目的:探讨肺泡/小气道一氧化氮(CaNO)在慢性阻塞性肺疾病(COPD)中的应用价值.方法:纳入2020年4月～2020年12月我院接诊的60例COPD患者作为本次的研究对象,所有患者均接受标准化治疗,按照治疗预后将患者分为有效组和无效组,比较两组患者入院时、出院前、出院后3个月、出院后12个月呼出气一氧化氮(FeNO)和CaNO检测结果差异.结果:两组患者FeNO检测结果入院时>出院前>出院后3个月>出院后12个月,CaNO检测结果入院时>出院前>出院后3个月>出院后12个月,数据间对比差异显著(P<0.05);有效组FeNO、CaNO入院时、出院前、出院后3个月、出院后12个月检测结果均低于无效组,数据间对比差异显著(P<0.05).结论:CaNO、FeNO与COPD患者的病情呈正相关,可以联合反应患者的病情严重程度.

目的 对药涂球囊(drug-eluting balloon,DEB)和普通球囊(conventional balloon,CB)在自体动静脉内瘘(AVF)腔内血管成形术(PTA)中的应用效果进行Meta分析.方法 检索Cochrane Library、PubMed、EmBase、CNKI、万方等数据库,查找药涂球囊与普通球囊在内瘘PTA中应用效果的文献,对文献进行筛选、提取资料及质量评价.应用RevMan 5.3软件进行统计,对两种方法治疗后随访3个月、6个月和12个月的通畅性进行Meta分析.结果 研究最终纳入8篇文献,其中6篇随机对照试验(randomized controlled trial,RCT),2篇前瞻性队列研究(prospective cohort study,PC),共纳入606例患者.Meta分析结果显示,随访3个月,DEB组相对于CB组改善了内瘘通畅性(OR 0.55,95％CI 0.32-0.93,P=0.03);随访6-12个月,内瘘目标病变通畅性方面,DEB组和CB组总体差异无统计学意义(6个月:OR 0.60,95％CI 0.24-1.45,P=0.25;12个月:R 0.60,95％CI 0.27-1.35,P=0.22).在研究类型的亚组分析中,在PC亚组中显示了DEB的优越性(3个月OR 0.08,95％CI 0.01-0.70,P=0.02;6个月OR 0.10,95％CI 0.02-0.58,P=0.01;12个月OR 0.12,95％CI 0.04-0.36,P=0.0001),而在RCT中没有显示出统计学差异(3个月OR 0.71,95％CI 0.30-1.71,P=0.45;6个月OR 0.93,95％CI 0.39-2.21,P=0.88;12个月OR 0.86,95％CI 0.41-1.82,P=0.70).结论 在介入治疗自体内瘘病变方面,与传统PTA相比,DEB血管成形术在短期内(3个月)显示了较好的通畅性,但中长期结果未显示出明显的优势.严格选择DEB的适应证,有助于提高内瘘PTA术后的通畅性.

Objective To compare the hemodynamic effects of two engaging and traditional end-to-side anastomoses by numerical simulating analysis for internal fistula.Methods Two fistula models of end-to-side anastomosis were developed and appropriate boundary conditions, cloud diagram of fluid velocity, pressure, vorticity and streamline diagram formed respectively.Along the center line of anastomotic lumen, the values of pressure, velocity and vorticity were calculated and displayed in an XY graph correspondingly.Results The results of two models with computational fluid dynamics showed that the pressure and velocity gradient of engaging anastomosis were smaller than traditional anastomosis in cloud diagram and the area of vorticity was less than the latter.In streamline diagram, streamline near engaging anastomosis was smoother and less disordered.And XY graph distinctly indicated that pressure and velocity gradient and vorticity intensity of engaging anastomosis were better than those of traditional anastomosis.Conclusion The geometric conformation of engaging anastomosis influences hemodynamics less and contributes more to maintain the patency of internal fistula.Thus the application of engaging end-to-side anastomosis is a kind of approach fitter for geometric design for internal fistula.

