目的 考察湿化经鼻高流量氧疗(HFNC)对肺癌术后患者感染、呼吸功能的影响.方法 将70例行肺癌根治术的肺癌患者随机分为两组,对照组35例给予哌拉西林钠他唑巴坦钠常规抗感染治疗+常规氧疗,观察组35例给予哌拉西林钠他唑巴坦钠常规抗感染治疗+湿化经鼻高流量氧疗.分析并比较两组患者治疗7 d后的感染率,治疗前及治疗7 d后的血气分析指标、第1秒用力呼气容积占总肺活量比值(FEV1/FVC)、气道湿化及舒适度,并记录两组住院时间、机械通气率的差异.结果 治疗7 d后,观察组患者术后感染率5.71％,明显低于对照组的22.86％(P<0.05);治疗前两组氧合指数(OI)、氧分压(PaO2)、二氧化碳分压(PaCO2)、FEV1/FVC水平比较,差异均无统计学意义(P>0.05),治疗7 d后观察组OI[(332.67±37.38)％]、PaO2[(83.12±9.06)mm Hg]、FEV1/FVC[(70.66±8.16)％]水平明显高于对照组[(300.25±32.52)％、(73.85±8.65)mmHg、(61.25±7.54)％],PaCO2水平[(31.45±4.28)mmHg]明显低于对照组[(40.36±4.79)mmHg],差异具有统计学意义(P<0.01).治疗7 d后,观察组气道湿化评分及舒适度评分为(1.27±0.65)分、(1.64±0.73)分,均明显低于对照组的(2.43±0.81)分、(2.29±0.85)分(P<0.01).观察组住院时间(10.15±2.18)d,对照组住院时间(12.36±2.95)d,差异具有统计学意义(P<0.05).两组机械通气率均为0,差异无统计学意义(P>0.05).结论 HFNC能够降低肺癌患者术后感染的发生率,改善肺癌术后患者呼吸功能,促进患者的恢复.

目的:探讨早期新型冠状病毒肺炎(COVID-19)的胸部薄层平扫CT表现特征.材料与方法:收集2022年11月至12月我院感染科确诊COVID-19且胸部CT表现阳性的患者153例,所有患者自发病后1～14天行胸部薄层平扫CT检查和有较完整的临床资料.根据患者年龄(≤60岁和＞60岁)和发病与CT检查的时间间隔(≤7天和＞7天)将患者各分为两组,比较两组患者的CT表现特征的差异性.结果:153例COVID-19患者中,累及肺部(100％)、血管(93.5％)、气道(73.4％)和胸膜(70.1％),其中年龄组间的对比显示病变数量、部位、大小、容积和束带影的差异有统计学意义;发病与CT检查时间间隔分组患者之间,病变的形态、密度、机化和纤维化以及胸膜受累等差异有统计学意义.结论:胸部薄层平扫CT可明确早期COVID-19的病变位置和范围,对COVID-19的定性诊断和鉴别有一定的特征,即以形态的多样化、胸膜内和血管周分布、肺泡为单元的间质性病变、早期混合性磨玻璃影常伴明显的机化和纤维化、胸膜局限性增厚而胸水极少等有助于COVID-19的诊断和鉴别.

目的 探索心脏磁共振成像(CMR)评估特发性肺动脉高压(IPAH)患者右心导管(RHC)指标的简便方法.方法 对25例IPAH患者行CMR及RHC检查.使用自主开发的计算机软件在心尖四腔心层面测量并计算右心室腔7个水平舒张末期和收缩末期室间隔至右心室游离壁距离的变化值(SFDC),自心尖向心底方向分别命名为SFDC1～ SFDC7,测量并计算三尖瓣环收缩期位移(TAPSE).分析SFDC1～ SFDC7、TAPSE及SFDC1 ～ SFDC7和TAPSE的乘积分别与RHC测算的右心室心输出量(RVCO)、右心室心脏指数(RVCI)、右心室心搏指数(RVSI)、肺动脉平均压(PAMP)、肺血管阻力(PVR)倒数1/PVR的相关性.结果 所有CMR参数与PAMP均没有相关性(P＞0.05).SFDC5×TAPSE与其他RHC参数相关性最高(r分别为0.86、0.81、0.78、0.74,P＜0.001).TAPSE与RVSI呈中度相关(r=0.50,P=0.01).结论 CMR右心室SFDC5×TAPSE也许可以简便并准确地评估IPAH患者部分RHC指标.

