重症肌无力患儿围术期呼吸功能训练器的应用

目的 探讨重症肌无力患儿围术期应用呼吸功能训练器对术后肺功能恢复的影响.方法 将60例Ia型重症肌无力手术患儿随机分为对照组和观察组各30例,对照组于围术期行常规呼吸训练,观察组在此基础上于手术前后应用呼吸功能训练器进行呼吸训练.监测两组肺功能指标,并观察肺部并发症发生情况.结果 观察组术后肺功能较对照组恢复迅速,术后第4天用力肺活量、第1秒呼气量、最大深吸气量和PaO2显著优于对照组(均P＜0.05).结论 重症肌无力患儿围术期应用呼吸功能训练器行呼吸功能锻炼,能显著恢复肺功能,有利于患儿早期康复.     

体外膈肌起搏在慢性阻塞性肺疾病患者康复护理中的应用

目的 探讨体外膈肌起搏在慢性阻塞性肺疾病患者康复护理中的应用效果。方法 将60例慢性阻塞性肺疾病患者随机分为观察组30例和对照组30例。对照组进行传统呼吸肌训练,观察组在传统呼吸肌训练基础上辅以体外膈肌起搏治疗,均干预20 d。干预前后采用慢性阻塞性肺疾病评估测试(CAT)评分、改良Barthel指数、用力肺活量 (FVC)、第1秒用力呼气容积(FEV1)评价干预效果。结果 干预后两组CAT评分、改良Barthel指数评分、FVC和FEV1比较,差异有统计学意义（均P＜0.01）。结论 体外膈肌起搏能有效改善慢性阻塞性肺疾病患者肺功能,提高患者日常生活活动能力和生活质量。     

重症肌无力患儿围术期呼吸功能训练器的应用

目的 探讨重症肌无力患儿围术期应用呼吸功能训练器对术后肺动能恢复的影响。方法 将60例Ia型重症肌无力手术惠儿随机分为对照组和观察组各30例，对照组于围术期行常规呼吸训练，观察组在此基础上于手术前后应用呼吸功能训练器进行呼吸训练。监测两组肺功能指标，并观察肺部并发症发生情况。结果 观察组术后肺功能较对照组恢复迅速，术后第4天用力肺活量、第1秒呼气量、最大深吸气量和PaO2显著优于对照组（均P〈0．05）。结论 重症肌无力惠儿围术期应用呼吸功能训练器行呼吸功能锻炼，能显著恢复肺功能，有利于患儿早期康复。     

基于肺通气功能状态护理方案的实践

目的探讨基于肺通气功能状态的护理方案对肺通气功能障碍患者肺功能状态、运动耐力和心理状态的影响。方法将100例肺通气功能障碍患者,按照入院时间先后顺序分为对照组和观察组,每组各50例,对照组接受常规护理,观察组根据肺通气功能评定结果实施功能状态相关护理方案。在入院当天和出院当天评价和比较两组患者的肺功能状态、活动耐力和心理状态。结果两组患者干预前的通气功能障碍分级、呼吸困难评分、肺功能状况与呼吸困难问卷评分差异比较无统计学意义(均P0.05)。干预后观察组呼吸困难评分、肺功能状况与呼吸困难问卷评分、医院焦虑抑郁量表评分显著低于对照组,6分钟步行距离显著长于对照组(均P0.05)。结论基于肺通气功能状态实施护理方案可促进患者肺功能状态的恢复,增强患者的运动耐力,减轻焦虑抑郁心理。     

皮瓣修复截瘫褥疮创面术后配合针刺治疗对其肺功能的影响

目的:探讨针刺治疗对截瘫患者褥疮皮瓣修复术后肺功能影响的研究。方法:选自2013年04月至2015年04月在湖南中医药大学第一附属医院烧伤科住院的截瘫褥疮患者125例,均行褥疮皮瓣修复,随机分成观察组65例和对照组60例,观察组进行戒烟,常规药物治疗配合呼吸操训练加上肺俞、肾俞、气海、关元、膻中、足三里针刺治疗,每天2次,连续治疗2个星期,对照组仅予戒烟加呼吸操训练常规药物治疗。两组均于术前1d和术后24h,48h、72h分别进行血气分析、肺功能检测、以及术后7d就肺部感染、肺不张发生率进行对比分析。结果:观察组与对照组相比,术后24h,48h、72h二氧化碳分压(Pa CO2)、动脉血压分氧(Pa O2)、动脉血氧饱和度(Sa O2)、第1秒用力呼气容积占预计值百分比(FEV1%)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC%)评分比较差异有统计学意义(P0.05)。结论:针刺治疗加呼吸训练对截瘫褥疮皮瓣修复患者动脉血气分析、肺功能、运动能力及生存质量的改善等均有重要意义。     

