病毒感染对慢性阻塞性肺疾病患者气道炎症的作用

目的探讨病毒感染与慢性阻塞性肺疾病(COPD)的关系及其对气道炎症的作用. 方法收集COPD急性加重期患者84例及23例健康人血清,应用ELISA方法检测患者呼吸道合胞病毒(RSV)、单纯疱疹病毒Ⅰ型(HSV-1)、副流感病毒(PIV)、巨细胞病毒(CMV)、腺病毒(ADV)的特异性IgM、IgG抗体;根据病毒检测结果及临床表现分成2组:病毒感染组(A组)及细菌感染组(B组);用ELISA法检测A、B两组患者治疗前后诱导痰液中白介素8(IL-8)和肿瘤坏死因子α(TNF-α)的水平. 结果 84例COPD急性加重患者81例检测到病毒抗体,IgM阳性者28例(33.3%),其中RSVIgM比例最高(53.5%),其次为PIV(26.7%);IgM阳性与感冒样症状、无脓痰等有关;经治疗后A、B两组痰液IL-8和TNF-α水平显著降低(P<0.05),A组治疗后IL-8下降更明显(P<0.05),TNF-α水平的变化两组间差异无显著性. 结论病毒感染是COPD急性加重的重要因素,并且可引起气道炎症加重.     

机械通气中Autoflow的应用价值

同步间歇强制通气(SIMV) 压力支持通气(PSV)为机械通气中最常用的辅助通气模式,可动员自主呼吸,并保证一定的通气量。但当患者气道阻力增加或肺顺应性减低时常导致呼气峰压增高并需经常调整通气机参数。Autoflow是一种与容量控制型通气相结合的通气方式,在保证预定的潮气量同时自动改变呼气流速,使气道峰压最低,并且在整个     

40例支气管哮喘患者的护理体会

支气管哮喘主要表现为广泛多变的可逆性气流受阻．反复发作喘憋、气急、胸闷或咳嗽等，多数患者可自行缓解或经治疗后缓解．少数发展为重症哮喘或哮喘持续状态。2003年10月～2004年5月．我们共收治40例支气管哮喘患者，疗效满意．现将护理体会报告如下。     

抗生素的合理应用原则

自青霉素问世至今，抗生素的使用已经有几十年历史了。尤其随着医药科技的发展，新型抗生素不断涌现，在治疗感染性疾病方面发挥了重要的作用。但是随着抗生素的广泛使用，尤其是无原则的滥用，也带来了诸多不良后果。不仅仅是患者负担加重、毒副作用增多和医疗费用增长，而且导致细菌感染性疾病诊治困难、和细菌耐药性的产生。     

血清瘦素水平与2型糖尿病合并脑梗死的关系研究

目的　研究血清瘦素水平与 2型糖尿病 (T2DM)合并脑梗死 (CI)的关系。方法　T2DM患者 1 2 8例 (男 65例 ,女 63例 ) ,其中 63例合并CI,应用酶联免疫法测定其血清瘦素水平。结果　 (1 )T2DM肥胖者血清瘦素水平高于非肥胖者 (P <0 0 0 1 ) ;(2 )血清瘦素水平在不同性别间差异显著 ,女性高于男性 (P <0 0 0 1 ) ;(3)DM合并CI者血清Leptin水平高于无CI者 (P <0 0 5) ;(4)相关分析发现 ,血清瘦素浓度无论男女均与体重指数 (BMI)、腰围 (Waistcircumference ,WC)、腰臀比 (WHR)、体脂百分比 (BF % )、甘油三酯 (TG)、空腹胰岛素 (FINS)等呈显著相关。用多元逐步回归分析发现 ,BF %、性别、FINS、腰围为影响瘦素最为显著的因素。结论　T2DM合并CI者血清瘦素水平升高 ,血清高瘦素水平与高胰岛素血症的相关性提示 ,瘦素可能在T2DM脑梗死的发病中起一定作用     

慢性阻塞性肺疾病急性发作期外周血及痰中IL-8和TNF-α测定的意义

为探讨COPD患者急性发作期以及病情缓解后全身炎症和气道炎症的变化及二者的相关性。对 4 5例COPD急性发作期患者治疗前及 10～ 14d病情缓解后分别行血常规及肺功能检查测定FEV1 0 占预计值百分数 (FEV1 0 pre )、用ELISA法检测外周血浆和诱导痰液中IL 8和TNF α的水平 ,并记录诱导痰液中性粒细胞占白细胞百分比 (Neu/Leu % )。结果COPD急性发作时外周血浆及诱导痰液中Neu/Leu %、IL 8和TNF α均明显高于缓解后水平 (P均 <0 0 1) ,痰液Neu/Leu %、IL 8和TNF α与血浆Neu/Leu %、IL 8和TNF α水平无明显差异 (P均 >0 0 5 ) ,外周血及痰液TNF α与FEV1 0 pre无明显差异 (P均 >0 0 5 ),外周血IL 8与FEV1 0 pre有关 (r= 0 6 2 71,P <0 0 5 ) ,痰液Neu/Leu %、IL 8与FEV1 0 pre呈显著负相关 (r= 0 85 2 7,P <0 0 1)。痰液Neu/Leu %、IL 8与COPD气道阻塞密切相关 ,气道炎症与全身炎症无关     

两种指血采集法致血糖值差异的研究

目的:寻找一种可以准确测量血糖的指血采集法.方法:将应用两种指血采集法的患者随机分为观察组和对照组,进行统计学处理、对比.结果:对照组指血血糖结果与静脉血糖结果有统计学差异(P<0.05) ;而观察组指血血糖结果与静脉血糖结果无统计学差异(P>0.05).结论:观察组所选用的指血采集法测量的血糖值更准确.     