目的:探究经鼻高流量氧疗仪用于机械通气撤机序贯治疗的效果评价.方法:研究对象选取我院2016年3月到2017年12月期间,收治的有创机械通气撤机序贯治疗的患者62例,采取随机数字法分为经鼻高流量氧疗(HFNC)组和无创正压通气(NPPV)组各31例.比较两组患者序贯治疗12、24、48 h后的痰液性状及动脉血气指标,比较两组患者序贯治疗时间,再插管率,RICU住院时间及总住院时间,记录进行序贯治疗7d内发生鼻面部压疮情况.结果:HFNC组各时间点患者痰液性状均明显优于NPPV组(均P＜0.05),动脉血氧饱和度(SaO2)、PaO2均明显高于NPPV组(均P＜0.05);PaCO2与NPPV组相比差异无统计学意义(P＞0.05);序贯治疗时间明显低于NPPV组的序贯治疗时间(P＜0.05);再插管率明显低于NPPV组(P＜0.05);RICU住院时间及总住院时间明显少于NPPV组(P＜0.05);HFNC组无鼻面部压疮发生,NPPV组序贯治疗7d内发生3例I度鼻面部压疮,两组对比差异无统计学意义(P＞0.05).结论:经鼻高流量氧疗与无创正压通气相比,可以明显改善痰液性状,提高动脉血氧饱和度及动脉血氧分压,缩短序贯治疗时间,降低再插管率,缩短RICU住院时间及总住院时间,减少鼻面部压疮发生率,值得在临床推广.

Objective To study the effects of pioglitazone on the expressions of peroxisome prolifer-ator-activated receptor-γ (PPAR-γ) in hippocampus and hypothalamus of diabetic rats and to explore the as-sociation between pioglitazone and cognitive function.Methods Thirty male SD rats were equally randomized into control group (C group), diabetic group (D group) and diabetes+pioglitazone group (DP group). The spatial learning and memory function were tested by Morris water maze after 8 weeks. Expressions of PPAR-γ in hippo-campus and hypothalamus were detected by Western Blot.Results In the Morris water maze, escape latencies of D group increased significantly compared to C group and DP group(P<0.05). The expressions of PPAR-γ in hippocampuses and hypothalamuses of D group were significantly lower than C group and DP group(P<0.05). Conclusions Pioglitazone could increase the expressions of PPAR-γ in hippocampus and hypothalamus of dia-betic rats, which may be related to the improvement of spatial learning and memory function caused by pioglita-zone.

Objective To evaluate the accuracy and reproducibility of the cardiac magnetic resonance (CMR) imagingderived left ventricular septal-to-free wall curvature ratio by CAD drawing software for prediction of the right ventricular systolic pressure (RVSP) in patients with idiopathic pulmonary arterial hypertension (IPAH).Methods Twenty patients with IPAH confirmed by right-side heart catheterization (RHC) underwent CMR imaging.Two doctors measured interventricular septal curvature (CIVS) and left ventricular free wall curvature (CFW) at end systole by using a third-party CAD drawing software and derived the curvature ratio (CIVS/CFW).Pressure rise of IVS (dPIVS) and pressure rise of FW (dPFW) derived from RHC and systemic systolic blood pressure was used to derive the dP ratio (dPIVS/dPFW).Interobserver and intraobserver curvature ratio measurements agreement was assessed by using Bland-Altman analyses.Linear regression analysis was performed to assess the relationship between curvature ratio and dP ratio.A regression equation was derived.By using this equation,the RVSP was computed in every patient,and the agreement between CMR-and RHC-derived RVSPs was assessed by using Bland-Altman analysis.Results A direct linear correlation between curvature ratio and dP ratio was observed (r =0.93).Bland-Altman analysis revealed moderate agreement between CMR-and RHC-derived RVSPs (mean difference =7.8 ± 12.1 mm Hg).Conclusion CMR-derived curvature ratio by CAD drawing software was a simple,fast,accurate and reproducible index for estimation of RVSP in patients with IPAH.

