目的 探讨炎症因子和肺功能与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syn-drome,OSAHS)病情程度相关性,为临床治疗提供参考.方法 选择浙江医院2018年3月—2020年3月收治的OSAHS患者179例;另选择同期健康体检者80例作为对照组.采用酶联免疫吸附法测定白介素(IL)-6、IL-18和肿瘤坏死因子-α(TNF-α)水平;采用肺功能仪测定潮气量(VT)、最大肺活量(VCmax)、用力肺活量(FVC)和第1秒用力呼气容积(FEV1);采用匹兹堡睡眠质量指数(PSQI)评价睡眠质量.结果 血清IL-6、IL-18和TNF-α水平比较,轻中度组[(28.21±5.12)pg/mL、(22.35±4.12)ng/L 和(187.46±37.23)ng/L]和重度组[(45.17±6.71)pg/mL、(42.10±5.62)ng/L 和(297.42±30.19)ng/L]高于对照组[(11.82±3.27)pg/mL、(9.65±2.19)ng/L 和(108.91±25.26)ng/L],均P＜0.05.VT、VCmax、FVC和FEV1比较,轻中度组和重度组低于对照组(均P＜0.05).IL-6、IL-18和TNF-α与重度OSAHS呈线性正相关,而VT、VCmax、FVC和FEV1与重度OSAHS呈线性负相关.结论 OSAHS患者存在炎症反应、肺功能下降,且与病情程度呈正相关.

Objective:To investigate the health-related quality of life (HRQOL) of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) through a questionnaire.Methods:The study period was from January 2019 to August 2019. A cross-sectional study was used to evaluate the quality of life of all 200 subjects diagnosed with OSAHS (OSAHS group) and 50 healthy controls (healthy control group) in Zhejiang Hospital by means of 36 summary health surveys (SF-36). Spirometry was performed to assess lung function, and the chronic lung disease (CLD) severity index was used to assess the severity of symptoms, measured patients′ neck circumference, and analyzed correlations between variables and patients′ quality of life.Results:The average disease duration of the OSAHS patients was (2.8 ± 0.5) years, the average Epworth sleep scale (ESS) score was (8.9 ± 0.8) scores, the CLD index was (30.5 ± 2.2) scores, and the average neck circumference was (41.5 ± 3.8) cm, respectively. Compared with healthy control group, the OSAHS patients had significant damage in all fields, and the difference was statistically significant ( P < 0.05). Lung function indicators including the percentage of forced expiratory volume in the first second occupied estimated value (FEV 1%), the ratio of forced expiratory volume in the first second and forced vital capacity (FEV 1/FVC) showed negative correlations with scores of SF-36 in all fields ( P < 0.05). The age, disease duration, ESS score, neck circumference and body mass index (BMI) were associated with poor HRQOL( P < 0.05). Patients′ living standard was significantly correlated with HRQOL ( χ2 = 71.25, P < 0.01). Conclusions:The HRQOL of patients with OSAHS is generally low. Poor lung function, increased disease duration, smoking, increased neck circumference and BMI, and increased daytime sleepiness can adversely affect HRQOL.

新型冠状病毒肺炎病原体为2019新型冠状病毒(WHO已将其正式命名为COVID-19),系β冠状病毒属 [1].据国家卫健委官方发布的最新数据显示,截至2020年2月17日24:00,全国累计报告确诊新型冠状病毒肺炎患者72436例,累计死亡1868例,治愈12552例.面对当前严峻的抗疫形势,浙江省卫健委积极响应国家号召,统一部署,于2020年1月24日就组建了首批抗击新型冠状病毒肺炎紧急医疗队,成员均为浙江省各大医院医、技、护专业骨干.1月25日,浙江紧急医疗队抵达疫情中心城市武汉,并进驻武汉市某定点三甲医院开展抗疫工作.护理团队作为此次救援行动的主体,在抗疫一线发挥了决定性作用.快速组建护理团队并规范管理,对于争取时间迅速开展救援至关重要,现将支援期间我们积累的经验总结报道如下.

目的 分析精细化护理对慢性阻塞性肺疾病加重期合并2型呼吸衰竭(简称“呼衰”)患者的影响.方法 选取2017年1月-2018年5月在浙江医院呼吸科收治的慢性阻塞性肺疾病加重期合并2型呼衰患者110例,按照随机数字表法分为观察组和对照组各55例.对照组患者应用常规护理,观察组患者应用精细化护理干预.比较2组患者临床症状、护理干预前后肺功能、血气指标的变化,并统计2组患者护理期间并发症的发生率.结果 护理干预前,2组患者肺功能及血气指标变化差异无统计学意义(均P＞0.05);护理干预后,观察组患者临床症状肺部啰音消失时间及憋喘消失时间明显短于对照组(均P ＜0.05);干预后观察组患者肺功能FEV1、FVC及FEV1/FVC指标明显优于对照组(均P＜0.05);观察组患者血气指标pH值、氧分压(PaO2)、二氧化碳分压(PaCO2)改善情况均优于对照组(均P＜0.05);护理期间2组患者均有不同程度并发症的发生,但观察组患者误吸、吸入性肺炎、口咽不适等发生率均明显低于对照组(均P ＜0.05).结论 慢性阻塞性肺疾病加重期合并2型呼衰患者应用精细化护理较常规护理更能提高患者肺功能,改善患者血气指标,降低患者并发症发生率,值得临床应用.

To introduce thoroughly the effect on the environment,attitude,staff positivity and their sense of belonging of nursing after the humanized managements to nursing staff in our hospital were carried out since 2009,and to expound the necessity and superiority of humanized managements on clinical nursing.