Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe p...Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.展开更多
BACKGROUND During surgery for gastric cancer,peritoneal lavage using warm distilled water can cause temporary hemodynamic changes.AIM To examine the associations between changes in heart rate and single nucleotide pol...BACKGROUND During surgery for gastric cancer,peritoneal lavage using warm distilled water can cause temporary hemodynamic changes.AIM To examine the associations between changes in heart rate and single nucleotide polymorphisms(SNPs).METHODS This was a prospective observational study of patients with gastric cancer who underwent gastrectomy and peritoneal hypotonic lavage at the Third Afliated Hospital of Soochow University from March 2018 to March 2019.Related SNPs were selected,and the verified exons were analyzed.Heart rate and blood pressure(BP)were measured before and after lavage.The patients were grouped as heart rate change≥30%vs<30%.Comparison and regression analyses of the selected SNPs were performed between the two groups.RESULTS According to the inclusion/exclusion criteria,194 patients were included in the analysis.Of these patients,138 were male,with a mean age of 65.9±0.8 years,and 56 were female,with a mean age of 65.0±1.3 years.Heart rate dropped by 0%-10%in 65 participants,by 10%-15%in 29,by 15%-20%in 23,by 20%-50%in 39,by 50%-100%in four,six had a cardiac arrest,and 28 had an increase in heart rate.Considering the possible impact of exonic SNPs on the phenotypes,TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)were analyzed.The haplotype analysis suggested that the haplotypes CTT[odds ratio(OR)=2.018,95%confidence interval(CI):1.012-4.025,P=0.0430]and GCC(OR=2.293,95%CI:1.174-4.477,P=0.0131)of TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)increased the risk of a drop in heart rate>30%.CONCLUSION The TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)SNPs were associated with changes in heart rate≥30%during intraperitoneal lavage using distilled water after gastrectomy for gastric cancer.展开更多
目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021...目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021年10月在我院接受诊治的急性加重期COPD伴发Ⅱ型呼吸衰竭患者124例,分为肺泡灌洗联合NPPV组和NPPV组(n=62)。NPPV组在常规药物治疗的基础上给予NPPV治疗,肺泡灌洗联合NPPV组在NPPV组治疗基础上给予支气管镜下肺泡灌治疗。治疗期间,记录患者的体温、生命体征恢复时间、症状消失时间及不良反应发生情况;治疗前和治疗2 w后,采用肺功能检测系统测定患者第1秒用力呼气容积(Forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占预计值的百分比(The forced expiratory volume in one second as a percentage of the predicted value,FEV1%prep)、第1秒用力呼气容积与用力肺活量的比值(Forced expiratory volume in one second/forced vital capacity,FEV1/FVC),采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、降钙素原(Procalcitonin,PCT)水平,采用免疫比浊法进行检测前白蛋白(Prealbumin,,PAB)水平,采用DxFLEX流式细胞仪检测患者血清CD4^(^(+))、CD8^(+)细胞水平并计算CD4^(+)/CD8^(+)值。结果:治疗后,肺泡灌洗联合NPPV组体温恢复时间、生命体征恢复时间、症状消失时间均少于NPPV组(P<0.05),FEV1、FEV1%prep、FEV1/FVC、PAB水平、CD4^(+)水平、CD4^(+)/CD8^(+)水平均高于NPPV组(P<0.05),TNF-α水平、PCT水平、CD8^(+)水平均低于NPPV组(P<0.05);肺泡灌洗联合NPPV组不良反应发生率与NPPV组比较,差异无统计学意义(P>0.05)。结论:在NPPV基础上联用支气管镜下肺泡灌洗治疗急性加重期COPD伴发Ⅱ型呼吸衰竭患者进行治疗,可改善患者肺功能和临床症状具有积极作用,可有效改善患者免疫功能,缓解机体炎症反应,效果安全可靠。展开更多
