影响COPD急性加重期患者无创通气治疗有效性的因素

目的分析影响无创通气(NIV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者有效性的因素。方法依据APACHEⅡ评分,将107例AECOPD患者分为轻症组(<15分,21例)、中度组(15-25分,71例)和重症组(>25分,15例)。每组再分为有效亚组和无效亚组。检测降钙素原(PCT)、血pH、血乳酸(LAC)、血磷、血糖等相关指标,并分析影响NIV治疗有效性的因素。结果三组内亚组比较,有效亚组中PCT水平均低于无效亚组(P<0.05)。中度组中,有效亚组血pH和血磷水平均升高(P<0.05)。重症组中,有效亚组血糖和LAC均降低,而血pH升高(P<0.05)。PCT是影响轻症组NIV治疗有效性的因素(P<0.05)。PCT、血pH、血磷是影响中度组NIV治疗有效性的因素(P<0.05)。PCT、血糖、血pH、LAC是影响重度组NIV治疗有效性的因素(P<0.05)。结论 PCT、血pH、血磷、LAC、血糖是影响NIV治疗不同严重程度AECOPD患者有效性的因素。     

地氟醚与丙泊酚的不同配伍对单肺通气时肺内分流的影响

目的探讨地氟醚与丙泊酚的不同配伍在食管癌根治术单肺通气(One lung ventilation,OLV)期间对肺内分流的影响。方法选择择期行食管癌左侧开胸切除术患者45例,ASAⅠ～Ⅱ级,随机均分为3组(每组15例):丙泊酚组(P组)、地氟醚-丙泊酚组(DP组)和地氟醚组(D组),分别于平卧位双肺通气15min(T0),右侧卧位双肺通气15 min(T1),单肺通气15 min(T2)、30 min(T3)、60 min(T4)、90 min(T5)进行动脉血及混合静脉血血气分析,计算肺内分流率(Qs/Qt)。结果 TLV(T0)时,Qs/Qt组间比较,差异无统计学意义(P>0.05);OLV期间(T2～T5)Qs/Qt与TLV(T0)时相比,有明显增高(P<0.05),且D组明显高于P组和DP组(P<0.05),P组与DP组相比,差异无统计学意义(P>0.05)。三组OLV各时的PaO2较TLV时下降(P<0.05),但仍在安全范围内。结论临床剂量[3 mg/(kg.h)]丙泊酚复合低浓度地氟醚(<0.83MAC)对OLV的患者更安全有效。     

双管喉罩在COPD呼吸衰竭患者无创通气中的应用效果

目的：探讨双管喉罩用于COPD呼吸衰竭无创通气中的应用效果。方法选取本院2012年1月~2014年6月收治的60例COPD合并Ⅱ型吸吸衰竭患者作为研究对象,随机分为两组,各30例。观察组给予双管喉罩,对照组给予普通口鼻面罩,比较两组的SpO2上升时间、动脉血气改善时间、通气失败率、脱机时间、并发症发生率。结果观察组的SpO2上升时间、脱机时间显著短于对照组,差异有统计学意义(P<0.01)。观察组的反流误吸率、通气失败率显著低于对照组,差异有统计学意义(P<0.05)。观察组治疗后8、48 h的pH、PaCO2水平显著高于对照组,观察组的PaCO2水平显著低于对照组,差异有统计学意义(P<0.01)。结论双管喉罩可以更好地改善COPD合并Ⅱ型呼吸衰竭患者的预后,能够替代口鼻面罩用于该类患者的无创通气治疗。     

