Analysis of the Effect of Non-Invasive Positive Pressure Ventilation in Emergency Treatment of Severe Bronchial Asthma with Respiratory Failure

Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.

Observation on the Effect of Non-Invasive Ventilator Combined with Conventional Therapy in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective:To explore the clinical effect of a non-invasive ventilator combined with conventional therapy in the treatment of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:68 patients with COPD combined with respiratory failure treated in our hospital from September 2021 to October 2023 were selected as the research subjects.Using the random number table method,they were divided into a control group and an experimental group of 34 cases each.The control group received conventional symptomatic treatment,and the experimental group received non-invasive ventilator treatment based on the control group.The clinical effects,blood gas indicators(partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))),lung function(forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),6 min walking distance),complications,and inflammatory factor levels(c-reactive protein(CRP),interleukin-6(IL-6),neutrophil-to-lymphocyte ratio(NLR))of the two groups of patients were observed.Results:(1)The clinical efficacy of the patients in the experimental group(33/97.06%)was more significant as compared with the control group(25/73.53%)(P<0.05);(2)After treatment,the clinical efficacy of the two groups of patients in terms of FEV1,FEV1/FVC,6-minute walking distance,PaO_(2)and SaO_(2)all increased in the experimental group as compared to that of the control group(P<0.05);(3)After treatment,the PaCO_(2),CRP,IL-6,and NLR of the two groups of patients decreased,and the decrease in the experimental group was higher than that of the control group(P<0.05);(4)The patients’complication rate in the experimental group(2/5.88%)was lower as compared to that of the control group(9/26.46%)(P<0.05).Conclusion:Non-invasive ventilators combined with conventional therapy achieved good clinical results in treating patients with COPD and respiratory failure.

Invasive versus non-invasive ventilation in patients with COVID-19 pneumonia:A retrospective study

Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.Methods:After obtaining approval from the Hospital Director,the data of COVID-19 patients including demographics,type of respiratory support(non-invasive ventilation or invasive ventilation),duration of ventilation,length of stay,discharge,and death were collected and analyzed.Results:Out of the 152 patients identified,134 patients were analyzed.The median intubation days were 10.0(Q1:3.5,Q3:13.5)in the IV group and 0.0(Q1:0.0,Q3:0.0)days in the NIV-only group.Out of the 101 patients who received NIV,43 patients were subsequently intubated due to failure of NIV.Of the 63 patients(47.01%)who died,22(66.66%)were from the IV group and 40(92.02%)were from the NIV-followed-by-intubation group,and 1(1.72%)were from the NIV-only group.Multivariate analysis showed that the presence of a respiratory comorbidity(OR=16.56,95%CI=1.56-175.48,P=0.02)was an independent predictor of survival.Conclusions:Respiratory co-morbidity is a significant adverse predictor of survival outcome.The decision on the type of respiratory support should be made on a patient-to-patient basis.

Application of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU

Objective:To observe the application effect of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU.Methods:A total of 80 patients with acute heart failure merged with respiratory failure who were admitted in ICU from January, 2015 to January, 2016 were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the two groups were given routine treatments after admission. On this basis, the patients in the observation group were given non-invasive ventilator. The patients in the control group were given continuous low flow oxygen inhalation. PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before and after treatment between the two groups were compared. The serum NT-pro BNP and cTnI levels before treatment, 24 h and 48 h after treatment in the two groups were compared.Results:The comparison of PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before treatment between the two groups was not statistically significant. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the two groups were significantly elevated, while PaCO2 was significantly reduced when compared with before treatment. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the observation group were significantly higher than those in the control group, while PaCO2 was significantly lower than that in the control group. The comparison of NT-pro BNP and cTnI levels before treatment between the two groups was not statistically significant. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the two groups were significantly elevated when compared with before treatment. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the observation group were significantly lower than those in the control group.Conclusions:Non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure can effectively improve the ventilation function, reduce NT-pro BNP and cTnI levels, and is of great significance in enhancing the rescued effect.

Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Insights from respiratory virus co-infections

Respiratory viral co-infections present significant challenges in clinical settings due to their impact on disease severity and patient outcomes.Current diagnostic methods often miss these co-infections,complicating the epidemiology and management of these cases.Research,primarily conducted in vitro and in vivo,suggests that co-infections can lead to more severe illnesses,increased hospitalization rates,and greater healthcare utilization,especially in high-risk groups such as children,the elderly,and immunocompromised individuals.Common coinfection patterns,risk factors,and their impact on disease dynamics highlight the need for advanced diagnostic techniques and tailored therapeutic strategies.Understanding the virological interactions and immune response modulation during co-infections is crucial for developing effective public health interventions and improving patient outcomes.Future research should focus on the molecular mechanisms of co-infection and the development of specific therapies to mitigate the adverse effects of these complex infections.

Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective:To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects,and randomly divided into the control group and the experimental group,each with 35 cases.The control group received only conventional treatment,and the experimental group received non-invasive positive pressure ventilation,and the treatment effects and changes in the levels of IL-18,hs-CRP,and CES2 inflammatory factors were observed and evaluated in the two groups.Results:There was no significant difference between the general data of the two groups(P>0.05);after treatment,the total effective rate of clinical efficacy of the observation group(91.43%)was significantly higher than that of the control group(71.43%),and the difference showed a significant correlation(P<0.05);after treatment,the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group,and the difference showed a highly significant correlation(P<0.001).Conclusion:The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect,effectively controls the level of inflammatory factors,and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure,showing a good clinical application prospect.

Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pregnant Patient: A Case Series

Rationale: Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. Currently, there are no guidelines for the management of respiratory failure in pregnancy. Objectives: To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. Methods: We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the paO2/FiO2 ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. Measurements and Main Results: Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 305/7 ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the paO2/FiO2 ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and paO2/FiO2 ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in pa/FiO2 ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. Conclusion: The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.

肺保护通气策略对慢性阻塞性肺疾病模型呼吸功能和血液动力学的影响

目的:本研究旨在不同潮气量和呼气正末压(PEEP)的肺保护通气策略对慢性阻塞性肺疾病COPD模型大鼠呼吸功能和血液动力学的影响。方法:采用烟熏和气管内滴注脂多糖(LPS)法构建COPD大鼠模型。将大鼠随机分为9组,每组10只:对照组和COPD组仅给予气管插管,不给予机械通气;L+P0组、L+P3组、L+P5组、L+P10组在气管插管后分别给予6mL/kg小潮气量和0cm H_(2)O、3cm H_(2)O、5cm H_(2)O、10cm H_(2)O PEEP的机械通气120min;H+P0组、H+P3组、H+P5组、H+P10组在气管插管后分别给予20mL/kg大潮气量和0cm H_(2)O、3cm H_(2)O、5cm H_(2)O、10cm H_(2)O PEEP的机械通气120min。分别在小动物无创呼吸功能监测系统和血气分析仪中测量呼吸功能和血液动力学指标。采用酶联免疫吸附实验检测肺组织和肺泡灌洗液(BALF)中炎症介质的水平。结果:与对照组相比,COPD组大鼠呼吸功能指标和PaO_(2)均明显降低(P<0.05);与COPD组相比,L+P0组、L+P3组、L+P5组呼吸功能指标和PaO_(2)均明显升高(P<0.05),而L+P10组、H+P0组、H+P3组、H+P5组和H+P10组均明显降低(P<0.05);L+P5组呼吸功能指标和PaO_(2)均明显高于L+P0组和L+P3组(P<0.05);与L+P5组相比,L+P10组、H+P0组、H+P3组、H+P5组和H+P10组呼吸功能指标和PaO_(2)均明显降低(P<0.05)。与对照组相比,COPD组肺组织和BALF中IL-8和TNF-α水平显著升高,而IL-10水平显著降低(P<0.05);与COPD组相比,L+P0组、L+P3组、L+P5组IL-8和TNF-α水平显著降低、IL-10水平显著升高(P<0.05),而L+P10组、H+P0组、H+P3组、H+P5组和H+P10组IL-8和TNF-α水平显著升高、IL-10水平显著降低(P<0.05);L+P5组肺组织中IL-8和TNF-α水平显著低于L+P0组和L+P3组,而IL-10水平显著高于L+P0组和L+P3组(P<0.05);与L+P5组相比,L+P10组、H+P0组、H+P3组、H+P5组和H+P10组IL-8和TNF-α水平显著升高,而IL-10水平显著降低(P<0.05)。结论:小潮气量与较高PEEP(如5cm H_(2)O PEEP)的肺保护通气策略能够减轻COPD大鼠的肺部炎症和肺损伤,改善COPD患者呼吸功能和血液动力学。

基于ABCDEF集束策略的量化评估与动态干预策略在呼吸危重症患者中的应用

目的:探讨基于ABCDEF集束策略的量化评估与动态干预策略在呼吸危重症患者中的应用效果。方法:将2022年5月1日~2023年4月1日诊治的呼吸危重症患者60例作为对照组,实施常规护理干预;将2023年5月1日~2024年2月1日收治的60例作为研究组,实施基于ABCDEF集束策略的量化评估与动态干预策略。比较两组临床效果、血气指标、肺功能和并发症。结果:研究组临床总有效率高于对照组(P<0.05);研究组使用抗生素时间和住院时间短于对照组(P<0.05);干预后,两组动脉血二氧化碳分压(PaCO_(2))低于干预前(P<0.05),且研究组低于对照组(P<0.01);干预后,两组动脉血氧分压(PaO_(2))、pH值、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC高于干预前(P<0.05),且研究组高于对照组(P<0.01);研究组并发症发生率低于对照组(P<0.01)。结论:将基于ABCDEF集束策略的量化评估与动态干预策略应用在呼吸危重症患者中,可提高临床疗效,促进患者更快康复,改善血气指标和肺功能,降低并发症发生率。

Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation:A narrative review of bench to clinical studies

Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.

