Objective To explore the correlation between fraction of exhaled nitric oxide ( FeNO) and pul-monary function in different degrees tobacco dependence patients. Methods 116 patients with tobacco dependence from July 2016 and October 2017 were divided into three groups according the degree of tobacco dependence, 48 ca-ses in the mild group, 36 cases in the moderate group, and 32 cases in the severe group. Another 28 non-smoking subjects were taken as controls ( the control group) . The FeNO values and pulmonary function indexes were compared among the four groups. The correlation between FeNO and pulmonary function was analyzed with Pearson correlation analysis. Results The FeNO values were significantly lower in the severe group than in the mild group and the con-trol group (16. 3 ± 9. 2 vs 21. 9 ± 13. 6 and 22. 7 ± 8. 6, P<0. 05). However, there was no significantly difference between the mild and moderate group and the control group (21. 9 ± 13. 6 and 19. 4 ± 11. 9 vs 22. 7 ± 8. 6, P>0. 05). The value of FEV1％ and FEV1/FVC was significantly lower in the mild, moderate and severe groups than in the control group, and it was significantly lower in the severe group than in the moderate group. However, there was no significantly difference in the value of FEV1％ and FEV1/FVC between the mild group and the moderate group. There was a positive correlation between FeNO and FEV1％ or FEV1/FVC in the mild, moderate and severe tobacco dependent groups. In particular, there was a significant positive correlation in the severe tobacco dependent group. Conclusion There is a positive correlation between FeNO and FEV1％ or FEV1/FVC in the mild, moderate and se-vere tobacco dependence groups. The heavier the tobacco dependence is, the more serious the lung function damage is.

目的 探讨局麻纤支镜下胸交感神经切断术治疗手汗症的安全性和临床应用价值.方法 对51例手汗症患者行局麻纤支镜下胸交感神经切断术治疗,记录手术完成情况、手术时间、并发症发生情况,住院费用,术后随访观察治疗效果.结果 51例均顺利完成手术,术中患者生命体征平稳,手术时间42~92min平均56min,无霍纳氏综合征和血胸等严重并发症发生,仅3例术后并发少量气胸;术后第三天恢复学习和工作,住院费明显降低.随访3~12个月,所有患者手部多汗症状完全消失,切口未见明显瘢痕,隐匿于腋毛内完全不可见.结论 局麻纤支镜下胸交感神经切断术治疗手汗症安全有效,费用低,术后瘢痕小而隐匿,更加适合美容.

目的 探讨支气管哮喘患者外周血细胞白三烯受体-1(CysLTR1)基因MicroRNA的表达及临床意义.方法 选择支气管哮喘急性发作患者17例(哮喘发作组)、支气管哮喘诊断明确且临床症状完全缓解3个月以上患者15例(哮喘缓解组)和健康体检者20例(正常对照组),采用RT-PCR技术检测外周血细胞CysLTR1基因MicroRNA的表达,并比较分析3组检测结果.结果 CysLTR1基因MicroRNA在正常对照人群和支气管哮喘患者中均有表达,但表达水平不同:哮喘发作组、哮喘缓解组和正常对照组CysLTR1/GAPDH分别为2.4059±0.1983、2.1800±0.2210和1.2300±0.1174,与正常对照组相比,哮喘发作组和哮喘缓解组CysLTR1基因MicroRNA的表达均明显增高(均P＜0.05);哮喘发作组与哮喘缓解组比较,差异无统计学意义(P≥0.05).结论 哮喘患者CysLTR1基因MicroRNA高表达可能与哮喘发生或急性发作相关.

目的：了解医务人员的手机卫生状况及与手卫生的关系，提高医务人员对手机卫生重要性的认识，减少医院感染的风险。方法随机选择正在进行临床诊疗护理工作的各科室医务人员，对手机和手进行采样培养，计算菌落数，并做细菌鉴定。结果手机细菌检出率为76.63％，手细菌检出率为82.59％，两者呈正相关。结论手机卫生不容忽视，与手卫生密切相关，医务人员应高度重视。

目的：探讨血清降钙素原(PCT)联合C-反应蛋白(CRP)测定在支气管哮喘急性发作期合并细菌感染的临床意义。方法100例支气管哮喘急性发作期患者,其中55例合并细菌感染患者作为观察组,45例非合并细菌感染者作为对照组。比较两组患者治疗前、后的血清PCT、CRP水平。结果治疗前,观察组患者的血清PCT、CRP水平均明显高于对照组,差异具有统计学意义(P<0.05)；治疗后,两组患者的血清PCT、CRP水平比较,差异无统计学意义(P>0.05)。结论在急性发作期,给予支气管哮喘患者血清PCT联合CRP检测,能够协助判断出患者是否合并细菌感染,且血清PCT、CRP水平的高低为支气管哮喘急性发作期患者是否使用抗感染药物提供了参考依据,值得在临床上大力推广应用。

