中频止鼾器治疗中度阻塞性睡眠呼吸暂停低通气综合征的临床疗效观察

目的 观察应用中频止鼾器治疗中度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopneasyndrome,OSAHS)的临床疗效。方法 选择2022年7月—2023年6月在上海市金山区亭林医院确诊的中度OSAHS患者30例为研究对象,夜间睡眠时给予中频止鼾器治疗,分别在治疗前、治疗后4周完成睡眠监测、睡眠呼吸暂停生活质量指数量表(sleep apnea quality of life index, SAQLI)评分、日间嗜睡状态量表(epworthsleepinessscale,ESS)评分,分析各项数据。结果 与治疗前相比,治疗后患者睡眠呼吸暂停指数(apnea hypopneaindex,AHI)、脉氧饱和度(pulseoxygensaturation,SPO2)<90%持续时间、鼾声、最长呼吸暂停时间均降低(P<0.05),最低脉氧饱和度(lowest pulse oxygen saturation, LSPO2)升高(P<0.05),SAQLI评分、ESS评分均有改善(P<0.05)。结论 中频止鼾器能够改善中度OS...     

老年人重叠综合征双水平正压通气治疗观察

目的探讨双水平正压通气对老年人重叠综合征的治疗效果.方法对36例住院老年重叠综合征患者双水平正压无创通气治疗前和治疗中进行全夜多导睡眠图(PSG)监测,并对治疗前后的监测结果进行分析.结果治疗后最低血氧饱和度(LSaO2%)由56.2±6.1升至89.5±6.7,呼吸暂停低通气指数(AHI)由40±18降至11±3(P＜0.01),平均呼吸暂停时间下降了14s,而最长呼吸暂停时间下降了58s,睡眠效率改善.结论双水平正压通气治疗老年重叠综合征有效.     

对阻塞性睡眠呼吸暂停低通气综合征患者多导睡眠图常用指标间的相关性分析

目的 探讨能够更加全面反映阻塞性睡眠呼吸暂停低通气综合征(OSAHS)缺氧程度的多导睡眠图指标.方法 回顾性分析确诊的63例OSAHS患者多导睡眠图,收集其呼吸紊乱指数(AHI)、呼吸暂停占总睡眠时间百分比(AM)、低通气时间占总睡眠时间百分比(HM)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)和最长呼吸暂停时间(LAT)等资料.结果 OSAHS患者的AHI与AM、HM、LAT呈正相关(P＜0.01或＜0.05),与MSaO2、LSaO2呈负相关(P＜0.01).AHI与AM、HM和LSaO2呈线性回归关系(F=202.264,P＜0.01).结论 OSAHS患者AM与AHI密切相关,AM、HM较LSaO2等多导睡眠图指标能更准确地反映OSAHS患者缺氧程度.

Abstract：

Objective To study the polysomnography(PSG) indexes which can reflex the severity of anoxia in obstructive sleep apnea-hypopnea syndrome(OSAHS) more comprehensively. Methods Sixtythree OSAHS patients' PSG indexes, including the apnea-hypopnea index (AHI), apnea time/total sleeping time (AM), hypoventilation time/total sleeping time (HM), mean oxygen saturation (MSaO2),the lowest oxygen saturation (LSaO2) and the longest apnea time (LAT) were analyzed retrospectively. Results In patients with OSAHS,the AHI was positively correlated with AM, HM and LAT(P ＜ 0.01 or ＜ 0.05 ), and was negatively correlated with MSaO2 and LSaO2(P ＜ 0.01 ). The AHI had linear regression relationship with AM,HM and LSaO2 (F =202.264,P ＜0.01). Conclusions Among the PSG indexes,AM is intimately associated with AHI. Therefore,compared with LSaO2,AM and HM can reflex the severity of anoxia in patients with OSAHS more accurately.     