基于目标策略的医院-社区-家庭并轨联动对反复上呼吸道感染患儿的影响

目的:探讨基于目标策略的医院-社区-家庭并轨联动对反复上呼吸道感染患儿遵医行为及家属认知程度的影响。方法:根据随机数字表法将2021年1月1日~2022年6月30日收治的120例反复上呼吸道感染患儿分为对照组和观察组各60例,对照组采取常规护理,观察组采用基于目标策略的医院-社区-家庭并轨联动护理,连续干预1个月;比较两组患儿遵医行为、症状改善情况及并发症发生情况,同时比较干预前后两组家属认知程度及患儿肺功能指标。结果:干预后,观察组患儿总遵医率高于对照组(P<0.05);干预后,两组家属发病机制、临床症状、治疗方法、护理操作评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01);观察组患儿咳嗽消退时间、发热消退时间、气喘时间、肺部湿啰音消退时间、病原菌转阴所需时间、住院时间均短于对照组(P<0.01);干预后,两组患儿用力肺活量(FVC)、第一秒用力呼气容积(FEV_(1))、FEV_(1)/FVC%、呼气流量峰值(PEF)均高于干预前(P<0.05),且观察组高于对照组(P<0.01);观察组并发症总发生率低于对照组(P<0.05)。结论:基于目标策略的医院-社区-家庭并轨联动能有效改善反复上呼吸道感染患儿相关临床症状,提高家属认知程度,促进患儿恢复。

Non-invasive ventilation for acute hypoxemic respiratory failure,including COVID-19

Optimal initial non-invasive management of acute hypoxemic respiratory failure(AHRF),of both coronavirus disease 2019(COVID-19)and non-COVID-19 etiologies,has been the subject of significant discussion.Avoidance of endotracheal intubation reduces related complications,but maintenance of spontaneous breathing with intense respiratory effort may increase risks of patients’self-inflicted lung injury,leading to delayed intubation and worse clinical outcomes.High-flow nasal oxygen is currently recommended as the optimal strategy for AHRF management for its simplicity and beneficial physiological effects.Non-invasive ventilation(NIV),delivered as either pressure support or continuous positive airway pressure via interfaces like face masks and helmets,can improve oxygenation and may be associated with reduced endotracheal intubation rates.However,treatment failure is common and associated with poor outcomes.Expertise and knowledge of the specific features of each interface are necessary to fully exploit their potential benefits and minimize risks.Strict clinical and physiological monitoring is necessary during any treatment to avoid delays in endotracheal intubation and protective ventilation.In this narrative review,we analyze the physiological benefits and risks of spontaneous breathing in AHRF,and the characteristics of tools for delivering NIV.The goal herein is to provide a contemporary,evidence-based overview of this highly relevant topic.

基于目标策略的针对性护理结合序贯式排痰护理方案对重症卒中气管切开患者呼吸状态及排痰情况的影响

目的探讨基于目标策略的针对性护理结合序贯式排痰护理方案在重症卒中气管切开患者中的应用。方法选择2021年4月至2022年6月我院收治的100例重症卒中气管切开患者为研究对象,根据入院时间将其分为对照组和观察组,各50例。对照组接受常规护理,观察组在对照组护理基础上给予基于目标策略的针对性护理结合序贯式排痰护理方案。比较两组的干预效果。结果出ICU时,观察组的呼吸系统动态顺应性(Cdyn)高于对照组,气道阻力(Raw)低于对照组(P<0.05)。观察组的每日排痰量和痰液黏稠度Ⅰ度占比高于对照组(P<0.05)。出ICU时,观察组的C反应蛋白/白蛋白比值(CAR)、单核细胞/淋巴细胞比率(MLR)低于对照组(P<0.05)。结论基于目标策略的针对性护理结合序贯式排痰护理方案用于重症卒中气管切开患者护理中,可改善排痰情况,调节炎症状态,促进呼吸状态恢复,值得推广。