目的考察纤维支气管镜肺灌洗联合无创正压通气(NIP-PV)对重症肺部感染C反应蛋白(CRP)和细胞因子的影响。方法选择2012年3月～2013年1月第二军医大学长征医院南京分院确诊为呼吸衰竭的重症肺部感染患者50例(观察组),行纤维支气管镜肺灌...目的考察纤维支气管镜肺灌洗联合无创正压通气(NIP-PV)对重症肺部感染C反应蛋白(CRP)和细胞因子的影响。方法选择2012年3月～2013年1月第二军医大学长征医院南京分院确诊为呼吸衰竭的重症肺部感染患者50例(观察组),行纤维支气管镜肺灌洗联合NIP-PV治疗,选择2012年3月前呼吸衰竭合并重症肺部感染患者50例为对照组,给予常规治疗;比较治疗前及治疗后15 d对照组患者白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)的变化;观察血气指标、治疗效果及并发症情况。结果观察组总有效率[90.0%(45/50)]高于对照组[70.0%(35/50)],差异有统计学意义(P<0.05)。观察组及对照组治疗后15 d IL-6[(9.7±3.9)、(33.3±5.1)ng/L]、IL-8[(18.4±5.8)、(82.1±22.7)ng/L]、TNF-α[(12.0±2.3)、(25.2±7.6)ng/L]和CRP[(4.5±1.9)、(23.5±2.7)mg/L]与同组治疗前比较明显下降,差异均有统计学意义(均P<0.05);观察组治疗后15 d IL-6、IL-8、TNF-α和CRP水平均低于对照组,差异均有统计学意义(均P<0.05)。观察组治疗后15 d血气指标PaO2[(89.6±12.5)mm Hg]、PaCO2[(36.8±4.1)mm Hg]、SaO2[(98.7±5.0)%]、HR[(82.3±8.2)次/min]、RR[(21.6±3.2)次/min]较治疗前明显好转,差异均有统计学意义(均P<0.05)。观察组治疗后15 d PaO2、HR、SaO2和RR均优于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率[24.0%(12/50)]低于对照组[58.0%(29/50)]。结论纤维支气管镜肺灌洗联合NIP-PV可显著降低重症肺部感染患者IL-6、IL-8、TNF-α和CRP水平,改善患者血气指标及预后。展开更多
文摘Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.
文摘BACKGROUND During surgery for gastric cancer,peritoneal lavage using warm distilled water can cause temporary hemodynamic changes.AIM To examine the associations between changes in heart rate and single nucleotide polymorphisms(SNPs).METHODS This was a prospective observational study of patients with gastric cancer who underwent gastrectomy and peritoneal hypotonic lavage at the Third Afliated Hospital of Soochow University from March 2018 to March 2019.Related SNPs were selected,and the verified exons were analyzed.Heart rate and blood pressure(BP)were measured before and after lavage.The patients were grouped as heart rate change≥30%vs<30%.Comparison and regression analyses of the selected SNPs were performed between the two groups.RESULTS According to the inclusion/exclusion criteria,194 patients were included in the analysis.Of these patients,138 were male,with a mean age of 65.9±0.8 years,and 56 were female,with a mean age of 65.0±1.3 years.Heart rate dropped by 0%-10%in 65 participants,by 10%-15%in 29,by 15%-20%in 23,by 20%-50%in 39,by 50%-100%in four,six had a cardiac arrest,and 28 had an increase in heart rate.Considering the possible impact of exonic SNPs on the phenotypes,TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)were analyzed.The haplotype analysis suggested that the haplotypes CTT[odds ratio(OR)=2.018,95%confidence interval(CI):1.012-4.025,P=0.0430]and GCC(OR=2.293,95%CI:1.174-4.477,P=0.0131)of TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)increased the risk of a drop in heart rate>30%.CONCLUSION The TEP1(rs938886),TEP1(rs1713449),and RECQL5(rs820196)SNPs were associated with changes in heart rate≥30%during intraperitoneal lavage using distilled water after gastrectomy for gastric cancer.
