目的 探讨无创呼吸机治疗慢性阻塞性肺疾病(COPD)合并睡眠呼吸暂停低通气综合征(SAHS)的效果评价.方法 选取2014年10月～2019年10月我院收治的70例COPD合并SAHS患者作为研究对象,按照抽签随机分组方法分为观察组(n=35)与对照组(n=35).观察组采用无创呼吸机治疗方法,对照组采用常规治疗方法.比较两组的经皮血氧饱和度(SaO2)、碳酸氢盐(HCO3-)、pH值、二氧化碳分压(PCO2)、氧分压(PO2)、第1秒用力呼气容积(FEV1)占用力肺活量(FVC)的百分比(FEV1/FVC)、FEV1占预计值的比值(FEV1％)、治疗效果.结果 观察组的SaO2、血HCO3-、PCO2、PO2治疗前后比较,差异有统计学意义(P＜0.05);pH值治疗前后比较,差异无统计学意义(P＞0.05);对照组的SaO2治疗前后比较,差异有统计学意义(P＜0.05);血HCO3-、pH值、PCO2、PO2和治疗前比较,差异有统计学意义(P＜0.05);观察组治疗后的SaO2、血HCO3-、pH值、PCO2、PO2优于对照组,差异均有统计学意义(P＜0.05).两组治疗前的FEV1/FVC、FEV1％比较,差异无统计学意义(P＞0.05);观察组的治疗后FEV1/FVC、FEV1％预计值高于对照组,差异均有统计学意义(P＜0.05).观察组的吸气峰压、潮气量高于对照组,差异均有统计学意义(P＜0.05).观察组的治疗总有效率高于对照组,差异有统计学意义(P＜0.05).结论 COPD合并SAHS予其无创呼吸机治疗,能显著改善患者动脉血气结果、肺功能指标、机械通气参数指标,值得推广和应用.

目的:探讨结核菌感染过程中单核细胞miR-20a-5p的表达变化情况及其与肺结核诊断、治疗的关系.方法:选取健康人群(HD)、结核菌潜伏感染(LTBI)、活动性肺结核(PTB)各5例,采集外周血并分离外周血单个核细胞(PBMC),利用免疫磁珠分选外周血CD14+单核细胞,提取总RNA并采取miRNA芯片检测,将肺结核差异表达最为显著的miRNA分子筛选出来,采用定量PCR技术在大样本人群中进行验证(每组各10例),并对5例活动性肺结核患者进行动态随访,利用定量PCR技术检测抗结核治疗前、治疗3个月后、6个月后miR-20a-5p分子的表达情况.利用结核菌强毒株H37Rv、弱毒株H37Ra以及BCG分别感染分化的人单核细胞进行体外实验验证.结果:miRNA芯片显示PTB人群与LTBI、HD人群表达谱存在显著差异,TB人群中共发现14个下调的miRNA分子,包括miR-20a-5p.定量PCR技术证实miR-20a-5p分子在TB人群中的表达水平显著低于HD和LTBI,当服用抗结核药后,其表达水平逐渐上调.用H37Rv、H37Ra及BCG在MOI=10时感染分化的人单核细胞,不同菌株均显著下调miR-20a-5p表达,而以弱毒株下调最为明显.结论:无论是体内还是体外,结核菌感染均下调单核细胞miR-20a-5p表达,而抗结核治疗则显著逆转这种抑制状态.

