经面罩无创通气治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效观察

目的:探析经面罩无创通气在慢性阻塞性肺疾病合并呼吸衰竭患者中应用效果.方法:在本院2017年9月~2018年12月收治的慢性阻塞性肺疾病合并呼吸衰竭患者中选出138例为观察对象,根据治疗方法分组,对照组患者给予常规治疗,观察组在对照组基础上给予经面罩无创通气(BiPAP无创正压通气).结果:治疗24h后两组动脉血气指标以及呼吸频率均明显好转,P<0.05;治疗24h后的PaCO2、PaO2和呼吸频率对比,观察组均好于对照组,P<0.05;治疗24h后的pH组间比较差异无统计学意义,P>0.05;观察组的住院时间和治疗3d、治疗7d后的呼吸困难发生率均低于对照组,P<0.05.结论:经面罩无创通气治疗可快速缓解慢阻肺合并呼吸衰竭患者的通气换气障碍,提高治疗效果.     

上海市29084例羁押人员HIV感染状况分析

目的了解上海市监管场所羁押人员艾滋病感染现状,寻找可能影响羁押人员感染的因素,为制定综合防治措施提供依据。方法对辖区内6家监管场所羁押人员有高危行为的新进人员进行HIV相关行为学调查并做抗体筛查,筛查呈阳性反应者送上海市艾滋病确认实验室确认;并运用EpiData3.1和SPSS13.0对有效问卷进行统计分析。结果 29084例羁押人员中,确认HIV抗体阳性者525例,阳性率为1.80%,男性阳性率为1.90%,女性阳性率为1.11%。被调查人员中男女平均年龄差异有统计学意义。上海市户籍的阳性检出率为0.33%。新疆户籍的阳性检出率最高为59.61%,且25～39岁之间HIV抗体阳性率高于其他年龄组。单因素分析HIV抗体阳性与性别、入所年份、年龄、户籍、入所季度、吸毒、性乱有关。多元回归分析显示影响因素为性别、入所年份、年龄、户籍、入所季度和注射吸毒。结论监管场所HIV抗体阳性检出率呈逐年下降趋势,应重点加强对注射吸毒和部分省市的青壮年人群进行有效的行为干预。     

Infections at the bottom end of the gastrointestinal tract

This article concentrates on specific infections of the distal gastrointestinal (GI) tract, particularly those that are transmitted sexually, by anal intercourse. Syphilis, gonorrhoea and lymphogranuloma venereum (LGV) are age old and well known diseases, but the features may be unfamiliar to GI histopathologists. Every histopathology trainee will have seen Herpes simplex virus (HSV) infection of squamous epithelium (e.g. oesophagus, vulva and anus), but the HSV pseudotumour of the anus/perineum can present a pitfall to those who have not previously encountered this entity. Another, more recently described, entity that has a predilection for the ano-rectal region is Epstein–Barr Virus (EBV) positive mucocutaneous ulcer, and this also presents a diagnostic trap to the unwary.     

Evaluation of a Desensitization Program for Continuous Positive Airway Pressure–Intolerant Patients

This is a retrospective chart review evaluating the effectiveness of a nurse practitioner–implemented continuous positive airway pressure (CPAP) desensitization protocol on adherence in CPAP-intolerant OSA patients. CPAP adherence (use for ≥ 4 hours/night, ≥ 70% of nights) was calculated after 90 days of CPAP desensitization. The CPAP desensitization protocol resulted in a 1-hour increase in use in one-third of the patients. Only 4 of 22 (18%) patients achieved adequate adherence. Adherence was not associated with demographic, clinical, or polysomnographic variables. A CPAP desensitization protocol for CPAP-intolerant patients can enhance adherence. A larger, multicenter, randomized controlled trial is needed to validate our findings.     

线上积极自我呈现与大学生人际困扰的关系:多重中介效应分析

目的:为探讨线上积极自我呈现、线上积极反馈、自尊与人际困扰的关系。方法:采用人际关系综合诊断量表、社交网站积极反馈问卷、社交网站自我呈现问卷和自尊量表,对内蒙古地区1069名大学生进行调查,使用SPSS进行描述性分析,使用Mplus进行多重中介效应分析。结果:(1)线上积极自我呈现、线上积极反馈、自尊均与人际困扰间呈显著负相关,积极自我呈现、线上积极反馈、自尊三者间两两呈显著正相关。(2)线上积极自我呈现对人际困扰的影响通过三条中介路後发生作用,分别通过自尊与线上积极反馈的独立中介作用,以及线上积极反馈与自尊的链式中介作用。结论:线上积极自我呈现不但能使大学生获得更多线上积极反馈和提高自尊水平,而且还能通过二者中介作用缓解人际困扰。     

NIPPV和NCPAP作为早产儿拔管后无创呼吸支持模式的临床应用疗效对比

目的 探讨经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)作为早产儿气管插管拔管后无创呼吸支持模式的临床应用疗效对比。方法 选取2016年1月～2017年6月在我院治疗的新生儿呼吸窘迫综合征65例,采用随机数字表法将患儿随机分为NIPPV组(n=32)和NCPAP组(n=33),观察两组撤机失败率、无创呼吸支持时间、无创后吸氧时间及总用氧时间,同时检测治疗前后二氧化碳分压(PaCO_2)、氧分压(PaO_2)和氧合指数(OI),两组并发症的发生情况。结果 NIPPV组和NCPAP组撤机失败率、无创后吸氧时间和总用氧时间比较,差异无统计学意义(P0.05);NIPPV组无创呼吸支持时间为2(1,3)d,明显短于NCPAP组(P0.05);NIPPV组和NCPAP组治疗前后PaO_2、PaCO_2比较,差异无统计学意义(P0.05);NIPPV组治疗后12 h、24 h OI分别为(240.100±31.140)%和(260.040±38.890)%,明显高于NCPAP组(P0.05);NIPPV组和NCPAP组支气管肺发育不良、早产儿视网膜病、新生儿坏死性小肠结肠炎和总发生率的比较,差异无统计学意义(P0.05)。结论 相比较NCPAP,早产儿气管插管拔管后应用NIPPV可缩短无创呼吸支持时间,值得临床使用。     

How to use noninvasive positive airway pressure device data reports to guide clinical care

There has been a significant increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. At present, PAP therapy can be successfully used in children of all ages, for a variety of indications. Data acquired from PAP devices is clinically useful, providing objective information regarding adherence, leak, and efficacy of PAP therapy. However, guidelines outlining a standardized approach to interpretation of PAP device data in pediatrics is currently lacking. Given the rapidly expanding use of PAP therapy in pediatric practice, we aim to provide an overview of the interpretation of data reports, otherwise called “data downloads,” from PAP devices and illustrate how they can be used to guide clinical care.