文摘目的 探讨经鼻高流量氧疗(HFNC)治疗尘肺全肺大容量灌洗术后合并Ⅱ型呼吸衰竭的疗效和安全性。方法 采用前瞻性研究方法,将入选的尘肺全肺灌洗术后合并Ⅱ型呼吸衰竭的43例患者随机分为HFNC组和无创正压通气(NPPV)组,其中HFNC组22例,NPPV组21例。HFNC组应用经鼻高流量氧疗,NPPV组应用无创呼吸机辅助通气。观察两组的咳痰难度、舒适度、口干程度、呼吸困难缓解时间、呼吸衰竭改善率及并发症。结果 HFNC组患者咳痰难度评分[(1.8±0.7)分vs(3.2±1.1)分]、舒适度评分[(1.1±0.6)分vs(3.1±1.0)分]、口干程度评分[(0.9±0.2)分vs(3.9±0.9)分]均低于NPPV组,呼吸困难缓解所需时间较NPPV组缩短[(53.2±12.7) min vs(123.3±31.5)min],差异均有统计学意义(P<0.05)。2小时呼吸衰竭改善率、呼吸支持时间、血气分析、呼吸频率、心率差异均无统计学意义,两组均无鼻面部损伤,HFNC组胃、肠胀气发生率小于NPPV组(0 vs 19.0%,P=0.048)。结论 HFNC治疗尘肺全肺大容量灌洗术后伴Ⅱ型呼吸衰竭是有效和安全的。
文摘目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021年10月在我院接受诊治的急性加重期COPD伴发Ⅱ型呼吸衰竭患者124例,分为肺泡灌洗联合NPPV组和NPPV组(n=62)。NPPV组在常规药物治疗的基础上给予NPPV治疗,肺泡灌洗联合NPPV组在NPPV组治疗基础上给予支气管镜下肺泡灌治疗。治疗期间,记录患者的体温、生命体征恢复时间、症状消失时间及不良反应发生情况;治疗前和治疗2 w后,采用肺功能检测系统测定患者第1秒用力呼气容积(Forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占预计值的百分比(The forced expiratory volume in one second as a percentage of the predicted value,FEV1%prep)、第1秒用力呼气容积与用力肺活量的比值(Forced expiratory volume in one second/forced vital capacity,FEV1/FVC),采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、降钙素原(Procalcitonin,PCT)水平,采用免疫比浊法进行检测前白蛋白(Prealbumin,,PAB)水平,采用DxFLEX流式细胞仪检测患者血清CD4^(^(+))、CD8^(+)细胞水平并计算CD4^(+)/CD8^(+)值。结果:治疗后,肺泡灌洗联合NPPV组体温恢复时间、生命体征恢复时间、症状消失时间均少于NPPV组(P<0.05),FEV1、FEV1%prep、FEV1/FVC、PAB水平、CD4^(+)水平、CD4^(+)/CD8^(+)水平均高于NPPV组(P<0.05),TNF-α水平、PCT水平、CD8^(+)水平均低于NPPV组(P<0.05);肺泡灌洗联合NPPV组不良反应发生率与NPPV组比较,差异无统计学意义(P>0.05)。结论:在NPPV基础上联用支气管镜下肺泡灌洗治疗急性加重期COPD伴发Ⅱ型呼吸衰竭患者进行治疗,可改善患者肺功能和临床症状具有积极作用,可有效改善患者免疫功能,缓解机体炎症反应,效果安全可靠。
文摘目的考察纤维支气管镜肺灌洗联合无创正压通气(NIP-PV)对重症肺部感染C反应蛋白(CRP)和细胞因子的影响。方法选择2012年3月～2013年1月第二军医大学长征医院南京分院确诊为呼吸衰竭的重症肺部感染患者50例(观察组),行纤维支气管镜肺灌洗联合NIP-PV治疗,选择2012年3月前呼吸衰竭合并重症肺部感染患者50例为对照组,给予常规治疗;比较治疗前及治疗后15 d对照组患者白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)的变化;观察血气指标、治疗效果及并发症情况。结果观察组总有效率[90.0%(45/50)]高于对照组[70.0%(35/50)],差异有统计学意义(P<0.05)。观察组及对照组治疗后15 d IL-6[(9.7±3.9)、(33.3±5.1)ng/L]、IL-8[(18.4±5.8)、(82.1±22.7)ng/L]、TNF-α[(12.0±2.3)、(25.2±7.6)ng/L]和CRP[(4.5±1.9)、(23.5±2.7)mg/L]与同组治疗前比较明显下降,差异均有统计学意义(均P<0.05);观察组治疗后15 d IL-6、IL-8、TNF-α和CRP水平均低于对照组,差异均有统计学意义(均P<0.05)。观察组治疗后15 d血气指标PaO2[(89.6±12.5)mm Hg]、PaCO2[(36.8±4.1)mm Hg]、SaO2[(98.7±5.0)%]、HR[(82.3±8.2)次/min]、RR[(21.6±3.2)次/min]较治疗前明显好转,差异均有统计学意义(均P<0.05)。观察组治疗后15 d PaO2、HR、SaO2和RR均优于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率[24.0%(12/50)]低于对照组[58.0%(29/50)]。结论纤维支气管镜肺灌洗联合NIP-PV可显著降低重症肺部感染患者IL-6、IL-8、TNF-α和CRP水平,改善患者血气指标及预后。