2019—2021年复旦大学附属妇产科医院低分子肝素的使用合理性分析

目的 分析2019—2021年复旦大学附属妇产科医院住院患者低分子肝素的使用情况，并评价其合理性，为妇产科低分子肝素合理性使用提供数据资料。方法 采用回顾性研究方法，从复旦大学附属妇产科医院住院医院信息系统（HIS）中查询2019年1月—2021年12月使用低分子肝素的病史信息，包含患者年龄、科室、出入院诊断、手术名称、药品名称及规格、使用频次、单次剂量和给药途径等。结果 2019—2021年使用低分子肝素的患者共54 138例，其中产科14 068例，妇科40 070例。产科年龄分布在19～35岁，妇科年龄分布在41～60岁。诊断为静脉血栓栓塞的患者共102例，妇科患者居多，占比90.20%。预防用药方面，产科剖宫产患者居多，占比63.25%；妇科为手术患者，占比98.06%，妇科恶性肿瘤的患者占比26.28%。产科及妇科患者预防用药和治疗性用药疗程主要集中在1～7 d，不合理的用法用量主要表现为给药途径不合理、单次剂量超限和给药频次不合理等，共64例，占比0.12%。结论 2019—2021年复旦大学附属妇产科医院低分子肝素的使用以预防使用为主。产科以剖宫产患者为主，妇科以手术患者为主，用法用量基本合理。     

Effects of traditional herbal medicine, Hwaotang, on atherosclerosis using the spontaneous familial hypercholesterolemia model, Kurosawa and Kusanagi-hypercholesterolemic rabbits and the venous thrombosis rats

Hwaotang (HOT), a traditional Korean medicinal formulation, is a dried decoctum of a mixture of seven herbal medicines, consisting of Angelica gigantis Radix, Rehmanniae Radix, Paeoniae Radix, Ciniamomi Cortex, Cnidii Rhizoma, Persicae Semen and Carthami Flos. In the present study, the inhibitory effects and anti thrombic properties of HOT on the progression of atherosclerotic lesions were studied using the spontaneous familial hypercholesterolemia (FH) model, Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits and rats. Changes in blood chemistry, pathology and low-density lipoprotein (LDL) oxidation were measured in a control and HOT group. In the control group, the area of atheromatous plaques of the aorta progressed between week 12 (36.65%) and week 14 (46.22%). This progression of atherosclerotic lesions did not occur in the HOT-treated group after 12 (24.24%) and 14 (23.34%) weeks. Antioxidative effects on LDL were seen in the HOT in weeks 12 and 14. HOT improved the hypercholesterolemia in the KHC rabbits. On the other hand, HOT and five of the seven herbs, except Cnidii Rhizoma and Carthami Flos, inhibited the endotoxin-induced hepatic venous thrombosis in high cholesterol diet-treated rats. However, Ciniamomi Cortex showed a very weak inhibitory effect on the endotoxin-induced hepatic venous thrombosis. The extract also inhibited the endotoxin-induced decrease in blood platelets and fibrinogen, and endotoxin-induced increase in fibrin degradation products (FDP) on disseminated intravascular coagulation in normal rats. In conclusion, these results suggest that HOT has inhibitory effects on the development of atheromatous plaque formation in spontaneous FH rabbits. It is also suggested that the antioxidative effects of HOT on LDL led to the beneficial effects observed in this study. The protection by HOT and its herbs on the artificially induced ischemic infarction might be related to their inhibitory effects on disseminated intravascular coagulation, platelet coagulation and thrombotic action.     

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。     

Paeonol protects rat vascular endothelial cells from ox-LDL-induced injury in vitro via downregulating microRNA-21 expression and TNF-α release

Aim： Paeonol （2＇-hydroxy-4＇-methoxyacetophenone） from Cortex moutan root is a potential therapeutic agent for atherosclerosis. This study sought to investigate the mechanisms underlying anti-inflammatory effects of paeonol in rat vascular endothelial cells （VECs） in vitro.
Methods： VECs were isolated from rat thoracic aortas. The cells were pretreated with paeonol for 24 h, and then stimulated with ox-LDL for another 24 h. The expression of microRNA-21 （miR-21） and PTEN in VECs was analyzed using qRT-PCR. The expression of PTEN protein was detected by Western blotting. TNF-α release by VECs was measured by ELISA.