改良呼吸肌功能训练对COPD康复期患者肺功能的影响

目的 探讨改良呼吸肌功能锻炼对慢性阻塞性肺疾病(COPD)康复期患者肺功能的影响.方法 将COPD康复期患者100例分为常规组和改良组各50例,分别采用常规呼吸功能锻炼和改良呼吸肌功能锻炼方法,后者将腹式呼吸改为呼吸操并分卧、坐、立3种姿势交替进行,连续6个月后评价效果.结果 改良组肺通气功能各项指标及SaO2显著优于常规组(均P＜0.01).结论 改良呼吸肌功能训练法可有效改善康复期COPD患者肺功能,可作为其常规康复护理手段.     

肺癌术后呼吸功能衰竭高危因素临床分析

目的 探讨肺癌术后发生呼吸功能衰竭的高危因素。方法 实验组采用肺癌术后呼吸衰竭21例,并以同期肺癌手术未发生呼衰的84例作为对照组,用x~2检验。结果 术后呼衰组的术前肺功能指标,如肺活量占预计值百分比(VC％)、最大通气量占预计值百分比(MVV％)、第一秒呼气容积(FEV1.0)、第一秒呼气量占用力肺活量百分比(FEV1.0/FVC％)等均明显低于无呼衰组。根据手术方式分析,袖式肺叶切除、肺叶切除组的呼衰发生率均低于全肺切除组。肺癌术后肺部感染亦导致呼衰发生率增高。结论 肺功能下降、术后肺部感染是肺癌术后呼吸功能衰竭的高危因素。肺功能较差的病人应尽量避免全肺切除。     

BODE分级方案用于慢性阻塞性肺疾病急性加重患者康复干预

目的 提高慢性阻塞性肺疾病急性加重(AECOPD)患者肺功能及生活质量.方法 将188例AECOPD患者按入院时间分为对照组(90例)与观察组(98例).两组均行规范治疗,在此基础上对照组行常规护理和肺功能锻炼,观察组根据对患者的BODE指数评分构建和实施A、B、C、D4级康复训练与护理方案.实施1年后评价效果.结果 对照组85例、观察组92例完成全程研究进入数据分析.观察组FEV1、FEV1/FVC％及6分钟步行测试距离显著优于对照组,生活功能量表的躯体功能、社会功能、情绪功能评分显著优于对照组(P＜0.05,P＜0.01).结论 对AECOPD患者,依据BODE指数评分构建和实施分级康复训练与护理方案,可有效持续改善患者肺功能水平及运动耐力,从而改善生活质量.     

生物反馈训练对哮喘患者生活质量的影响

目的 探讨生物反馈训练对哮喘患者生活质量的影响.方法 将60例哮喘患者分为干预组和对照组各30例;对照组予药物治疗和常规护理,干预组在此基础上给予生物反馈训练4周;于干预前后(6周后)评定哮喘控制效果和最大呼气高峰流速(PEF),采用哮喘生活质量评定量表(AQLQ)评定两组生活质量.结果 干预后哮喘控制效果、PEF值及AQLQ中活动受限、哮喘症状、心理状况3个维度和总分观察组显著优于对照组(均P＜0.05).结论 生物反馈训练有利于改善患者的肺功能,有助于控制病情和提高其生活质量.     

腹腔镜胆囊切除术后呼吸功能训练效果观察

将腹腔镜胆囊切除术后病人随机分为呼吸功能训练组(观察组)和对照组,各30例.对照组术后采用一般常规护理,观察组在此基础上进行深呼吸训练.分别于手术前后检测病人的动脉血气分析和肺功能.结果两组手术前后VC、FVC及FEV1%比较,均P＜0.05,差异有显著性意义.提示腹腔镜胆囊切除术后病人接受呼吸功能训练后肺功能的恢复效果明显.     