目的 探讨激活及抑制腺苷酸活化蛋白激酶(AMPK)对阻塞性睡眠呼吸暂停综合征(OSAS)所致胰岛素抵抗、血脂水平变化以及炎症介质释放的影响.方法 选取SPF级健康雄性SD大鼠16只,随机分为对照组、OSAS组、OSAS+激动剂组、OSAS+抑制剂组4组,每组各4只,对照组无处理,对其余3组构建OSAS模型.观察AMPK激动剂AICAR和抑制剂即AMPKα2 shRNA质粒对甘油三酯、总胆固醇、空腹血糖、胰岛素抵抗指标HOMA-IR、脂联素、瘦素,以及炎症因子TNF-α、IL-6的影响.结果 OSAS模型大鼠的甘油三酯、总胆固醇、空腹血糖、HOMA-IR、TNF-α、IL-6水平均显著高于对照组,而脂联素、瘦素水平均显著低于对照组(所有P＜0.05).给予AICAR后,甘油三酯、总胆固醇、空腹血糖、HOMA-IR水平均显著下降,脂联素、瘦素水平均显著升高,炎症因子TNF-α、IL-6水平均显著下降(所有P＜0.05).而给予AMPKα2 shRNA质粒后,则有相反的效果,导致了以上指标的恶化(P＜0.05).结论 AMPK能缓解OSAS模型大鼠引起的胰岛素抵抗,降低血脂水平,并减少炎症介质的释放.

目的:分析孟鲁司特钠联合糖皮质激素治疗中老年哮喘治疗效果及对患者满意度的影响.方法:研究时段自2016年11月至2018年11月,选定本院收治的中老年哮喘患者72例,以随机化原则分组,分对照组(36例,采纳糖皮质激素治疗)、研究组(36例,在对照组基础上采纳孟鲁司特钠联合治疗),比较临床疗效、临床症状缓解时间、肺功能、患者满意度.结果:研究组临床总有效率、患者满意度显著较对照组高,研究组胸闷、咳嗽、喘息症状消失时间显著较对照组短,研究组治疗后EFV1/FVC、PEF、FEV1水平显著较对照组高,P＜0.05(具统计学差异).结论:孟鲁司特钠与糖皮质激素联合,可有效缓解中老年哮喘患者临床症状,改善肺功能,效果显著,值得借鉴.

目的 评价慢性阻塞性肺疾病急性加重期患者应用布地奈德联合复方异丙托溴铵雾化吸入治疗效果及对其肺功能的影响.方法 80例慢性阻塞性肺疾病急性加重期患者作为研究对象,根据治疗方法不同分为观察组与对照组,各40例.对照组患者实施常规治疗,观察组患者在常规治疗的基础上给予复方异丙托溴铵联合布地奈德雾化吸入治疗.比较两组患者治疗前及治疗后1周肺功能指标水平;比较两组患者临床治疗效果;比较两组患者不良反应发生情况.结果 治疗前,两组患者第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、呼气峰流速(PEF)、最大呼气中期流速(MMEF)水平比较差异无统计学意义(P>0.05);治疗后1周,观察组患者FEV1、FEV1/FVC、PEF、MMEF水平均明显高于对照组,差异具有统计学意义(P<0.05).观察组患者临床治疗总有效率为87.50％,明显高于对照组的55.00％,差异具有统计学意义(P<0.05).观察组患者不良反应发生率为5.00％,明显低于对照组的20.00％,差异具有统计学意义(P<0.05).结论 慢性阻塞性肺疾病急性加重期患者经布地奈德联合复方异丙托溴铵雾化吸入治疗,可以有效改善患者的肺功能,促进支气管平滑肌扩张,改善气道痉挛和局部感染,对患者病情的控制起到明显的促进作用.

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.

