早期乳酸清除率对重症慢性阻塞性肺疾病患者预后的评估

目的 探讨早期乳酸清除率对重症慢性阻塞性肺疾病(COPD)患者的临床意义.方法 选取COPD合并呼吸衰竭住院患者108例进行前瞻性观察研究,根据患者病情转归分为存活组82例、死亡组26例;存活组中根据是否行有创机械通气治疗再分为常规治疗组55例、有创机械通气组27例.测定患者治疗前与治疗6 h后的动脉血乳酸、动脉血气、急性生理与慢性健康状况(APACHE)Ⅱ评分及早期(6 h)乳酸清除率.同时以早期乳酸清除率10%为临界值分为高、低乳酸清除率两组,分析早期乳酸清除率与预后的关系.结果 治疗前有创机械通气组与死亡组比较,动脉血乳酸、pH值、PaCO2、PaO2、APACHEⅡ、氧合指数等差异均无统计学意义.治疗6 h后常规治疗组、有创机械通气组分别与死亡组比较,早期乳酸清除率有统计学意义(P＜0.01),APACHEⅡ评分、pH值差异均无统计学意义.存活病例两组比较,治疗6 h后各项指标包括早期乳酸清除率差异均无统计学意义(P＞0.05).三组治疗前、后自身对比中每组APACHEⅡ评分均无统计学意义.高乳酸清除率组病死率4.2%,显著低于低乳酸清除率组62.2%,差异有统计学意义(P＜0.01).结论 早期乳酸清除率可作为评估重症COPD患者病情严重程度、初始治疗效果和预后的指标之一.     

护理干预在早期慢性阻塞性肺疾病患者戒烟中的应用效果

目的探讨护理干预在早期慢性阻塞性肺疾病患者戒烟中的作用与效果。方法将早期慢性阻塞性肺疾病患者分为实验组102例和对照组110例。对照组给予常规健康教育,实验组给予多种形式的护理干预。比较两组患者的吸烟知识知晓率及吸烟行为。结果实验组患者吸烟知识知晓率高于对照组(P0.01),吸烟行为优于对照组(P0.01)。结论护理干预对提高早期慢性阻塞性肺疾病患者吸烟知识知晓率,降低吸烟率、戒烟后复吸率有重要作用。     

COPD患者血气分析和生化试验的结果分析

目的研究各级COPD患者治疗前血气和生化结果的数值、互相的相关性和诊断价值。方法 120例COPD患者进行分级、主要血气和相关生化指标的测定、指标间的相关性分析以及诊断价值研究。结果 PaO2、PaCO2、pH、NA、CL、CO2结合力、TP、ALB、A/G在COPD患者各个分级之间的差异显著（P〈0.05）。ALT、AST、GLB在各个级别之间的差异不显著（P〉0.05）。除了PO2与CO2结合力、PO2与A/G之外（P〉0.05）,其他指标两两之间均具有相关性（P〈0.05）。鉴别COPD患者处于0~Ⅱ级或Ⅲ~Ⅳ级,下列指标的诊断价值中等：PO2、PCO2、CL、CO2结合力。当PCO2/PO2大于0.75、CO2CP/PCO2大于0.60、PCO2/CL大于0.46时,诊断为COPD的Ⅲ级以上的灵敏度和特异度均较高。结论 COPD患者血气和生化指标随着患者的病情进展而变化。PO2与PCO2、PCO2与CO2结合力之间的具有很强的相关性。PO2、PCO2、CL、CO2结合力在其切点下,对患者的病情具有中等水平的鉴别诊断价值。当PCO2小于48.70mmHg时,其灵敏度为100%,即区别0~Ⅱ级与Ⅲ~Ⅳ级COPD的漏诊率为0。PCO2/PO2、CO2CP/PCO2、PCO2/CL的联合指标对COPD患者处于0~Ⅱ级或Ⅲ~Ⅳ级具有优秀的诊断价值。     

Lactoferrin and leukocytes in the blood of oncologic patients]

Peripheral blood lactoferrin level and leukocyte count were measured by enzyme immunoassay in the sera of 288 normal subjects and 247 patients with malignant tumors of various localization. Normal lactoferrin level has been found 1055 +/- 191.0 ng/ml. In the patients it was changed either higher or lower, irrespective of the tumor site. This has led the authors to a conclusion on the acute phase pattern of the time course of lactoferrin level in oncologic patients. Elevation of lactoferrin level anticipated changes in leukocyte count.     