目的回顾性总结局麻纤支镜下胸交感神经链切断术术后1年随访结果，评估该技术的手术效果。方法2012年12月~2014年4月，42例手汗症患者接受局麻纤支镜下胸交感神经链切断术，男19例，女23例；年龄16~35岁，平均23岁。从治愈率、疼痛持续时间、术后满意率以及并发症发生率等方面进行随访。结果42例手术均成功完成，手术时间42~92min平均56min；术中无严重并发症发生。39例随访1.0~1.4年，平均1.2年；所有手汗症均达到临床治愈；气胸2例，轻度代偿性多汗2例,刀口疼痛平均持续时间2d；无霍纳综合征、血胸等并发症发生。结论局麻纤支镜下胸交感神经链切断术治疗手汗症安全有效，远期疗效稳定，术后瘢痕小而隐匿，更加适合美容。

Objective To explore the clinical characteristics of patients with totally controlled asthma. Methods 186 patients with totally controlled asthma from January, 2012 to June, 2014 were enrolled in the study and 28 healthy subjects were selected as the control group. Results The forced expiratory volume in one second (FEV1% ) and the forced vital capacity rate of one second (FEV1 / FVC% ) was significant lower in the study group than in the control group (P < 0. 01). The serum levels of immunoglobulin E and eosinophil were significant higher in the study group than in the control group (P < 0. 01). There was no significant difference in FEV1% and FEV1 /FVC% in patients with controlled asthma treated with different dose drugs (P > 0. 05). Conclusion The lung func-tion of patients with totally controlled asthma don′t return to normal, and they still have airway inflammation and need to be given anti-inflammatory treatment.

目的 探讨以咽喉部异物感为主诉的鼻后滴流综合征的临床特征.方法 对65例以咽喉部异物感为主诉的鼻后滴流综合征的临床资料进行分析.结果 90.8％患者有鼻窦炎,仅一组鼻窦部病变占32.2％,67.8％的患者为2组以上鼻窦部病变,35.6％单侧鼻窦部异常,双侧鼻窦部异常占64.4％,57.6％的患者有鼻窦腔移液,鼻窦腔黏膜增厚占42.4％,20.3％的患者有鼻息肉,69.2％患者表现为频繁清喉或鼻吸后咯痰,有轻微咳嗽症状患者为26.2％,能咯出少许痰的患者仅占18.5％,有打喷嚏症状者占30.8％,16.9％患者有鼻塞症状,35.4％有流涕,27.7％为少许脓涕,6.2％有胸闷,9.2％有头痛,38.5％的患者有明确的鼻后滴流症状,36.9％的患者咽后壁有淋巴滤泡增生,32.3％有鹅卵石样改变,23.1％的患者咽部充血.96.9％的患者经鼻喷激素、口服复方盐酸伪麻黄碱及大环内酯类抗生素治疗有效.结论 咽喉部异物感或咽喉部有痰为鼻后滴流综合征的特殊临床表现,多数是由鼻窦炎和过敏性鼻炎所致,在临床上容易引起误诊,提高对鼻后滴流综合征的认识和诊断,经规范治疗可以取得满意的疗效.

Objective To explore the features and clinical significance of sinus CT in the diagnosis of upper airway cough syndrome.Methods The CT findings of 132 patients with upper airway cough syndrome were retrospectively analyzed. Results CT scan revealed abnormities in 116,including thickening and increased density of sinus mucosa,gas-liquid plance,soft tissue shadow in sinus cavity,and hyperplasia and thickening of bone.In 116 patients,87 had bilateral paranasal sinusitis,92 had multiple paranasal sinusitis,105 had maxillary sinusitis,76 had frontal sinusitis,53 had ethmoid sinusitis and 26had sphenoid sinusitis.Conclusions Sinus CT has a diagnostic value to upper airway cough syndrome.

Objective To understand the present situation of hospital infection, in order to take effective measures to prevent and control hospital infection. Methods The clinical data of 20 161 discharged patients were ret-rospectively analyzed. Results Of the 20 161 discharged patients, 413 occurred hospital infection, with the infection rate of 2.05% (1.73%～2.29%). The infection rate was highest in the Department of Neurosurgery. The infection occurred were mostly respiratory tract infection, and high-risk group were the patients with diseases of the nervous system. The pathogen species were mostly gram negative bacilli. Conclusion The occurrence of hospital infection is mainly related with basic diseases characteristics. Effective measures should be taken according to specific circum-stances as soon as possible to prevent hospital infection.