Objective To investigate the effect of home noninvasive positive pressure ventilation (HNPPV) on time to hospital readmission or death,frequency of acute exacerbation and mortality in patients with chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD).Methods We conducted a study on patients hospitalized in September 10,2014 to March 10,2017 because of AECOPD with hypercapnic respiratory failure and whose arterial partial pressure of carbon dioxide in arterial blood were still higher than 50 mmHg (1 mmHg=0.133 kPa) before they left hospital.Finally 84 patients were included and divided into two groups:HNPPV group who used HNPPV and control group who did not.Compare time to hospital readmission or death,frequency of acute exacerbation in 1 year and mortality between two arms.Results At 90 days of follow-up from the index admission,Kaplan-Meier survival analysis was performed for event-free survival of control group and HNPPV group,and the differences didn't reach statistical significance (0.771 ±0.061 vs 0.889±0.052,x2=1.956,P =0.162).However,Kaplan-Meier survival analysis showed that the control group had a significantly lower event-free survival and significantly shorter median survival time to hospital readmission or death at 180 and 365 days of follow-up from the index admission,compared to HNPPV group (at 180 days,0.396±0.071 vs 0.611±0.081,x2=3.868,P =0.049;at 365 days,0.065±0.036 vs 0.303±0.080,x2 =7.168,P =0.007,median event-free survival time 212.000 vs 155.000,x2 =5.733,P =0.017).And the differences reached statistical significance.Cox regression model was used to identify covariants associated with the time to hospital readmission or death,which were further adjusted for two arms using multivariate analysis (adjusted HR=2.012,95％ CI:1.143-3.542,P =0.015).Nonparametric test was performed for frequency of acute exacerbation within one year (P =0.036) and there was significant between-group difference in 1-year frequency of acute exacerbation.The HNPPV group showed no significant improvement in mortality (control group 20.83％ versus HNPPV group 11.11％,x2 =1.400,P =0.237).Conclusions HNPPV use plus oxygen therapy can prolong the time to hospital readmission or death and reduce frequencies of acute exacerbation,compared to oxygen therapy alone.However,patients did not benefit from HNPPV in reduction of mortality in current study.

目的 探究应用无创呼吸机治疗慢性阻塞性肺疾病与II型呼吸衰竭的效果.方法 选择2014年7月-2018年3月来本院接受治疗的慢性阻塞性肺疾病并II型呼吸衰竭患者80例作为研究对象,随机分为对照组与实验组;对照组患者采用常规方法进行治疗;而实验组患者在进行常规治疗的基础上再加上无创呼吸机进行优化治疗.在进行一段时间的治疗后,分别统计两组患者的治疗效果并进行比较.结果 实验组患者的治疗效果普遍好于对照组患者,恢复效率与总体满意度高于对照组,差异有统计学意义(P<0.05).结论 应用无创呼吸机治疗慢性阻塞性肺疾病与II型呼吸衰竭的效果好,提高患者对治疗的满意度,同时提高了患者的恢复效率,值得临床推广使用.

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：探讨哮喘患者中血清总IgE的表达水平及临床意义。方法本研究选择的对象为2012年5月至2014年3月医院收治的的128例哮喘患者作为实验组，根据哮喘患者病情发作特点将其分为急性期60例，控制期68例，根据病情严重程度的不同分为重度28例，中度45例，轻度55例，同时选择同期医院体检的健康人员50例作为对照组。对哮喘患者与正常对照组血清中IgE水平以及不同哮喘严重程度患者血清中IgE水平进行比较。结果急性期哮喘患者血清中IgE水平显著高于控制期哮喘患者的水平，同时哮喘患者血清中IgE水平高于健康对照组患者的水平，进行比较均有显著性差异（ P＜0．05）；重度哮喘患者血清中IgE水平高于中度以及轻度哮喘患者的水平，同时中度哮喘患者血清中IgE水平显著性的高于轻度患者的水平，两两进行比较均有显著性差异（P＜0．05）。结论血清总IgE水平能够在一定程度上反应哮喘的发作情况，有利于对哮喘的早期诊断与及时治疗。

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.