Measurement of transfer factor during constant exhalation.

BACKGROUND--Transfer factor of the lung for carbon monoxide (TLCO) was measured by a new method based on analysis of the ratio of the concentrations of carbon monoxide to an inert gas (methane) relative to lung volume during a constant exhalation. Since this new technique is based solely upon exhalation, anomalies associated with inspiration and breath holding do not affect results. Additionally, because prolonged breath holding is not required, measurements can readily be made in dyspnoeic patients. METHODS--Exhalation TLCO (TLCO,ex) was compared with the standard (Jones and Meade) 10 second breath holding TLCO (TLCO,bh) in 100 consecutive patients. Patients did not practise the exhalation manoeuvre prior to testing. RESULTS--The comparative results were very close; mean difference (bias) +/- standard deviation (precision) was 0.05 (0.84) mmol/min/kPa. The relation was equally strong in patients with severe pulmonary disease; for patients with FEV1 < 1.51 the mean difference was 0.21 (0.80) mmol/min/kPa. CONCLUSIONS--Since the results were essentially identical between the techniques, it seems that comparable pathophysiological factors affect TLCO during breath holding and constant exhalation. Constant exhalation may therefore be a useful alternative to the breath holding technique for clinical measurement of TLCO.     

Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation

We studied 12 children with pectus excavatum (mean age, 13.8 years) using pulmonary function and exercise testing. Eight patients had surgical repair and were studied before and after repair. Four patients did not have repair and were tested twice. The degree of chest wall deformity in the two groups was similar. All patients reached 86% or more of their maximal predicted heart rate with exercise. Total lung capacity decreased 8% (p less than 0.01) after operation. In the nonoperated control group, total lung capacity was similar during both studies. The ratio of ventilation at maximal exercise to maximal voluntary ventilation was 68% +/- 12% before and 66% +/- 9% after operation in the operated group and 69% +/- 18% and 79% +/- 30% at two studies in the nonoperated group (nonsignificant changes). Maximal oxygen uptake was 36.1 +/- 4.4 ml/kg/min preoperatively and 38.1 +/- 8.1 postoperatively and 41.2 +/- 7.3 ml/kg/min and 43.0 +/- 6.9 on two studies in the nonoperated group (nonsignificant changes). Cardiac output and stroke volume increased appropriately with exercise both before and after operation. Operation had no physiologically significant effect on the cardiorespiratory response to exercise. Slight changes in cardiorespiratory function occurred in both operated and nonoperated subjects. These results emphasize the importance of studying patients before and after operation and of using a control group.     

An audible indication of exhalation increases delivered tidal volume during bag valve mask ventilation of a patient simulator

Self-inflating manual resuscitators (SIMRs) can mislead caregivers because the bag, unlike a Mapleson-type device, reinflates even without patient exhalation. We added a whistle as an audible indicator to the exhalation port of a SIMR. In randomized order, each participant provided two sets of breaths via mask ventilation with a SIMR, one with and one without audible feedback, to a Human Patient Simulator modified to log lung volume changes. The last three breaths in each set were used to compare average tidal volume (Vt) under both conditions. Eighty-seven advanced cardiac life support trainees (54 males, 33 females) with clinical experience averaging 6.4 +/- 9.4 yr were recruited. Average Vt delivered with the standard SIMR was 486 +/- 166 mL and 624 +/- 96 mL with the modified SIMR. Average Vt delivered by a modified SIMR was significantly larger by 40% when it followed standard SIMR use and 19% when using the modified SIMR first. Use of a SIMR with an audible indicator of exhalation significantly (P < 0.001) increased mask ventilation of a patient simulator, suggesting that mask ventilation of a patient with a SIMR may also be increased by objective, real-time feedback of exhaled Vt.     