Objective To investigate the clinical features of upper airway cough syndrome(UACS).Methods The clinical data of 98 confirmed cases of upper airway cough syndrome were analyzed.Results In all confirmed cases,81.6% cases had nocturnal cough symptom,55.1% cases had daytime and nocturnal cough symptom,86.7% cases had sinusitis,78.6% cases had rhinocleisis,66.3% cases had purulent nasal discharge,33.7% cases had sneeze,73.3% cases had phlegm in phlegm in pars laryngeal pharyngis,42.9% cases had postnasal drip,16.3% cases had dysosmia,53.1% cases had stethocatharsis,23.5% cases had cobblestone-like changes on pharyngeal mucosa,34.7% cases had tenderness in paranasal sinuses.In 85 cases of sinusitis with upper airway cough syndrome,76.5% cases had bilateral and many paranasal sinuses.After the treatment of 3 weeks and 3 months,excellence rate was 23.5% and 66.3%,respectively;the total effective rate was 100%.Conclusion The clinical feature of upper airway cough syndrome is multiplicity.The reasonable therapy can achieve a satisfactory effect.

Objective To investigate the clinical features and treatment effectiveness of confirmed cases of sinusitis with upper airway cough syndrome.Methods Analysied the clinical data of 56 confirmed cases of sinusitis with upper airway cough syndrome were.All cases were treated with pseudoephedrine hydrochloride,ambroxol,erythromycin for 3 weeks and fluticasone propionate nasal spray for 12 weeks.Results In all confirmed cases,76.8% cases had daytime cough symptom,85.7% cases had nocturnal cough symptom,75% cases had phlegm in pars laryngea pharyngis,more than 82% cases had rhinocleisis and purulent nasal discharge.The 71.4% of cases had notable improvement from treatment,28.6% was cured,total effective rate was 100%.Conclusion The clinical feature of sinusitis with upper airway cough syndrome is complex and easily misdiagnosis.We need to apply standardized therapy to achieve a satisfactory effect.

目的 探讨激素不同吸入方法对过敏性鼻炎-哮喘综合征患者血清免疫复合球蛋白(IgE)、外周血嗜酸细胞(Eog)、白细胞介素4(IL-4)及肺功能的影响及最好的治疗方法.方法 90例过敏性鼻炎-哮喘综合征患者被随机分为三组:鼻吸组30例,给予丙酸氟替卡松鼻喷雾剂,早:每个鼻孔各2次,晚:每个鼻孔各3次,鼻腔吸入,每喷50 μg;口吸组30例,给予丙酸氟替卡松气雾剂,早:吸入2次,晚:吸入2次,经口吸入,每吸125μg；联合组30例,给予丙酸氟替卡松气雾剂,每天早晚各吸入1次,同时给予丙酸氟替卡松鼻喷雾剂,每个鼻孔每天早晚各喷1次,每晚增加一个鼻孔喷入1次.三组每天给药剂量均为500 μg,分别于治疗前及治疗12周后检测患者血清IgE、EOS、IL-4及肺功能指标,进行统计分析.结果 三组患者治疗后血清IgE、Eos、IL-4较治疗前均明显下降(均P＜0.05),第一秒用力呼气容积(FEV1)、第一秒用力呼气容积与用力肺活量比值( FEV1/FVC％)明显提高(均P＜0.05),治疗后血清IgE、Eos、IL-4联合组、鼻吸组与口吸组差异均无统计学意义(均P＞0.05),而联合组与鼻吸组差异均有统计学意义(均P＜0.05).治疗后肺功能指标FEV1、FEV/FVC(％)联合组、口吸组与鼻吸组差异均有统计学意义(均P＜0.05),但联合组与口吸组差异均无统计学意义(均P＞0.05).结论 口鼻联合吸入激素能显著降低血清IgE、Eos、IL-4水平,改善肺功能,与口吸组、鼻吸组比较是过敏性鼻炎-哮喘综合征患者最好的治疗方法。

Objective To investigate the levels of D-dimer in the patients with pulmonary heart disease. Methods D-dimer in the plasma was measured in 30 cases with chronic pulmonary heart disease in the acute exacerbation, 30 cases with chronic pulmonary heart disease in the Clinical remission and in 30 healthy cases serving as controls. Results The levels of D-dimer in the patients with pulmonary heart disease in the acute exacerbation [(2.62±0.91)μg/L] and the clinical remission [(2.16±0.78)μg/L] were higher than that in the healthy control group [(1.74±0.63)μg/L]. And the level of D-dimer in the patients with chronic pulmonary heart disease in the acute exacerbation[(2.62±0.91)μg/L] was higher than that in the patients with clinical remission[(2.16 ± 0.78)μg/L]. Conclusion D-dimer increased due to the change of clinical pathophysiology of chronic pulmonary heart disease and correlating with the severity of pulmonary heart disease.

