproBNP）水平、不良反应发生率。结果 治疗前两组的左心室射血分数（left ventricular ejection fraction,LVEF）、左室收缩末内径（left ventricular end systolic diameter,LVESD）、左室舒张末内径（left ventricular end diastolic diameter,LVEDD）比较差异无统计学意义（P> 0.05）;治疗后观察组的LVEF高于对照组,LVESD、LVEDD低于对照组,总有效率（92.86%）高于对照组（76.19%）,差异有统计学意义（P <0.05）;治疗前,两组...     

强心汤治疗阳虚水泛型冠心病慢性心力衰竭临床观察

目的 分析阳虚水泛型冠心病慢性心力衰竭患者采用强心汤治疗的临床效果.方法 回顾性分析收治的98例阳虚水泛型冠心病慢性心力衰竭患者临床资料(纳入时间:2017年9月—2019年9月),根据治疗方法将其分成2组,常规组(49例)患者采用鲁南欣康治疗,试验组(49例)患者采用强心汤联合鲁南欣康治疗,观察2组患者的临床治疗效果...     

胃肠功能障碍和衰竭对老年危重病患者临床预后的影响

目的观察胃肠功能障碍与衰竭（GIDF）对老年危重病患者临床预后的影响。方法将105例危重病患者分为胃肠功能障碍组和非胃肠功能障碍组,观察2组患者30 d内多器官功能障碍综合征（MODS）的发生率、APACHEⅡ评分和病死率,胃肠功能障碍组存活患者和死亡患者GIDF评分。结果胃肠功能障碍组30 d内MODS发生率、病死率、APACHEⅡ评分均明显高于非胃肠功能障碍组。63例胃肠功能障碍者,存活30例,死亡33例,存活组GIDF评分为（1.77±0.90）分,死亡组GIDF评分为（2.85±0.87）分,存活组GIDF评分低于死亡组。结论胃肠功能障碍老年危重病患者MODS发生率、APACHEⅡ评分、病死率高于非胃肠功能障碍患者。GIDF评分对老年危重病患者临床预后的评估有一定的临床意义,且GIDF评分越高,临床预后越差。     

益气活血复方对慢性心力衰竭大鼠TNF—α及IL-6的影响

目的探讨中药益气活血复方对慢性心力衰竭大鼠血清中TNF-α及IL-6的影响。方法选用健康雄性Wistar大白鼠，采用冠状动脉结扎术配合饥饿、游泳等方法造成慢性心力衰竭的动物模型。将造模成功的大鼠随机分为4组：模型组、中药大剂量组、中药中剂量组和西药对照组，每组8只；另设一组正常大鼠作为对照组。喂药及正常喂养8周后，用彩色超声多普勒心动图测定大鼠心功能且采用放射免疫方法测定血清中肿瘤坏死因子-α（TNF-α），白介素6（IL-6）的含量。结果大鼠模型组心功能明显降低（P〈0．01）；血清中TNF-α和IL-6含量显著高于对照组（P均〈0．01）；中药组和西药组TNF-α及IL-6含量均低于模型组（P均〈0．01）。结论益气活血复方可以降低TNF-α、IL-6的水平，改善心脏功能。     

滋肾温阳汤联合克龄蒙治疗卵巢储备功能下降45例

目的:观察滋肾温阳汤联合克龄蒙治疗卵巢储备功能下降(DOR)患者的临床疗效,并探讨其对患者血清激素水平、细胞因子Toll样受体1(TLR1)、Toll样受体2(TLR2)的影响。方法:将90例肾虚血瘀型DOR患者按随机数字表法分为对照组和观察组各45例。对照组采用口服克龄蒙治疗,观察组在对照组治疗的基础上加用滋肾温阳汤。比较两组患者治疗前后的中医症状评分、血清性激素水平、卵巢状态及细胞因子TLR1、TLR2表达率,并评价临床疗效。结果:观察组疗效优于对照组(P=0.048)。治疗后,两组中医症状评分较治疗前均降低(P<0.001),且观察组明显低于对照组(P<0.001);两组血清促卵泡激素(FSH)、黄体生成素(LH)水平较治疗前明显降低(P<0.05),雌二醇(E2)水平较治疗前明显升高(P<0.05),且观察组血清FSH、LH、E2水平均低于对照组(P<0.05);两组治疗后卵巢窦卵泡数(AFC)、卵巢动脉收缩期峰值流速(PSV)明显升高(P<0.05),且观察组AFC、PSV高于对照组(P<0.001);两组TLR1、TLR2表达率较治疗前均显著下降(P<0.05),且观察组明显低于对照组(P<0.05)。治疗期间,观察组和对照组患者均未出现明显不良反应。结论:滋肾温阳汤联合克龄蒙治疗DOR疗效显著,可明显改善患者临床症状,降低血清FSH、LH水平,提高血清E2水平,增加AFC,提高PSV,降低TLR1、TLR2表达率。     

补益强心片联合沙库巴曲缬沙坦治疗慢性心力衰竭的临床研究

目的 探讨补益强心片联合沙库巴曲缬沙坦治疗慢性心力衰竭的临床效果。方法 选取2020年7月—2021年8月蚌埠医学院第二附属医院收治的98例慢性心力衰竭患者,按随机数字表法分成对照组和治疗组,每组各49例。对照组口服沙库巴曲缬沙坦钠片,100 mg/次,2次/d。治疗组在对照组基础上口服补益强心片,4片/次,3次/d。两组均连续治疗4周。观察两组的临床疗效,比较治疗前后两组超声心动图指标[左室射血分数（LVEF）、左心房容积指数（LAVI）、二尖瓣舒张期血流E峰与A峰比值（E/A）],运动耐力[6 min步行距离（6MWD）]和生活质量状况,血液流变学指标[血浆黏度（PV）、红细胞聚集指数（EAI）、全血高切黏度（HBV）],血清N末端B型利钠肽原（NT-proBNP）、白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)和内皮素-1(ET-1)水平。结果 治疗后,治疗组患者总有效率是95.9%,较对照组83.7%显著提高（P<0.05）。治疗后,两组LVEF、E/A比治疗前均显著升高,LAVI则均显著降低（P<0.05）;且均以治疗组改善更显著（P<0.05...