稳定期COPD患者家庭无创通气治疗的五段式培训效果探讨

目的探讨对家庭无创通气治疗稳定期COPD患者实施五段式培训的效果。方法将108例稳定期COPD家庭无创通气治疗患者按住院时间段分为对照组与观察组各54例。对照组行常规护理,观察组采用五段式培训,比较两组肺功能和生活质量。结果出院时、出院后6个月观察组FEV_1、FVC及FEV_1/FVC与对照组相比,差异无统计学意义(均P0.05);出院后6个月,观察组活动、症状及影响评分较对照组降低,急性加重次数少于对照组,PaCO_2、PaO_2及SaO_2水平显著优于对照组,差异有统计学意义(均P0.01)。结论将五段式培训方法运用于家庭无创通气治疗的稳定期COPD患者中有利于提高其生活质量,改善动脉血气,延缓病情发展,但对患者肺功能无明显改善作用。     

呼吸功能训练对食管裂孔疝术后患者康复效果的研究

目的分析呼吸功能训练法对食管裂孔疝修补术后患者呼吸功能状况、术后肺部并发症发生及住院天数的影响,评价呼吸功能训练对术后患者的康复效果。 方法选择2016年12月至2017年12月,四川省广元市中心医院住院并接受手术治疗的食管裂孔疝患者50例,随机分为训练组和对照组。对照组接受责任护士常规护理;训练组除常规护理外接受研究者术前及术后呼吸功能训练指导。以血氧饱和度、肺部并发症发生与否分析患者呼吸功能状况,并结合术后住院天数综合评价患者术后康复效果。 结果主观呼吸功能评价2组比较,差异无统计学意义（P>0.05）;训练组术前2 d和术后5 d平均血氧饱和度均高于对照组,但术后5 d 2组比较,差异有统计学意义（t=8.17,P<0.05）;术后肺部感染发生率稍高于对照组,但2组比较,差异无统计学意义（P>0.05）;训练组术后总住院天数比对照组短,差异有统计学意义（t=13.98,P<0.05）。 结论围术期呼吸功能训练对改善食管裂孔疝患者呼吸功能、血氧饱和度指标有明显效果,可提高患者术后康复效果。     

HOW THE RISE TIME OF CARBON DIOXIDE ANALYSERS INFLUENCES THE ACCURACY OF CARBON DIOXIDE MEASUREMENTS

Carbon dioxide measurements are not accurate, especially inchildren, if the response time of the carbon dioxide analyseris too slow and its output fails to reach the actual carbondioxide concentration at the end of the breath. The distortionof the carbon dioxide waveform is a function of the "rise time"of the analyser. We have simulated an expired carbon dioxidecurve and calculated the rise time required to measure accuratelyend-tidal carbon dioxide and VCO₂ in adults and children. Arise time of 80 ms (10–70%) is sufficient to measure end-tidalcarbon dioxide concentration with 5% accuracy in patients withrates of ventilation less than 100 b.p.m. and l: E ratios lessthan 2:1. We have measured the rise time of 11 commerciallyavailable carbon dioxide analysers and found that only six ofthe 11 responded quickly enough to be accurate for rates upto 100 b.p.m. All 11 responded rapidly enough to measure end-tidalcarbon dioxide concentration with 5% accuracy when ventilatoryrates were less than 30 b.p.m. To measure VCO₂ with 5% accuracy,an analyser should have a rise time of 20 ms. Only one analysermet this specification. An analyser's rise time can be estimatedclinically to within 10 (SD 8) ms by a simple breath hold andforced exhalation, thus providing an estimate of the accuracyof carbon dioxide measurements in adults or children.     

呼吸功能训练对肺癌患者术后肺功能的影响

目的通过探讨呼吸功能训练对肺癌患者术后肺功能的影响。方法将80例肺癌术后患者分为观察组、对照组,每组40例。对照组采用传统的常规护理,观察组在对照组的基础上,采取在围手术期对患者呼吸功能训练的护理干预,入院后第一天及术后第一周对肺功能的测定。结果术前两组血气指标、肺功能指标等无明显差异(P0.05);术后一周观察组血氧饱和度、氧分压、FEV1%、FEV1\FVC%指标值均优于对照组,差异具有统计学意义(P0.05)。观察组肺功能质量均好于对照组,并且患者对术后的生活质量期望值明显提高。结论肺癌术后在常规护理基础上进行呼吸功能训练可提高肺癌患者术后的呼吸功能,促进肺功能的恢复。     