Results： Ox-LDL treatment inhibited VEC growth in dose- and time-dependent manners （the value of IC50 was about 20 mg/L at 24 h）. Furthermore, ox-LDL （20 mg/L） significantly increased miR-21 expression and inhibited the expression of PTEN, one of downstream target genes of miR-21 in VECs. In addition, ox-LDL （20 mg/L） significantly increased the release of TNF-α from VECs. Pretreatment with paeonol increased the survival rate of ox-LDL-treated VECs in dose- and time-dependent manners. Moreover, paeonol （120 μmol/L） prevented ox-LDL-induced increases in miR-21 expression and TNF-α release, and ox-LDL-induced inhibition in PTEN expression. A dual-luciferase reporter assay showed that miR-21 bound directly to PTEN＇s 3＇-UTR, thus inhibiting PTEN expression. In ox-LDL treated VECs, transfection with a miR-21 mimic significantly increased miR-21 expression and inhibited PTEN expression, and attenuated the protective effects of paeonol pretreatment, whereas transfection with an miR-21 inhibitor significantly decreased miR-21 expression and increased PTEN expression, thus enhanced the protective effects of paeonol pretreatment.

Conclusion： miR-21 is an important target of paeonol for its protective effects against ox-LDL-induced VEC injury, which may play critical roles in development of atherosclerosis.     

内镜下低温等离子治疗舌甲状舌管囊肿

目的：探讨内镜下低温等离子治疗舌甲状舌管囊肿的手术方法、疗效和适应证。方法：对11例舌甲状舌管囊肿患者行内镜下低温等离子舌甲状舌管囊肿切除术,观察疗效及并发症情况。结果：1l例患者术后症状改善,无严重并发症发生,随访1-3年,无复发。结论：内镜下低温等离子治疗舌甲状舌管囊肿手术时间短,术中出血少,术后反应轻、恢复快,疗效满意。     

鼻腔扩容术的临床疗效观察

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图（PSG）描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表（Epworth sleepiness score,ESS）、鼻塞主观视觉模拟量表（visual analogue scale,VAS）评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术（鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放）。结果鼻腔扩容术后患者鼻腔总阻力显著降低[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L,P〈0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P〈0.01],白天嗜睡ESS评分显著降低（12.7±1.2 vs 8.6±2.9,P〈0.01）,打鼾程度减轻（62.2±25.6 vs 45.6±18.6,P〈0.01）。轻度OSAHS患者呼吸暂停低通气指数（apnea and hypopnea index,AHI）较术前显著下降（P〈0.05）,觉醒指数较术前显著下降（P〈0.01）,最低动脉血氧饱和度（lowest SaO2,LSaO2）较术前显著升高（P〈0.01）。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变（P〉0.05）。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化（P〉0.05）。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。     

Sex-Dependent Effects of the Intake of NOVA Classified Ultra-Processed Foods on Syndrome Metabolic Components in Brazilian Adults

Longitudinal studies evaluating the relationship between UPF consumption and the incidence of Metabolic Syndrome (MetS) and its components are still scarce. This study aimed to evaluate the effect of UPF consumption on the incidence of MetS and its components in adults. A prospective study was conducted with 896 participants from the 1978/79 Ribeirão Preto cohort, São Paulo, Brazil. UPF consumption was evaluated in %kcal and %g at ages 23–25 years. Incidence of MetS and its components were estimated at ages 37–39 years, according to the Joint Interim Statement criteria. Poisson regression was used to assess associations, and interactions with sex were investigated. UPF consumption had no association with MetS (%kcal Adjusted PR: 1.00; 95% CI: 0.99–1.01; %g Adjusted PR: 1.00; 95% CI: 0.99–1.01). However, women with higher UPF consumption, in %kcal and %g, had a higher risk of abdominal obesity (%kcal: p = 0.030; %g: p = 0.003); and women with higher UPF consumption, in %g, had a higher risk of low HDL-cholesterol (p = 0.041). For the other components of MetS, no significant associations were observed in either sex. These findings suggest evidence of no association between UPF consumption and MetS; however, consumption of UPF was associated with increased WC and low HDL-c, but only in women.