肺彗星对血液透析患者心功能的评估作用

目的:评估肺彗星对血液透析患者心功能的评估作用。方法:选取维持性血液透析患者142例,根据美国心脏病协会(NYHA)心功能分级方法进行分级,142例患者中NYHA分级1～2级66例,3～4级76例,所有患者进行多普勒超声肺部及心脏检测;并检测血常规、生化、超敏C反应蛋白、肿瘤坏死因子水平。结果:NYHA 1～2级组透析龄、血红蛋白、血白蛋白、胆固醇、左室射血分数均高于NYHA 3～4级组;NYHA 1～2级组的平均年龄、透析间期体重增加、肺彗星数目、肺动脉收缩压、超敏C反应蛋白、肿瘤坏死因子、肌钙蛋白均低于NYHA 3～4级组(均P0.05)。多因素logistics回归分析显示肺彗星数目、左室射血分数、透析龄是NYHA独立相关危险因素(均P0.05)。肺彗星是预示NYHA恶化的独立危险因素(标准化回归系数为8.6662)。结论:不同心功能分级的血液透析患者出现肺部彗星指数不同,肺彗星是心功能变化的良好标记物,肺彗星对血液透析患者心力衰竭判断有重要作用。

Assessment of heart function by lung comets in maintenance hemodialysis patients

Objective: To explore the efficacy of transnasal hyperflow (HFNC) oxygen therapy in invasive ventilator sequential therapy for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: Thirty-five patients with AECOPD given tracheal intubation and invasive ventilator therapy were included in the study. After the improvement of the patients'' conditions and the "pulmonary infection control window", the patients were randomly divided into the invasive-HFNC sequential therapy group (HFNC, 18 cases) and the invasive-no-invasive sequential therapy group (NIV, 17 cases). The primary endpoint was the reintubation rate within 48 h, and the secondary endpoint was the length of ICU hospital stay and the incidence of adverse events. Results: Three patients (16.7%) in the HFNC group (16.7%) and two patients (11.8%) in the NIV group (P>0.05) were reintubated within 48 h. ICU hospital stay in the HFNC group was significantly shortened as compared with that in the NIV group \(10.4±1.8)days vs (14.2±1.1) days, P=0.023\]. Conclusion: The results of invasive ventilator-transnasal high-flow sequential ventilation strategy with "pulmonary infection control window" as the switching point are similar to those of non-invasive sequential ventilation, which can shorten the ICU hospitalization time and significantly reduce the adverse events of non-invasive ventilation.