Preoperative Evaluation with Differential Pulmonary Function

Twenty patients in whom the determination of right and left lung function was advisable for management of their pulmonary disease underwent lateral position testing, quantitative ventilation/perfusion radionuclide studies, and bronchospirometry. An excellent correlation existed between the radionuclide perfusion study and the differential oxygen uptake measured by bronchospirometry. Similarly, there was excellent correlation between the radionuclide single-breath ventilation study and vital capacity measured by bronchospirometry. The lateral position test was statistically inferior in both areas. There was no difference between the lateral position test and the radionuclide rebreathing ventilation study in predicting differential minute ventilation. The routine use of quantitative radionuclide studies along with preoperative pulmonary function studies in patients with marginal pulmonary reserve is encouraged since it provides a simple, accurate method of determining differential pulmonary function and is well accepted by the patient.     

757例麻疹患儿流行病学和临床特征

目的分析儿童麻疹患者住院病例的流行病学和临床特征，为麻疹防控及其诊治提供依据。 方法回顾性收集首都医科大学附属北京地坛医院儿科2009年3月至2019年7月收治住院的757例麻疹患儿的临床资料，包括发病时间、性别、年龄、麻疹疫苗接种史、麻疹患者接触史、临床表现、并发症、辅助检查、治疗及转归。采用描述性流行病学方法对757例患儿临床资料进行统计，正态分布计量资料采用± s表示，偏态分布计量资料则采用中位数（四分位数）[M（P25，P75）]表示；计数资料以[例（%）]描述。 结果757例麻疹患儿多发病于3~5月份（450例、59.4%），其中男性患儿505例（66.7%）；女性患儿252例（33.3%）；年龄为8.7（6.7，12）个月，< 1岁患儿占71.7%（543/757）；未接种疫苗患儿653例（86.3%）。入组患儿临床表现以皮疹[100%（757/757）]、发热[99.5%（753/757）]、咳嗽[72.0%（545/757）]以及麻疹黏膜斑（Koplik斑）[58.4%（442/757）]多见，并发症以肺炎最为常见[77.5%（587/757）]。16例（2.0%）患儿出现肺气漏：纵隔气肿及皮下气肿13例（81.3%），其中合并气胸7例；单独气胸3例（18.7%）。入组患儿均按呼吸道传染病进行隔离，给予对症支持治疗，54例（7.1%）患儿因并发重症肺炎、不同程度低氧血症转入重症监护室，其中34例（62.9%）患儿予机械通气治疗。入组患儿临床治愈共738例（97.5%），死亡19例，病死率为2.5%。 结论儿童麻疹高发季节在春夏，好发于未接种麻疹疫苗< 1岁的男性婴儿，并发肺炎最常见，易出现肺气漏，可导致死亡；需加强适龄儿童麻疹疫苗接种，尽量早识别、治疗，并重视并发症的诊断和治疗。     

Paralysed diaphragm after cardiac surgery in children: value of plication

Over a 2-year period (1987-1988), 31 children (3% of 960 operations) were found to have a paralysed diaphragm following cardiac surgery. The median age was 5 months with 65% less than 1 year of age. In the 31 patients, 38 paralysed diaphragms were identified. The phrenic nerve injury was on the right in 8 cases, the left in 16, bilateral in 7 and 40% were related to modified Blalock Taussig shunts. The time to extubation was analysed for each patient in two separate groups: Group A: (greater than 1 year): 11 children of whom 5 were extubated without difficulty, 4 had non-respiratory reasons for prolonged ventilation and only 2 were plicated--both were extubated within 4 days. Group B: (less than 1 year): 20 infants of whom 16 were plicated and 4 were not. Three of the children who were plicated died from cardiac causes. Of the 13 survivors, there were 3 who had other reasons for prolonged ventilation. Thus 10 infants required prolonged ventilation (mean 11 days) because of respiratory difficulties. All underwent plication and were extubated at a mean of 2.4 days postoperatively. The 4 who were not plicated were extubated at a mean of 11 days postoperatively. In infants in whom there is no cardiac cause for failure to wean from ventilation, diaphragmatic paralysis should be suspected and plication performed if not extubated 2 weeks after operation.