Objective To observe the clinical effect of treatment of allergic rhinitis and asthma syndrome(CARAS) by different ways of inhaling corticosteroids. Methods Totally 55 cases of patients suffered from allergic rhinitis and asthma syndrome were randomly divided into two groups.Nasal spray group: 27 cases were treated with fluticasones propionate nasal spray 100μg(2 puffs) a.m.and 150μg(3 puffs) p.m.into each nostril twice daily.Inhaling group: 28 cases were treated with fluticasones propionate inhaling 250μg(2 puffs) twice daily for 12 weeks,respectively.The symptom scores of rhinitis,asthma,quality of life and pulmonary function were examined before and after treatment. Results The symptom scores of rhinitis,ACT and QOL after treatment in nasal spay groups and inhaling groups were significantly improved(P0.05),the scores of rhinitis in nasal spay groups than that in inhaling groups were significantly decreased(P0.05),the scores of ACT,QOL and pulmonary function in inhaling groups than that in nasal spay groups were significantly increased(P0.05). Conclusions The symptoms of rhinitis and asthma,quality of life on CARAS in two groups by two ways of inhaling fluticasones propionate are greatly improved,however,it is not best ways and is no satisfaction that nasal spay or inhaling fluticasones propionate single on CARAS.

目的 观察布地奈德鼻喷雾剂治疗过敏性鼻炎的临床疗效.方法 98例确诊过敏性鼻炎患者给予布地奈德鼻喷雾剂治疗,每个鼻孔各2喷,64μg/喷,2次/d.视症状消失后,减为每个鼻孔各1喷,2次/d,用1周后改为1次/d,再用1月后改为隔日1次,合并支气管哮喘患者给予吸入舒利迭50/100 ug或50/250 ug,1吸/次,2次/d,疗程8周.观察过敏性鼻炎的临床症状消失时间及治疗有效率.结果 布地奈德鼻喷雾剂治疗过敏性鼻炎临床症状消失时间为3-10 d,过敏性鼻炎症状越重,需控制症状时间越长.总有效率达到100%.在46例合并支气管哮喘患者中,有414例(95.7%)患者哮喘控制测试(ACT)达到完全控制或良好控制.结论 布地奈德鼻喷雾剂能够有效控制过敏性鼻炎临床症状,对预防和控制哮喘病发作有积极作用.

Objective To evaluate the therapeutic effect of budesonide nasal spray in combination with inhaled seretide in treating alergic rhinitis and asthma syndrome(CARAS).Methods 60 CARAS cases were selected from asthma clinic and divided into two groups randomly.The control group was treated with seretide(50/100 μg or 50/250 μg)twice daily via accuhaler.On the basis of inhalation,the treatment group was added budesonide nasal spray 64 μg(1 puff)into each nostril twice daily,for an 8-week treatment study was conducted.Results The treatment group was significantly higher than the control group on the score of quality of life(QOL)after the experiment.After the treatment,there wasn't better improvement in scores of allergic rhinitis symptoms in the control group.Conclusion On the basis of inhaled seretide,added budesonide nasal spray can improve the quality of life of the patients with combined allergic rhinitis and asthma syndrome(CARAS)quickly and effectively.

Objective To observe the effects of esmolol on patients with myocardial isehemia during cervical plexus block.Methods Forty patients were randomly divided into two groups:the control group(group A),the esmolol group(group B).Each group include 20 cases.Group B received mainline of esmolol 0.4mg/kg(initial dose)and continue infused at a rate of 5mg·kg~(-1)·h~(-1),and group A received normal saline as control.Various irculation function monitoring indexes,change of electrocardiogram and adverse reaction before block,at the end of block and 0min,30min after cervical plexus block were recorded.Results In group A,MAP,HR and RPP were significantly decreased at the end of block and 10min,30min after cervical plexus block compared with before block(P<0.01).But in group B,MAP,HR and RPP were not changed significantly than that before block(P>0.05);comparing the two groups,the corresponding parameter was significantly different at each time after block(P<0.01).In group A,the downward shift distance of S-T section was significantly increased at each time after block than that before block (P<0.05),but in group B,that was significantly decreased(P<0.05);comparing the two groups,the corresponding downward shift distance of S-T section was significantly different at each time after block(P<0.01).The group B have higher proportion of palpitation,headache than that of group A,the difference was significant.Conclusion Esmolol has protective effects in lessening myocardial oxygen consumption,improving myocardial blood oxygen supply and reducing proportion of adverse reaction on patients with myocardial ischcmia.

Objective In order to standardize the general ward hospital-acquired pneumonia(HAP) of the anti-inflammatory treatment to promote the rational use of antibiotics.Methods The bacteriology of the 62 patients with HAP whithout organ dysfunction,in the general ward between Jan.2005 and Dec.2009 in our hospital were analyzed.Result All cases of the general ward HAP is cured According to the results of sputum bacterial culture and drug sensitivity of the basic anti-bacterial medication.Conclusion Hospital-acquired pneumonia in the general ward can be cured by appropriate commonly used antibiotics.