老年COPD病人启动和维持吸烟行为的原因的质性研究

[目的]为了深入了解中国文化背景下老年慢性阻塞性肺疾病（COPD）病人启动和维持吸烟的原因,为促进老年COPD病人戒烟提供依据。[方法]采用质性研究方法深入访谈了12例老年COPD病人,以Giorgi的现象学分析法分析资料。[结果]中国烟文化下浓厚的吸烟氛围、强烈的生理心理依赖和社交依赖、局限的戒烟知识和获取知识的途径3个方面是老年COPD病人启动和维持吸烟行为的主要原因。[结论]医护人员应加强对COPD病人的宣传教育,纠正其对吸烟的认知偏差。     

老年COPD病人启动和维持吸烟行为的原因的质性研究

[目的]为了深入了解中国文化背景下老年慢性阻塞性肺疾病(COPD)病人启动和维持吸烟的原因,为促进老年COPD病人戒烟提供依据。[方法]采用质性研究方法深入访谈了12例老年COPD病人,以Giorgi的现象学分析法分析资料。[结果]中国烟文化下浓厚的吸烟氛围、强烈的生理心理依赖和社交依赖、局限的戒烟知识和获取知识的途径3个方面是老年COPD病人启动和维持吸烟行为的主要原因。[结论]医护人员应加强对COPD病人的宣传教育,纠正其对吸烟的认知偏差。     

Levels of compliance shown by hypertensive patients and their attitude toward their illness

AIM: The aim of this paper is to describe hypertensive patients' compliance by finding out more specifically what compliance, intention, activity, responsibility and collaboration mean in the treatment of hypertensive patients. A further aim was to clarify their attitudes toward their illness. RATIONALE: This study is part of a project titled 'Patients' self-motivated control of hypertension. METHOD: The intervention consists of a multimedia computer program and effective lifestyle counselling. Nine male and 12 female patients from one municipality were included in an intervention programme. Data were collected through thematic interviews and analysed using content analysis. FINDINGS: Four levels of compliance were found: subconscious, cognitive, action and attitudinal level. Patients also had four different ways of feeling about hypertension and its treatment: some were careless, some were serious, some adjusted well and yet others felt frustrated. CONCLUSION: Health care professionals should recognize each patient's way of complying with his/her treatment and his/her attitude toward the illness. Different patients need different kinds of care and support. In addition health care professionals should also recognize their own attitudes toward hypertension and the patient's position in the health care system.     

Cerebral blood flow and cerebral oxygen consumption in patients with COPD on mechanical ventilation

Objective To investigate the effect of PaCO₂ on cerebral blood flow (CBF) in chronic obstructive pulmonary disease (COPD).Design Before-after trial.Setting General ICU in a regional hospital.Patients 7 patients undergoing mechanical ventilation because of an exacerbation of COPD.Intervention CBF and cerebral metabolic rate of oxygen (CMRO₂) of COPD were measured before and after hyperventilation and were compaired by those of normal patients. CBF was measured by the Kety-Schmidt technique using 15% N₂O.Measurements/results Hyperventilation produced a significant reduction in CBF in COPD with no concomitant change in CMRO₂. CMRO₂ in COPD was significantly lower than those in normal patients. The regression equation was shifted significantly more to the right in COPD.Conclusion The sensitivity of CBF in CO₂ remained but CMRO₂ was reduced markedly in COPD patients.     

Functional heterogeneity of polymorphonuclear leukocytes population in peripheral blood of patients with acute dysentery

AIM: To study chemiluminescence (CL) of polymorphonuclear neutrophils (PMNL) in peripheral blood of patients with acute mild and moderate dysentery caused by Shig. Flexneri in response to Re- and S-chemotype lipopolysaccharide (LPS) Sh. Flexneri and agonists fMLP, PMA and OZ. RESULTS: PMNL population proved functionally heterogeneic, correlating with acute dysentery severity. Subgroups of PMNL varied by CL amplitude, reserve ability to additional stimulation. LPS rather modulated CL of PMNL than stimulated it. CL intensity depended on LPS structure and concentration. Mild acute dysentery was characterized by pool of primed PMNL which had higher functional reserves. CONCLUSION: CL analysis can be used for raising accuracy of dysentery prognosis and severity, assessment of implications of functional state of neutrophil granulocytes for support of antiendotoxin immunity in acute dysentery.     