目的 探讨百合固金汤治疗慢性阻塞性肺疾病(COPD)稳定期患者的临床效果.方法 选取2016年10月至2018年9月医院收治的96例COPD稳定期患者,按照随机数字表法分为对照组和试验组,各48例.对照组采用常规西医治疗,试验组在对照组基础上加用百合固金汤治疗,比较两组治疗前后的6 min步行试验(6MWT)距离、第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FVC)的百分比(FEV1/FVC)、临床疗效及不良反应.结果 治疗12个月后,两组6MWT距离均延长,FEV1、FEV1/FVC均升高,且试验组优于对照组,差异有统计学意义(P<0.05);试验组治疗有效率(91.67％)高于对照组(70.83％),差异有统计学意义(P<0.05);试验组不良反应发生率(4.17％)低于对照组(22.92％),差异有统计学意义(P<0.05).结论 百合固金汤治疗COPD稳定期患者,可以提高心肺功能及临床疗效,且用药安全性较高.

目的 :探讨福多司坦对老年慢性阻塞性肺疾病(COPD)急性加重期肺功能及呼出气一氧化氮的影响.方法 :选择2018年1月—2019年12月江西省新余市人民医院呼吸内科收治的COPD急性加重期老年患者78例,依据随机对照原则分为对照组和观察组各39例.对照组采用布地奈德同时雾化吸入特布他林治疗,布地奈德1 mg/次,3次/d,特布他林5 mg/次,3次/d.观察组在对照组基础上联合福多司坦片治疗,400 mg/次,3次/d.治疗1周后,观察呼出气一氧化氮(FeNO)、超氧化物岐化酶(SOD)和血清丙二醛(MDA)水平以及肺功能变化情况.结果 :干预后,观察组FeNO、SOD和MDA水平均有改善,其中FeNO、MDA水平低于干预前和对照组(P<0.05),SOD水平则高于干预前和对照组(P<0.05).干预后,观察组的肺功能改善较好,第1秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC均高于干预前和对照组(P<0.05).结论 :福多司坦对老年COPD急性加重期肺功能及呼出气一氧化氮有积极的影响,可以改善FeNO、SOD和MDA水平,恢复患者肺功能,应用价值较高.

目的:本研究探讨高通量血液透析对维持性血液透析患者并发症的影响.方法:以多中心、开放、自身对照方法评价高通量透析对维持性血液透析患者的影响.结果:Revaclear高通量血液透析器在毒素清除、血压改善、透析充分性、血液改善、精神状况方面优于低通量血液透析器.结论:高通量血液透析是目前常规血液透析的发展方向.百特Revaclear高通量透析器能够减少维持性血液透析患者的并发症,提高患者的生存质量.

目的 探讨无创呼吸机治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的疗效.方法 选取300例COPD并Ⅱ型呼吸衰竭患者作为研究对象,按随机数字表法分为观察组和对照组,每组150例.对照组采用常规治疗,观察组在对照组治疗的基础上配合无创呼吸机治疗.比较2组患者治疗前后动脉血气(PaCO2、PaO2和PaO2/FiO2)和肺功能(FEV1、FEV1/FVC和FEV1)改善情况.结果 与治疗前相比,治疗后2组患者的PaCO2值降低,PaO2和PaO2/FiO2值均升高(均P<0.05);治疗后观察组患者的PaCO2值明显低于对照组,PaO2和PaO2/FiO2值均明显高于对照组(均P<0.01).治疗后,2组患者FEV1、FEV1/FVC和FEV1值均较治疗前提高(均P<0.05),但观察组患者的各项值明显高于对照组(均P<0.01).结论 常规治疗配合无创呼吸机治疗COPD合并Ⅱ型呼吸衰竭能有效改善患者的肺功能和动脉血气分析指标.

