基于唾液SIgA免疫防御探讨开雍刺血法治疗喉源性咳嗽疗效机制

目的:基于唾液SIgA免疫防御功能观察开雍刺血法治疗喉源性咳嗽的临床疗效,探讨其免疫机制。为开雍刺血法治疗喉源性咳嗽提供依据。方法:采用随机数字表法分组,将符合条件的70例患者分为开雍刺血法组(治疗组)和苏黄止咳胶囊组(对照组),各35例。治疗组给予开雍刺血法治疗,7 d行1次治疗,2～3次为1个疗程。对照组给予苏黄止咳胶囊治疗,每日3次,每次3粒口服,疗程为21 d。观察并记录治疗前后临床症状和体征情况以及唾液SIgA的变化情况,并记录不良反应。结果:经统计学分析,治疗组和对照组治疗喉源性咳嗽均有效,且两组治疗后唾液SIgA高于治疗前,差异有统计学意义(P0.05),治疗组治疗前后唾液SIgA差值以及总有效率均优于对照组,差异有统计学意义(P0.05);治疗组治疗后症状体征总分以及各因子评分均低于治疗前,且明显优于对照组,差异有统计学意义(P0.05)。结论:开雍刺血法能快速显著缓解或消除喉源性咳嗽的症状,同时可以通过提高唾液SIgA的水平,提升患者免疫力,该方法治疗喉源性咳嗽安全有效。     

不同手术时机对急性肠梗阻患者治疗效果及预后的影响

目的:观察不同手术时机对急性肠梗阻患者治疗效果和预后的影响。方法:选取102例急性肠梗阻患者为研究对象,依据入院顺序将其分为观察组和对照组各51例。对照组在发病48 h后行手术治疗,观察组在发病48 h内行手术治疗。比较两组临床疗效、术后并发症发生率、住院时间、手术恢复时间和肠胃功能恢复时间。结果:两组治疗总有效率及术后并发症发生率比较,差异均无统计学意义(P>0.05);观察组术后住院时间、术后恢复时间和肠胃功能恢复时间均明显短于对照组,差异均有统计学意义(P<0.05)。结论:不同手术时机治疗急性肠梗阻均有效果,临床可根据患者的病情变化,结合其发病史及相应的医学检查结果,选择合适的手术治疗时机;尽快手术可以明显缩短患者术后肠胃功能恢复时间,改善预后。     

再灌注时间与Q波型心梗患者左心功能、心室重构的相关性研究

目的研究再灌注时间与Q波型急性心肌梗死(心梗)患者左心功能、心室重构的相关性。方法回顾性分析本院2015-2018年收治的心肌梗死患者资料,依据再灌注时间不同分为12 h组、24 h组、72 h组,每组各20例。对比各组治疗前后心室重构与左心功能指标的变化情况,分析再灌注时间与心室重构、左心功能的相关性。结果治疗后12 h组患者心室重构指标与左心功能指标均优于24 h组,24 h组均优于72 h组,差异具有统计学意义(P0. 05);再灌注时间与左心功能指标、心室重构均具有中度相关性(P0. 05)。结论再灌注时间与Q波型心梗患者的左心功能、心室重构间具有明确相关性,再灌注时间越短患者左心功能越理想,心室重构程度越轻。     

异甘草酸镁注射液治疗急性胰腺炎的疗效观察

目的分析异甘草酸镁注射液治疗急性胰腺炎患者的临床疗效。方法选择医院2017年3月~2020年10月收治的AP患者60例,根据治疗方案不同分为对照组(n=29)和观察组(n=31)。对照组患者接受常规药物治疗方案,观察组患者接受异甘草酸镁注射液治疗。比较两组患者一般指标、肝功能、炎性因子水平、不良反应。结果观察组患者腹胀复常时间、腹痛复常时间短于对照组(P<0.05)。治疗后,两组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBil)水平较治疗前下降,且观察组患者ALT、AST和TBil水平低于对照组(P<0.05)。治疗后两组患者CRP、IL-6水平较治疗前下降,其中观察组患者CRP(24.91±2.09)mg/L、IL-6(50.71±3.47)pg/L低于对照组(P<0.05)。观察组患者上消化道出血、头晕和呕吐不良反应总发生率高于对照组(P>0.05)。结论异甘草酸镁注射液治疗急性胰腺炎患者能明显改善其肝功能,抑制炎症,促使腹胀、腹痛等症状快速缓解。     

经鼻高流量氧气湿化治疗老年慢性阻塞性肺疾病急性加重合并呼吸衰竭的可行性研究

ObjectiveTo investigate the feasibility of transnasal heated humidified high flow nasal cannula oxygen therapy (HFNC) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure in elderly patients. MethodsA total of 176 elderly patients with AECOPD complicated with respiratory failure who were hospitalized at Peking University Shougang Hospital from December 2016 to January 2022 were enrolled, including 82 patients in an HFNC group and 94 patients in an NPPV group. After treatment, pulse oxygen saturation (SPO₂), arterial partial pressure of carbon dioxide (PaCO₂), oxygenation index (OI), respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP), comfort score, discharge rate, rate of endotracheal intubation, rate of transfer to intensive care unit (ICU), and mortality were compared between the two groups. The independent sample t-test was used for comparison between the two groups. Statistical data are expressed in percentage or number of cases and the χ² test was used for their comparisons. ResultsThe SPO₂ values at 30 min, 1 h, and 6 h were significantly higher in the HFNC group than in the NPPV group (t=-2.049,-2.618, and -3.314, P=0.043, 0.010, and 0.001, respectively). SPO₂ before discharge was significantly lower than that of the NPPV group (t=2.162, P=0.033), but OI at each time point and before discharge had no statistical significance (P＞0.05). MAP at 6 h was significantly higher in the HFNC group than in the NPPV group (t=-2.209, P=0.029), but within the normal range. HRs at 2 h and 3 h in the HFNC group were significantly higher than those of the NPPV group (t=-2.199 and -2.336, P=0.030 and 0.021, respectively). There were no significant differences in RR, HR, or MAP between the two groups at other time points and before discharge (P＞0.05). There was no significant difference in PaCO2 between the two groups (P＞0.05). Comfort score in the HFNC group was significantly higher than that of the NPPV group (t=-46.807, P＜0.001). There were no significant differences in discharge rate, ICU transfer rate, endotracheal intubation rate, and mortality between the two groups (P＞0.05). ConclusionHFNC is as effective as NPPV in treating elderly patients with AECOPD complicated with type Ⅰ or mild type Ⅱ respiratory failure, and HFNC is more comfortable than NPPV.     

B细胞介导的体液免疫应答在肝移植急性排斥反应中的作用

目前，国内外肝移植学界对肝移植术后急性排斥反应(AR)的机制阐释为T细胞介导的细胞免疫应答，但为获得长期生存仍需长期乃至终身服用免疫抑制剂。即使如此，临床上AR仍时有发生，并导致相当一部分受者移植肝功能丧失，更重要的是受者术后还受到感染、肿瘤和其他一系列不良反应及沉重经济负担的影响。因此，为肝移植AR机制提出新的理论解释，更全面深入阐明肝移植免疫排斥反应的内在机制，进而依据新的机制研制出新型免疫抑制剂已势在必行。本文就B细胞介导的体液免疫应答在肝移植AR中的作用作一综述。