持续气道正压通气缓解阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病患者的DNA损伤研究

目的探讨经鼻持续气道正压通气(nCPAP)治疗前后阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并慢性阻塞性肺病(COPD)患者外周血淋巴细胞微核率的变化和意义。方法选择2012年10月至2013年10月在江苏大学附属宜兴医院老年医学科就诊的住院患者,经多导睡眠仪器睡眠监测(PSG)确诊的34例患者(包括OSAHS 12例,COPD 8例,OSAHS合并COPD 14例)和21例对照组(体检的健康志愿者),使用Epworth嗜睡量表(ESS)评估白天嗜睡状况和睡眠呼吸暂停的严重程度,使用肺功能测定结果评估COPD患者的严重程度,用胞质阻滞法(CBMN)检测外周血淋巴细胞DNA损伤情况。结果 CPAP治疗后,OSAHS组(AHI:26.4±16.5 vs.23.2±14.8;ESS:11.6±4.4 vs.8.4±2.5;LSpO2:75.2±10.4 vs.83.2±3.7;MSpO2:87.2±3.5 vs.92.2±1.8)和OSAHS合并COPD组(AHI:67.6±22.0 vs.42.6±14.1;ESS:15.6±3.7 vs.10.8±3.2;LSpO2:57.0±6.3 vs.74.0±6.1;MSpO2:82.7±9.3 vs.89.4±3.8)的睡眠呼吸暂停情况有所好转,OSAHS合并COPD组肺功能有所增强(FEV1/pred:60.5±10.7 vs.72.3±7.3;FEV1/FVC:55.4±6.6vs.63.9±6.4),而OSAHS组[微核率:37.2(17.1⁴7.3)vs.17.6(12.147.3)vs.17.6(12.1²0.2);染色体桥率:4.3(1.020.2);染色体桥率:4.3(1.0¹4.2)vs.2.7(014.2)vs.2.7(0⁸.8);核芽率:4.5(1.28.8);核芽率:4.5(1.2¹2.0)vs.3.3(012.0)vs.3.3(0⁶.8)]和OSAHS合并COPD组[微核率:40.0(31.26.8)]和OSAHS合并COPD组[微核率:40.0(31.2⁷1.2)vs.19.3(10.771.2)vs.19.3(10.7³0.4);染色体桥率:9.1(1.830.4);染色体桥率:9.1(1.8²0.0)vs.4.9(020.0)vs.4.9(0⁹.9);核芽率:10.0(3.29.9);核芽率:10.0(3.2²1.7)vs.5.9(021.7)vs.5.9(0¹1.0)]微核率、染色体桥率、核芽率都有明显降低(P<0.05)。结论 CPAP能有效增强OSAHS合并COPD患者的肺功能,并能有效降低患者的DNA损伤。     

多层螺旋CT对早、中期慢性阻塞性肺疾病气道改变的检查及其病理基础

目的:探讨早、中期慢性阻塞性肺疾病(COPD)患者气道改变的多层螺旋CT(MSCT)表现及其病理基础方法:研究组为因外周孤立性肺结节在我院行肺部手术切除的患者15例,其中非COPD患者5例;COPD患者中级3例,1级5例,2级2例。行全肺扫描,120kVp,50mA,螺矩为1.375∶1,X线管旋转速度为0.5s/周。在右肺上叶尖段支气管水平或下肺静脉水平加扫同层电影扫描,120kVp,35mA,扫描范围为10mm,患者平静呼吸,采集时间为9.1s,包括2～3个呼吸周期。由2位放射诊断医师评价病变所在肺叶肺段支气管壁,同时在肺窗下(窗宽1000HU窗位-500HU)以电影方式观察小气道和中心气道在呼吸周期中的开闭情况。手术标本行HE染色,且用Masson三色染色法对胶原纤维、肌纤维进行染色。结果:随着病情的进展逐渐出现气道壁的增厚和弹力下降改变,相应的病理改变是气道腺体的增生和平滑肌的断裂。结论:早期表现为腺体增生,1级时即可出现细支气管壁平滑肌的断裂,2级时出现支气管壁平滑肌的断裂及胶原纤维的增多。     

The content of unbound polyamines in blood plasma and leukocytes of patients with polycythemia vera.