持续气道正压通气治疗老年阻塞性睡眠呼吸暂停低通气综合征的临床疗效分析

目的观察老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)应用持续气道正压通气治疗的临床疗效。方法选择本院2019年10月～2020年10月收治的老年OSAHS患者82例,观察组(随机抽取41例)与对照组(剩余41例)分别采用持续气道正压通气和手术治疗,观察治疗效果。结果治疗前,两组Epworth评分、匹兹堡睡眠指数评分、AHI、LSaO2、FⅡ:C、FⅤ:C、PC:A、AT:A无明显差异(P0.05);治疗后,观察组pworth评分、匹兹堡睡眠指数评分、AHI、FⅡ:C低于对照组,LSaO2高于对照组,差异显著(P0.05),但FⅤ:C、PC:A、AT:A无明显差异(P0.05)。结论老年OSAHS应用持续气道正压通气治疗可有效提升治疗效果,促进患者病情恢复。     

Epworth嗜睡量表在脑力劳动者中筛查阻塞性睡眠呼吸暂停低通气综合征患者的应用价值

[目的]探讨Epworth嗜睡量表(ESS)在脑力劳动者中筛查阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的应用价值. [方法]对因打鼾而就诊的脑力劳动者206人进行ESS评分(EP值),计算体重指数(BMI),测量颈围,对所有患者行整夜多导睡眠监测(PSG),并根据PSG结果(呼吸紊乱指(AHI)和最低血氧饱和度(LSaO2)把患者分为无OSAHS组和OSAHS(轻、中、重)组,比较组间基本情况、临床指标和EP值的差异,分析AHI与临床指标和EP值之间的相关性,以AHI大干5为诊断OSAHS的金标准,做EP值的ROC曲线,并选择最佳诊断点. [结果]无OSAHS组与OSAHS各组间BMI、颈围、EP值、AHI和LSaO2差异均有统计学意义(P＜ 0.01); AHI与BMI、EP值、颈围和LSaO2有较高的相关性,相关系数分别为0.596,0.660,0.596,-0.849,且差异均有统计学意义(P＜0.01),EP值的ROC曲线下面积为0.807 (P＜ 0.01),当EP=7.5时,其灵敏度为0.859,特异度为0.733. [结论]用Epworth嗜睡量表来筛查脑力劳动者中的OSAHS患者具有较高的应用价值.     

阻塞性睡眠呼吸暂停低通气综合征患者血清瘦素与Epworth嗜睡评分关系的研究

目的 探讨血清瘦素、Epwoah嗜睡评分(ESS)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中的变化及两者间的关系.方法 单纯性肥胖者15例(对照组)和OSAHS患者35例(OSAHS组)均测定其血清瘦素并进行ESS,比较两组血清瘦素和ESS,采用直线相关分析评估OSAHS患者血清瘦素、ESS与呼吸暂停低通气指数(AHI)的关系.结果 对照组血清瘦素为(6.58±1.34)μg/L,OSAHS组为(15.46±4.25)μg/L,两组比较差异有统计学意义(P＜0.01).对照组ESS为(5.13±3.52)分,OSAHS组为(12.93±3.62)分,两组比较差异有统计学意义(P＜0.01). OSAHS患者血清瘦素、ESS与AHI呈正相关,ESS与血清瘦素之间也呈正相关.结论 ESS能判断OS-AHS患者的病情,OSAHS患者的血清瘦素水平明显升高,与ESS和AHI呈正相关,ESS与血清瘦素对OSAHS患者的病情和治疗效果也有一定的判断作用.     

阻鼾器治疗轻中度阻塞性睡眠呼吸暂停低通气综合征疗效观察

目的评价阻鼾器治疗轻中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的效果.方法经多导睡眠图(PSG)确诊并符合治疗条件的轻中度OSAHS患者36例用阻鼾器治疗,对比治疗4周前、后PSG结果.结果阻鼾器治疗的客观有效率达78%,睡眠呼吸暂停低通气指数(AHI)由(28±10)次/h,降到(13±6)次/h,鼾声指数由302±98降至112±79,最低血氧饱和度由(74±10)%升到(86±7)%,呼吸暂停最长时间由(62±9)s降到(22±8)s,差异均有统计学意义(P＜0.001).结论阻鼾器作为轻中度OSAHS内科保守治疗方法效果肯定.     

