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.     

煮炸鹿茸加工过程中晚期糖基化终产物生成规律及动力学分析

目的研究煮炸鹿茸加工过程中晚期糖基化终产物的生成规律及动力学参数。方法通过构建葡萄糖与赖氨酸模拟煮炸鹿茸加工过程美拉德(Maillard)反应体系,分别采用紫外-可见分光光度法和UPLC-MS/MS法测定体系褐变指数和典型晚期糖基化终产物(羧甲基赖氨酸和羧乙基赖氨酸)含量变化,探讨晚期糖基化终产物的生成规律和动力学参数。结果鹿茸加工过程中煮炸时发生褐变反应,生成羧甲基赖氨酸和羧乙基赖氨酸反应的活化能分别为5.07、40.44、78.47 kJ/mol,且均为零级反应;烘烤时相应反应的活化能分别为6.72、89.34、164.77 kJ/mol,也均为零级反应。相对于生成羧甲基赖氨酸而言,生成羧乙基赖氨酸所需能量更高,反应更难发生。结论烘烤过程温度变化对晚期糖基化终产物的动力学参数影响显著高于煮炸过程,长时间较高温度的烘烤使鹿茸中产生了较多的晚期糖基化终产物,这些结果为鹿茸加工过程中晚期糖基化终产物的阻断、抑制策略提供了理论基础,对生产绿色安全的鹿茸及加强中药安全具有重要意义。     

荧光定最PCR法检测母乳巨细胞病毒感染的研究

目的了解母乳人巨细胞病毒(HCMV)感染状况.方法应用荧光定量PCR(FQ-PCR)法检测390份母乳中HCMV-DNA含量,其中236份母乳配对与患儿血液中HCMV-DNA含量作一定分析.结果可疑或确诊HCMV感染患儿母亲母乳HCMV-DNA阳性率达71.28%,HCMV-DNA阳性母乳喂养的婴儿,其血或尿HCMV-DNA阳性率明显高于HCMV-DNA阴性母乳喂养的婴儿.结论HCMV感染母乳是婴儿获得性感染的主要途径.     

Colles骨折手法复位的治疗体会

Colles骨折是指桡骨下端2～3cm以内、骨折远端向背及桡侧移位的骨折.本院门诊于1994年1月至2005年4月共诊治Colles骨折240例,其中40例关节内骨折,经闭合复位后,关节面的移位仍大于2mm者,收住院手术治疗;门诊复位满意的200例患者中186例获得随访,总结如下.     

完全型房室间隔缺损合并法洛四联症心内矫正术

目的总结心内矫正术治疗完全型房室间隔缺损合并法洛四联症(CAVSD-TOF)的经验. 方法从1985年1月至2002年5月,共行CAVSD-TOF心内矫正术12例,年龄6～16岁(11.1±2.8岁),采用右心房、右心室纵切口,前7例采用三片法补片,后5例用二片法补片修补房室间隔缺损,左侧房室瓣裂隙采用间断缝合,右心室流出道用跨瓣补片加宽. 结果术后早期死亡4例,前7例死亡3例,后5例死亡1例,死亡原因为严重低心排血量3例,灌注肺1例.长期随访6例,随访时间3个月至13.5年,无任何症状,NYHA心功能Ⅰ级或Ⅱ级. 结论 CAVSD-TOF采用右心房、右心室纵切口,二片法补片修补房室间隔缺损,常规间断缝合左侧房室瓣裂隙,跨瓣补片加宽右心室流出道能取得较良好的效果.     

烧伤兔血清对培养内皮细胞的影响

本实验采用血管内皮细胞培养模型，动态观察了家兔烧伤（３０％Ⅲ度）早期烧伤表对内皮细胞结构和功能的影响，通过相差显微动态观察、台盘菜染色、ＨＥ染色光镜检查及扫描电镜观察。同时检测孵育不同时相点增减液中ＬＤＨ、６－ｋｅｔｏ－ＰＧＥ１α、ｔＰＡ及内皮细胞抗上板粘附能力变化。结果显示：（１）烧伤血清对内皮细胞有明显的损伤作用功能改变早于结构损害，而结构损害又以细胞间连接及其表达结构改变为早；（２）烧伤血     

UVA对人角质形成细胞的氧化损伤作用

①目的　探讨紫外线A(UVA)对人角质形成细胞氧化损伤的机制。②方法　用 5J/cm2 UVA照射角质形成细胞 ,酶生化法检测活性氧 (ROS)的含量及超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH PX)活性的变化 ,流式细胞仪测定紫外线对角质形成细胞凋亡的影响 ,原位杂交技术观察 p2 1mRNA的变化 ,并与非照射组比较。③结果　与对照组比较 ,UVA照射组ROS含量升高 (t =113.6 8,P <0 .0 0 1) ,SOD、GSH PX活性下降 (t =5 7.2 3、19.0 4 ,P <0 .0 0 1) ,细胞凋亡率升高 (t=5 3.2 8,P <0 .0 0 1) ,p2 1mRNA表达增强。④结论　UVA对人角质形成细胞的损伤与氧自由基生成增多及细胞抗氧化能力抑制有关     

人工股骨头置换治疗高龄股骨颈骨折

1996年12月~2002年6月,我院应用人工股骨头置换术治疗80岁以上股骨颈骨折患者21例,效果满意。1材料与方法1.1病例资料本组21例,男4例,女17例,年龄80~89岁。其中2例脑血管疾病后轻度偏瘫。健侧发生股骨颈骨折。材料选用常州市康辉医疗器械有限公司产双极人工股骨头。1.2治疗方法     

环丙沙星、地塞米松膀胱灌注治疗慢性膀胱炎43例

环丙沙星、地塞米松膀胱灌注治疗慢性膀胱炎４３例夏津县卫生防疫站（２５３４００）宫翠兰夏津县人民医院葛吉奎我们收治慢性膀胱炎４３例，其中女３９例，男４例；年龄２３～７１岁；病史１～６年。４３例均有尿频、尿急、尿灼热感及下腹部坠疼不适，曾口服吡哌酸、复方...