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.     

EL4细胞STAT4沉默前后培养上清对小鼠肿瘤生长的影响

目的:探讨沉默小鼠T淋巴瘤细胞(EL4细胞)信号转导和转录激活因子4(STAT4)前后,其改变的培养上清液成分对H22肝癌荷瘤小鼠腹水生长及个体生存状况的影响.方法:应用ELISA方法检测肿瘤细胞STAT4沉默后培养上清液中白介素(IL)-10水平;将H22肝癌荷瘤小鼠随机分为STAT4(+)组、STAT4(-)组、IL-10组、培养基组,分别腹腔注射STAT4沉默前、后培养细胞上清液,IL-10,1640培养基,检测荷瘤小鼠体质量、腹围、腹水、生存率及腹水瘤细胞存活等指标;RT-PCR半定量检测荷瘤小鼠脾细胞的Foxp3 mRNA表达.结果:STAT4沉默后培养细胞上清液IL-10水平明显增高;用不同的培养上清液成分注射后STAT4(-)组体质量增长率较STAT4(+)组显著降低,与培养基组各指标比较差异无统计学意义;15 d内生存率比较,STAT4(-)组显著高于STAT4(+)组、IL-10组;STAT4(-)组脾细胞Foxp3表达水平高于其他3组.结论:STAT4沉默后培养细胞上清液局部注射荷瘤小鼠,能抑制癌性腹水增长,显著提高存活率,但脾细胞Foxp3 mRNA水平明显增高,可抑制荷瘤小鼠的抗肿瘤免疫,这与近期观察到的结果相悖.     

老年肺栓塞患者的临床特点分析

目的探讨老年肺栓塞的临床特点和诊断方法,减少误诊率和漏诊率。方法回顾性分析我院确诊的60例老年(≥65岁)肺栓塞的高危因素、临床表现和辅助检查结果。结果老年肺栓塞的危险因素为下肢静脉血栓(DVT,33.3%)、手术外伤(25.0%)、长期卧床(23.3%)。呼吸困难为最常见症状(80.0%),96.7%患者临床症状缺乏特异性。螺旋CT肺动脉造影(CTPA)结果显示老年患者肺栓塞部位主要为右下叶肺动脉(38.9%)、右肺动脉(35.2%)和左下叶肺动脉(29.6%),53.7%的患者为多支血管受累。核素肺通气/灌注扫描(V/Q扫描)的阳性率为73.9%,CTPA的阳性率为65.2%,43.5%的患者V/Q扫描和CTPA均为阳性,二者联用的检出率为95.7%。结论老年肺栓塞表现为多处、主要血管受累,以右肺动脉和双下叶肺动脉多见。提高老年肺栓塞的诊断水平,及时正确的诊断和治疗可改善预后,降低病死率。推荐联合使用V/Q扫描和CTPA检查。     

替考拉宁致支气管痉挛1例

患者男,88岁.因咳嗽、咳痰伴喘憋6年,加重伴发热1d,于2011年9月13日入院.查体:体温38.5℃,心率89次/min,呼吸19次/min,血压135/80 mmHg.口唇轻度紫绀,双肺呼吸音粗,双肺可闻及干湿啰音.心界不大,心率89次/min,律不齐,可闻及早搏2～3次/min,各瓣膜听诊区未闻及病理性杂音.血常规:白细胞9.1×109/L,N 93.9％,血红蛋白155 g/L,红细胞5.3×1012/L,血小板150×109/L.胸片:右肺癌术后改变;慢性支气管炎继发感染、肺气肿;右肺尖胸膜肥厚钙化.心电图:窦性心动过速.既