Epworth睡眠评价量表联合便携式睡眠监测仪对阻塞型睡眠呼吸暂停低通气综合征的诊断意义

目的 探讨Epworth睡眠评价量表(ESS)联合便携式睡眠监测仪(PM)对阻塞型睡眠呼吸暂停低通气综合征(OSAHS)的诊断意义.方法 对156例打鼾患者先行ESS评分,然后行PM检查,监测呼吸暂停低通气指数(AHI)、氧减指数(ODI)、最低血氧饱和度(LSpO2)、平均血氧饱和度(MSpO2).结果 156例患者经PM检查诊断为OSAHS共124例,其中轻度42例、中度47例、重度35例;单纯鼾症32例.单纯鼾症和不同程度OSAHS患者ESS评分、AHI、ODI、LSpO2、MSpO2比较差异有统计学意义[单纯鼾症:(5.8±2.9)分、(3.2±1.3)次/h、(3.3±2.6)次、0.911±0.121、0.973±0.132;轻度OSAHS:(9.7±3.5)分、(12.8±23.3)次/h、(14.2±5.7)次、0.875±0.083、0.902±0.095:中度OSAHS:(12.9±4.8)分、(27.6±4.5)次/h、(25.6±6.1)次、0.816±0.069、0.851±0.071;重度OSAHS:(16.1 ±5.2)分、(43.6±7.6)次/h、(38.6±7.8)次、0.701±0.061、0.795±0.063](P＜ 0.05);随着OSAHS严重程度增加,ESS评分、AHI、ODI逐渐增加,LSpO2、MSpO2逐渐下降,差异有统计学意义(P＜0.05).ESS评分与AHI和ODI呈正相关(r=0.42、0.51,P＜0.05),与LSpO2和MSpO2呈负相关(r=-3.70、-4.50,P＜0.05).结论 ESS评分与PM监测指标有很好的相关性,可以用ESS联合PM对OSAHS进行初步诊断,尤其是在基层医院.     

OSA-18量表评估过敏性鼻炎合并阻塞性睡眠呼吸暂停低通气综合征患儿治疗效果的临床价值

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)特异性生活质量调查(OSA-18)量表评估儿童OSAHS治疗效果的临床应用价值。方法选择该院2017年10月-2019年6月收治的合并过敏性鼻炎(AR)的轻度OSAHS儿童90例,按照随机数字表法将其分为观察组和对照组,各45例。观察组采用舌下含服免疫治疗(SLIT)联合穴位注射治疗,对照组采用舌下含服免疫治疗,随访观察3个月。两组患儿在治疗前后均行多道睡眠描记术(PSG)并采用OSA-18量表对治疗效果进行评估,分析最低血氧饱和度(LSaO2)和呼吸暂停低通气指数(AHI)与OSA-18评分的相关性。结果观察组治疗后AHI明显低于治疗前及同期对照组(P<0.05),观察组治疗后LSa O2高于治疗前及同期对照组(P<0.05),对照组治疗前后AHI、LSaO2比较,差异均无统计学意义(均P>0.05);观察组治疗后身体症状、睡眠障碍、对监护人的影响及总分均低于治疗前及同期对照组,差异有统计学意义(P<0.05),对照组治疗前后OSA-18各项指标评分及总分比较,差异均无统计学意义(均P>0.05);OSA-18各项指标评分及总分与AHI均呈正相关(P<0.05),OSA-18各项指标评分及总分除对监护人的影响外,均与LSa O2呈负相关(P<0.05)。结论OSA-18评分与PSG存在相关性,OSA-18评分对合并AR的OSAHS儿童健康状况及治疗效果的评估更为全面可行,值得推广。     

氧减饱和度指数对睡眠呼吸暂停低通气综合征的诊断价值

目的研究睡眠呼吸暂停低通气综合征(SAHS)患者缺氧指标、体型特征及嗜睡评分等因素与患者病情严重程度的关系。方法对拟诊有SAHS的368例患者进行多导睡眠图(PSG)监测,并对其临床资料进行回顾性分析。分别统计其睡眠呼吸暂停低通气指数(AHI)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)、氧减饱和度指数(ODI4)以及血氧饱和度<90%占整个记录时间的百分比(TS90%)、最长呼吸暂停时间、体重指数(BMI)、颈围、腹围、腰臀比、Epworth嗜睡评分(ESS)。结果ODI4与AHI的相关性最好(r=0.880,P<0.001),AHI与TS90%、最长呼吸暂停时间显著正相关,r分别为0.772、0.668(P均<0.01)。而与LSaO2、MSaO2显著负相关,r分别为-0.736-、0.623(P均<0.01)。对AHI≥5患者,ODI4≥5的敏感性达97.8%,特异性为63.8%;对AHI≥15的中重度患者,ODI4≥15的特异性可达89.7%,敏感性为94.4%。结论ODI4是SAHS较好的筛查指标,能够较好地反映SAHS严重程度,选用适当的ODI4标准对SAHS患者具有较高诊断价值。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。