Objective To explore the prognostic values of pneumonia severity index(PSI)and tracheal mucous IL-6 concentration and pH value in elderly patients with severe community-ac-quired pneumonia.Methods A total of 51 elderly patients with severe community-acquired pneu-monia(>60 years of age)were selected in this study,including PSI class Ⅲ in 14(group A),PSI class Ⅳ in 19(group B)and PSI class Ⅴ in 18(group C).Among these patients,45 recovered and 6 died.Tracheal mucous IL-6 concentration and pH value were measured,and differences were an-alyzed among different groups,as well as between recovered patients and dead patients.Results Compared with group B,tracheal mucous IL-6 concentration increased in group C and decreased in group A,but tracheal mucous pH value increased in group A and decreased in group C(P <0.05).Tracheal mucous IL-6 concentration gradually increased but tracheal mucous pH value gradually decreased in all the three groups.Compared with recovered patients,tracheal mucous IL-6 concentration increased but tracheal mucous pH value decreased in dead patients(P <0.05). Conclusion The high tracheal mucous IL-6 concentration,low pH and high PSI are associated with poor prognosis in elderly patients with severe community-acquired pneumonia.

目的：观察曲美他嗪片治疗腔隙性脑梗死的临床效果。方法：选取我院2013年6月～2015年5月间收治的100例腔隙性脑梗死患者临床资料，依据（0，1）分布随机均分为观察组及对照组。观察组患者运用常规治疗的基础上联合曲美他嗪片口服治疗，对照组采用常规治疗，观察两组患者的治疗效果。结果：观察组患者的总有效率为96.0%，明显高于对照组为82.0%，其差异具有统计学意义（P＜0.05）。结论：曲美他嗪片治疗腔隙性脑梗死效果显著，值得在临床中推广应用。

目的 探讨中-重度稳定期慢性阻塞性肺疾病(COPD)老年患者应用沙美特罗替卡松气雾剂(舒利迭)的最佳剂量.方法 选取2013—2015年新余市人民医院收治的中-重度稳定期COPD老年患者300例,随机分为对照组、低剂量组和高剂量组,各100例.其中对照组患者给予常规治疗,低剂量组和高剂量组患者在对照组基础上分别给予50/250μg、50/500μg舒利迭吸入治疗.观察3组患者治疗前后肺功能、6min步行试验(6-MWD)及动脉血气分析指标、临床症状评分和不良反应发生情况.结果 治疗前3组患者第1秒用力呼气末容积(FEV1)、FEV1/用力肺活量(FEV1/FVC)和FEV1占预计值百分比(FEV1%)、6-MWD比较,差异无统计学意义(P﹥0.05);治疗后低剂量组、高剂量组患者FEV1、FEV1/FVC、FEV1%、6-MWD高于对照组,高剂量组患者FEV1、FEV1/FVC、FEV1%、6-MWD高于低剂量组,差异有统计学意义(P﹤0.05);治疗前3组患者临床症状评分、动脉血气分析指标比较,差异无统计学意义(P﹥0.05),治疗后低剂量组、高剂量组患者临床症状评分、PaCO2低于对照组,高剂量组临床症状评分、PaCO2低于低剂量组,低剂量组、高剂量组患者PaO2高于对照组,高剂量组患者PaO2高于低剂量组,差异有统计学意义(P﹤0.05).3组患者不良反应发生率比较,差异无统计学意义(P﹥0.05).结论 舒利迭能有效改善中-重度稳定期COPD疾病老年患者肺功能、临床症状以及血气分析指标,高剂量时改善效果更佳,且无明显不良反应.

OBJECTIVE:To study the efficacy of intravenous thymosin injection in treatment of AECOPD and effects on T lymphocyte subsets.METHODS:300 cases of AECOPD patients admitted to Xinyu People’s Hospital from Jan.2014 Mar. 2016 were selected to be divided into observation group and control group via the random number table , with 150 cases in each.The control group were given the conventional treatment , while the observation group were treated with intravenous thymosin injection.The efficacy and changes of T lymphocyte subsets of two groups were compared before and after treatment.RESULTS:The total effective rate of observation group was 96.67%(145/150), significantly higher than that of control group[86.00%(129/150)], with statistically significant difference (P<0.05).After treatment, the blood oxygen partial pressure(PaO2), carbon dioxide partial pressure(PaCO2), 1 s forced expiratory volume(FEV1) and FEV1/forced vital capacity (FVC) of observation group were significantly better than those of control group , and CD3+, CD4 +, CD8 +, CD4 +/CD8 +levels were significantly higher than those of control group , with statistically significant difference(P<0.05). CONCLUSIONS:Intravenous injection of thymosin can improve the lung function in patients with acute exacerbation of immune period of COPD and improve the therapeutic effects .