慢性阻塞性肺疾病不同分期全身炎症与气道炎症的变化及相互关系

目的　探讨COPD患者急性发作期及缓解期全身炎症和气道炎症的变化及二者的相关性。方法　对 45例COPD急性发作期患者治疗前及治疗 1 0～ 1 4d后分别行肺功能检查 ,测定FEV1 0占预计值百分数 (FEV1 0pre)、用ELISA法检测外周血浆和诱导痰液中白介素 8(IL 8)和肿瘤坏死因子α(TNF α)的水平。结果　COPD急性发作时外周血浆及诱导痰液中IL 8和TNF α均明显高于缓解期水平 (P <0 0 5 ,P <0 0 1 ) ,痰液IL 8和TNF α与血浆IL 8和TNF α水平无明显相关 (分别为r =0 491 5 ,P >0 0 5 ;r=0 41 2 7,P >0 0 5) ,外周血及痰液TNF α与FEV1 0pre无明显相关 (分别为r=0 351 2 ,P >0 0 5 ;r =0 4739,P >0 0 5) ,外周血IL 8与FEV1 0 pre有关 (r=- 0 62 71 ,P <0 0 5) ,痰液IL 8与FEV1 0 pre呈显著负相关 (r=- 0 852 7,P <0 0 1 )。结论　痰液IL 8与COPD气道阻塞密切相关 ,气道炎症与全身炎症无关。     

Effect of Yiqi Huoxue（益气活血） Herbs on Vascular Endothelial Cells and Platelets in Patients with Chronic Cor Pulmonale

Objective: To observe the clinical effect of Yiqi Huoxue (益气活血, YQHX) herbs in treating the patients with chronic cor pulmonale and to explore its mechanism by determining the relationship of oxidation/antioxidation system and how such herbs change on the function of endothelial cells and platelets. Methods: Fifty-eight patients were divided into two groups: conventional therapy group (control group, 28 paventional management. The treated group were treated with YQHX 150 ml, twice a day, plus the conventional treatment, and the clinical efficacy was recorded. The lipid peroxidation (LPO), superoxide dismutase (SOD), α-granule membrane protein (GMP140), partial pressure of arterial oxygen (PaO2), partial pressure of carbon dioxide in artery (PaCO2) and circulating endothelial cells (CEC) were measured respectively before and after treatment, and the relationship between various parameters were analyzed. The results were compared with those of 10 healthy subjects got at the same period. Results: (1) The effective rate and PaO2 of the treated group was higher than that of the control group and there were no difference in PaCO2 between the two groups. (2) The levels of LPO, GMP140, CEC in all the patients before therapy were significantly higher than those of the healthy group, and there were marked decrease in the levels of those after treatment (all P＜0. 01). On the contrary, the levels of SOD in all the patients before therapy were markedly lower than those in the healthy subjects and increased after treatment, P＜0.01. (3) The increase of SOD in the treated group was significantly more obvious than that of the control group. In the treated group, the decrease of LPO, GMP140, CEC were markedly more obvious than those in the control group (all P＜0.01).(4) The number of CEC, as well as GMP140, was negatively correlated to PaO2 (P＜0.01) and SOD (P＜0.01), which was positively correlated to LPO (P＜0.01). There was a positive correlation between CEC and GMP140 (P＜0.05). Conclusion: YQHX herbs in treating chronic cor pulmonale proved to be effective by balancing the oxidation and antioxidation, protecting the pulmonary endothelial cells and activated platelets and helpful in treating respiratory failure.     

超短波治疗对COPD患者诱导痰中炎症细胞及IL-8和TNF-α的影响

目的研究超短波对慢性阻塞性肺疾病(COPD)患者气道炎症细胞及细胞因子的影响。方法将74例急性发作期C0PD患者分为超短波治疗组(治疗组)42例和对照组32例。治疗组除常规治疗外行超短波治疗10～14d，对照组仅行常规治疗。2组患者均在治疗前、后分别计算诱导痰液中中性粒细胞占白细胞的百分比(Neu／Leu％)，检测诱导痰液中白介素8(IL-8)、肿瘤坏死因子α(TNF-α)以及肺通气功能指标用力肺活量(FVC)和第一秒用力呼气量(FEV1.0)。结果与对照组比较，治疗组治疗后痰液Neu／Leu％，、IL-8、TNF-α均显著降低(P＜O、05)，FVC的实测值占预计值的百分比(FVc％pred)、F：EV。。的实测值占预计值的百分比(FEV1.0％pred)明显升高(P＜O．05)。Neu／Leu％与IL-8呈正相关(P＜O．05)，Neu／Leu％、IL-8、TNF-α含量与FEV。均呈负相关(P＜O．05)。结论超短波治疗COPD具有减轻气道炎症、提高肺通气功能的作用。