Objective:To study the effect of Tongxinluo on HIF-1α in rats with hypobaric and hypoxia pulmonary hypertension.Method:30 male SD rats weighing 200-250 g were randomly divided into three groups:control group with normal pressure and normal oxygen(control group),pulmonary hypertension group with low-pressure and low-oxygen(model group),and the group treated by Tongxinluo in low-pressure and low-oxygen condition(Tongxinluo intervention group).Each group included 10 rats.Auto-modulating hypobaric and hypoxic cabin was used to simulate 5000 mhigh altitude environment(air pressure 50 kpa,oxygen concentration 10%).Tongxinluo(1.2g/kg crude drug)was given by gastrogavage to rats in Tongxinluo intervention group once daily.Control group were exposed to normal-pressure and normal-oxygen in the same laboratory environment.4 weeks later,the mean pulmonary arterial pressure(mPAP)and right ventricular(RV)mass index were measured.Concentrations of HIF-1α,VEGF and ET-1 in blood were detected.Results:Compared with control group,mPAP,RV mass index and the levels of HIF-1α,VEGF,ET-1 in model group were significantly increased(P<0.05).Compared with model group,rats of Tongxinluo intervention group showed lower mPAP and RV mass index,and the levels of HIF-1α,VEGF and ET-1 decreased remarkably(P<0.05).There was no significant difference between control group and Tongxinluo intervention group in right ventricular hypertrophy index and the levels of serum HIF-1α and ET-1(P>0.05).Conclusion:Tongxinluo may influence the occurrence and development of hypobaric and hypoxia pulmonary hypertension by downregulated the level of HIF-1α.

患者男,55岁.因右下肢肿胀7月余,加重伴左下肢肿胀、腹胀5月余,胸闷1月余入院.7个月前无明显诱因渐出现右下肢凹陷性肿胀,由小腿发展至大腿,不伴局部红、肿、热、痛,感右下肢无力伴双手麻木,于当地医院诊断为颈椎病和腰椎病,行颈椎前路及腰椎后路手术,术后当日出现左下肢肿胀,伴疼痛,渐出现腹胀.左下肢彩色超声检查示静脉血栓形成,予局部热敷、利尿等治疗无效,于当地医院行溶栓、抗凝,并植入下腔静脉滤器,治疗无效,双下肢肿胀加重,腹胀加重,腹围增大,并出现进行性加重的呼吸困难,当地医院复查下肢血管彩色超声及造影检查未见血栓形成,腹部CT示腹腔积液.反复利尿治疗效果不佳,双下肢呈橡皮肿样,并出现胸腹水,呼吸困难进行性加重,考虑双下肢静脉血栓形成、淋巴水肿,为进一步诊治收入我院淋巴外科.

Objective: To study the heart rate variability(HRV) indicators of differences in age and heart rate variability(HRV)in patients with coronary heart disease changes.Methods: 24 h Holter monitoring,HRV time domain analysis to confirm the diagnosis by coronary angiography,133 cases of coronary heart disease patients and 37 patients with non-coronary heart disease patients(SDNN,SDANN,RMSSD,pNN50,SDNNindex),and results done to contrast,analysis of the relationship.Results: In patients with coronary heart disease,HRV time domain indicators(SDANN,RMSSD,pNN50) were lower than that of the non-CAD group,with statistical significance(P 0.05).Not only in the group of patients with coronary heart disease,but also in non-CAD group,HRV time domain indi-cators in the elderly group were lower than that of the middle-aged group,with statistical significance(P 0.05).Conclusion: Vascular lesions of coronary heart disease and vagus nerve function impairment related,and the vagus nerve function decline with age increasing.