Objective To investigate the application of ring clamp in abdominal tubal ligation. Methods A total of 83 women undergoing voluntary abdominal tubal ligation were randomly divided into two groups. In observation group(n=42),the ring clamp was placed into uterine cavity by circulati-ng nurse to adjust the position of the uterus after the anterior lip of cervix was fixated with vaginal cervical clamp. In control group(n=41), the anterior uterus was restored with index finger and no ring clamp was used in operation. The operative time, success rate and complications were compared between the two groups. Results The operative success rate was 97.62% in observation group and 80.49%in control group(P<0.05).The operative time was(5.0±2.5) minutes in observation group and(12.0± 6.5) minutes in control group. The pelvic operation time was (16.5±5.5) minutes in observation group and(23.0±8.5)minutes in control group. There were significant differences in these parameters between the two groups(P<0.001). However, no significant difference in the incidence of operative complications was found between observation group and control group (2.38% vs 7.32%, P>0.05).Conclusion The application of ring clamp in abdominal tubal ligation can shorten operation time, relieve intraoperative pain and improve operative success rate, but can not reduce operative complications.

资料与方法 临床资料 依据WHO制定的缺血性心脏病命名及诊断标准确诊为不稳定型心绞痛.选取我科2011年10月-2012年10月住院的不稳定型心绞痛患者80例,随机分为治疗组40例,对照组40例.治疗组男25例,女15例;年龄39～80岁,平均(61.5±4.5)岁;其中恶化性心绞痛9例,自发性心绞痛13例,初发劳力性心绞痛18例;合并高血压病26例,糖尿病10例,高血脂18例.对照组男27例,女13例;年龄40～ 79岁,平均(60.8±3.6)岁;其中恶化性心绞痛10例,自发性心绞痛14例,初发劳力性心绞痛16例;合并高血压病24例,糖尿病11例,高血脂19例.两组基础资料比较差异无统计学意义(P＞0.05),具有可比性.

<正>急性有机磷农药中毒是农村常见急诊之一,其发病急、病情重、病程进展快、病死率高,对其除积极对症治疗外,护理质量也至关重要。2010年8月至2012年8月新余市水西镇卫生院共抢救急性有机磷农药中毒患者34例,效果良好,现就其护理体会报告如下。

目的观察生脉注射液联合尿激酶治疗急性心肌梗死的疗效。方法对我院近2年来50例急性心肌梗死患者应用生脉注射液联合尿激酶注射液治疗效果进行分析。结果显效41例,有效8例,死亡1例,总有效率为98%。结论生脉注射液联合尿激酶治疗急性心肌梗死可以显著提高疗效。特别适用于急性心肌梗死伴有血压较低者。

目的探讨纳洛酮治疗肺性脑病的疗效及作用机制。方法对我院近3年来38例肺性脑病住院患者应用纳洛酮治疗的效果进行分析。结果显效26例,有效9例,气管切开抢救1例、死亡1例,总有效率94%。结论纳洛酮能使患者意识状态很快改善,提高治愈率,在缺少机械通气的基层医院,值得推广应用。

目的探讨尼可刹米联合纳洛酮治疗肺性脑病的疗效及作用机制。方法对我院近年来21例肺性脑病住院患者应用尼可刹米联合纳洛酮治疗的效果进行分析。结果显效17例,有效3例,死亡1例,总有效率95%。结论尼可刹米与纳洛酮联合应用治疗肺性脑病有协同作用。