In the blood plasma and isolated leukocytes of 11 patients with polycythemia vera and 3 healthy subjects, the polyamines putrescine, spermidine and spermine were determined. The average values in the leukocytes of the healthy volunteers were found to be 1.8 +/- 1.4 nmol putrescine/10(8) cells, 3.0 +/- 0.9 nmol spermidine/10(8) cells and 12.9 +/- 3.8 nmol spermine/10(8) cells. In the plasma of healthy persons the amounts of the polyamines were below the sensitivity level of the method employed. In 4 patients with polycythemia vera no polyamines were detected. In contrast, in 7 cases 0.1 to 3 nmol polyamines/ml were found. The level of polyamines in the leukocytes of 6 of these patients was decreased and in one patient corresponded to the values found in the normal range (17.7 +/- 6.0 nmol polyamines/10(8) cells). Continued blood-letting therapy on 3 patients led to values approaching the concentrations found in normal subjects in both blood plasma and leukocytes. A decreased amount of these diamines in the leukocytes of the patients was seen to correlate with an elevated concentration in the plasma.     

脑出血患者预后与血脂血糖及凝血等指标变化的相关性

目的:检测脑出血时多种指标的变化,探讨对脑出血患者预后的影响。方法:测定50例脑出血患者的凝血、纤溶指标,血糖、血脂水平,白细胞含量及血小板和相关指标的改变。结果:脑出血组血糖、三酰甘油、载脂蛋白B、低密度脂蛋白胆固醇水平显著高于对照组(P<0.05),血清低密度脂蛋白胆固醇水平低于正常值(P<0.05)。脑出血组D二聚体含量为(2.35±1.70)mg/L,大于对照组(0.31±0.25)mg/L,差异有显著性意义(P<0.05),而凝血指标与对照组差异无显著性意义。脑出血组白细胞含量显著增加,血小板及相关指标未受影响。急性期血糖增高者较血糖正常组预后差,病死率高。结论:血脂异常与脑出血的发生关系密切,脑出血对血糖水平、白细胞数量及纤溶状态均有一定程度的影响,但对血小板和相关指标影响不大。提示急性期血糖增高预示预后不良。     

慢性阻塞性肺疾病合并糖尿病病人肺功能改变的护理干预

慢性阻塞性肺疾病（COPD））是严重危害人们健康的常见病，常合并有不可逆的气道阻塞。肺功能检查对COPD的诊断、疾病严重程度分级及指导治疗、判断预后具有一定作用。糖尿病是一种常见病、多发病，是以慢性高血糖为特征的全身多系统损害的一种疾病。近年来，国内外学者对肺脏是否为糖尿病攻击的“靶器官”进行了大量的研究工作，力图了解糖尿病病人，的肺脏病理变化及发生肺损害的可能机制。     

慢性阻塞性肺疾病合并糖尿病病人肺功能改变的护理干预

慢性阻塞性肺疾病(COPD)是严重危害人们健康的常见病,常合并有不可逆的气道阻塞。肺功能检查对COPD的诊断、疾病严重程度分级及指导治疗、判断预后具有一定作用。糖尿病是一种常见病、多发病,是以慢性高血糖为特征的全身多系统损害的一种疾病。近年来,国内外学者对肺脏是否为糖     

脑卒中病人血气变化的探讨

目的 :探讨脑卒中患者酸碱失衡的类型、原因与救治原则。方法 :对 134例经CT确诊的急诊或住院的脑卒中患者进行动脉血气分析 ,并在同一天抽取静脉血测血Na+ 、Cl-浓度 ,所测数值均按各型酸碱失衡预计代偿公式计算。结果 :134例共进行 2 10例次动脉血气分析 ,不同类型不同程度的酸碱失衡共 14 8例次 (占 70 48% ) ,其中单纯性酸碱失衡 79例次 (占 37 6 2 % ) ,二重酸碱失衡 6 0例次 ( 2 8 5 7% ) ,三重酸碱失衡 9例次 ( 4 2 9% )。结论 :脑卒中患者存在酸碱失衡 ,以代谢性酸中毒、代谢性酸中毒合并呼吸性酸中毒、呼吸性碱中毒最为常见。原则上以治疗原发病为基础 ,纠正原发酸碱失衡 ,维持水电解质平衡 ,使pH值恢复正常