Objective To analyze the effect of noninvasive mechanical ventilation on the levels of serum BNP and ET-1 in patients with chronic pulmonary heart disease complicated with respiratory failure. Methods Eighty patients with chronic pulmonary heart disease complicated with respiratory failure were collected and were randomly divided into the experimental group( n = 40) and the control group( n = 40). The control group was given conventional treatment and the experimental group was treated with additional noninvasive mechanical ventilation. The clinical curative rate,blood gas analysis and BNP and serum ET-1 levels were compared between the two groups 72 hours after the treatment. Results The clinical symptoms,signs and blood gas analysis results improved significantly in the experimental group 72 hours after the treatment,among which Sa O2,Pa O2 significantly increased while Pa CO2,HR and RR decreased significantly( P 0. 05). BNP and ET-1 levels of the experimental group decreased with the improvement of symptoms of hypoxia and carbon dioxide retention( P 0. 01,P 0. 05),which was significantly better than the control group. BNP and ET-1 levels were positively correlated. BNP and ET-1 and partial pressure of oxygen were negatively correlated. Pressure was positively correlated with carbon dioxide. Conclusion Noninvasive mechanical ventilation can improve ventilation function in patients with chronic pulmonary heart disease complicated with respiratory failure,reduce the serum BNP and ET-1 levels and improve the clinical efficacy.

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。

Objective To analyze influencing factors of postoperative non-small-cell lung cancer patients with respiratory failure and to assess the clinical value of resting lung function. Methods General conditions of 60 postopera-tive non-small-cell lung cancer patients with respiratory failure (observation group) and 120 postoperative non-small-cell lung cancer patients without respiratory failure (control group) undergoing the operation during January 2012 and May 2014 were retrospectively recorded, and the influencing factors of respiratory failure underwent the multi-factor Logistic regression analysis, and then indexes of resting pulmonary function of the two groups were comparatively analyzed. Re-sults The differences in values of age, smoking rate, incidence rate of combined chronic obstructive lung disease, oper-ation time, preoperative lung function, cutting range and incidence rate of serious complications in the two groups were statistically significant (P < 0. 05, P < 0. 01). The indexes of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ), maximal voluntary ventilation (MVV), forced expiratory vital capacity of 25% and 50% instantaneous velocity (FEF25% , FEF50% ), peak expiratory flow (PEF) and maximal expiratory medi-um flow (MMEF) in the observation group were significantly lower than those in the control group ( P < 0. 05, P <0. 01). Risk factors of postoperative non-small-cell lung cancer patients complicated with respiratory failure were age, preoperative degree of pulmonary dysfunction, pneumonectomy and postoperative serious complications (P < 0. 05, P <0. 01). Conclusion Clinicians should check indexes of resting lung function to evaluate the patients'respiratory function for postoperative non-small-cell lung cancer patients with respiratory failure so as to guide the clinical therapic plans.

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.

目的 探讨舒利迭联用孟鲁司特钠对成人支气管哮喘的临床疗效.方法 将150例成人支气管哮喘患者随机分为对照组和观察组,每组各75例,对照组给予单一舒利迭治疗,观察组给予舒利迭联合孟鲁司特钠治疗.分析比较两组患者的临床疗效及呼吸肺活量(FVC)、第一秒用力呼气容积(FEV1)、呼气峰值流速(PEV)、最大呼气流量占预计值百分比(PEF％)的变化情况.结果 观察组总体有效率(93.33％)高于对照组(74.67％),差异有统计学意义(x2=9.722,P=0.002);治疗后,观察组患者FVC、FEV1、PEV、PEF水平显著高于对照组,差异有统计学意义(P＜0.05).结论 舒利迭联合孟鲁司特钠治疗成人支气管哮喘疗效显著,2周内可迅速减轻患者症状表现,改善患者肺功能,且不增加不良反应发生的风险.

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 Analysis Efficacy of Noninvasive ventilation in tHe treatment of cHronic obstructive pulmonary disease CHronic obstructive pulmonary disease witH respiratory failure.Methods 96 cases acute exacerbation COPD witH respiratory failure were divided into tHe control group and tHe observation group,tHe control group were treated witH conventional treatment,and tHe observation were treated witH non-invasive ventilation,breatHing,Heart rate,blood gas cHanges and adverse reactions,intubation conditions were observed.Results BreatHing,Heart rate,blood gas cHanges and intubation in observation group were significantly better tHan tHe control group,tHe adverse reactions in tHe observation group remission after symptomatic treatment.Conclusion Non-invasive ventilation is effective in treating cHronic pulmonary disease witH respiratory failure.