南阳市儿童反复呼吸道感染与肠道微生态变化的相关性调查

目的:分析南阳市儿童反复呼吸道感染(RRTI)患儿临床特征与肠道微生态状况的相关性,为RRTI患儿的预防及治疗方案制定提供参考。方法:选取2018—2021年河南大学附属南阳市第一人民医院收治的218例符合条件的RRTI患儿作为RRTI组,按照1∶1比例纳入同期同医院行健康体检的218名儿童作为传统组。收集所有纳入受试儿童的年龄、性别、喂养方式、体重、身高等信息并分组比较。明确并整理观察组患儿感染部位、1年内感染频次、淋巴细胞百分比(CD3+、CD4+、CD4+/CD8+)数据。应用16S rRNA荧光定量PCR检测所有受试儿童肠道中双歧杆菌和大肠杆菌菌落数,计算B/E值并行组间比较。比较观察组患儿中不同感染部位、不同感染频次、不同淋巴细胞百分比范围患儿双歧杆菌、大肠杆菌、双歧杆菌与大肠杆菌比值(B/E值)。以B/E值<1为肠道微生态紊乱,分析反复呼吸道感染患儿感染部位、不同感染频次、不同淋巴细胞百分比与肠道微生态异常间的相关性。结果:RRTI组患儿肠道双歧杆菌菌落数、B/E值明显低于传统组受试儿童,大肠杆菌数明显高于传统组,差异均有统计学意义(t=12.727、22.466、24.572,P<0.05);RRTI患儿下呼吸道感染、1年内感染频次与肠道微生态紊乱呈负相关(r=-0.621、-0.703);治疗后,RRTI组患儿CD3+、CD4+/CD8+高于传统组、CD4+低于传统组,差异均有统计学意义(t=5.312、4.799、4.424,P<0.05);治疗后,RRTI组患儿大肠埃希菌、肠球菌数量低于传统组、双歧杆菌数量低于传统组,差异均有统计学意义(t=5.874、6.031、8.192,P<0.05)。结论:南阳市儿童反复呼吸道感染相关指标与肠道微生态紊乱呈高度相关,临床应高度关注反复呼吸道感染患儿的肠道微生态平衡调整,以期提高反复呼吸道感染防治效率,促进儿童健康水平。

磁共振影像学改变评估肝癌立体定向放疗精度的研究进展

在原发性肝癌和转移性肝癌治疗中,可以采用立体定向放射治疗技术(SBRT)给予肿瘤高剂量以达到消融治疗的效果。由于SBRT单次高剂量的特点,使其对放疗精度有更高的要求。尤其是肝癌受摆位误差与呼吸运动的影响,需要同时使用呼吸运动管理和影像引导。然而,现有研究者报道的放疗精度验证均使用模体进行间接验证,而不是在患者治疗实施过程中进行在体验证,使得最终的治疗精度受到怀疑。肝脏在接受一定放射治疗剂量后会在磁共振影像中呈现相应的形态学改变,可以反映放射治疗的精度。该文将就肝癌体部立体定向放射治疗后磁共振影像改变的发生原理、表现形式和出现时间、精度评价方式、临床困境及未来发展方向进行讨论分析。

反复呼吸道感染儿童的维生素D营养状况、影响因素及干预策略

目的 分析反复呼吸道感染(RRTIs)儿童的维生素D(VitD)营养状况、影响因素及干预策略。方法 选取82例RRTIs患儿作为研究对象,采用荧光免疫竞争法定量测定VitD水平,将VitD充足{25-羟维生素D[25-(OH) D] 50~250 nmol/L}的患儿归为VitD正常组(n=44),VitD不足及缺乏[25-(OH)D<50 nmol/L]的患儿归为VitD缺乏组(n=38)。利用病历资料统计及问卷调查的方式收集两组患儿相关资料,采用Logistic多因素回归分析RRTIs儿童VitD缺乏的危险因素。结果 VitD正常组母亲文化程度初中及以下、母乳喂养、厌食、深海鱼类摄入<1次/周、贫血和鱼肝油服用不规律占比分别为9.09%、13.64%、18.18%、6.82%、4.55%、11.36%,VitD缺乏组分别为47.37%、39.47%、39.47%、28.95%、26.32%、39.47%。VitD正常组和VitD缺乏组母亲文化程度、哺乳期喂养方式、厌食情况、深海鱼类摄入情况、贫血情况及鱼肝油服用情况存在差异(P<0.05)。两组年龄、性别、居住地、日均户外活动时间及反复腹泻情况比较无差异(P>0.05)。Logistic多因素回归分析显示,母亲文化程度初中及以下、母乳喂养、厌食、深海鱼类摄入<1次/周、贫血和鱼肝油服用不规律是RRTIs儿童VitD缺乏的危险因素(P<0.05)。结论 RRTIs儿童的VitD属于不足水平,母亲文化程度初中及以下、母乳喂养、厌食、深海鱼类摄入<1次/周、贫血和鱼肝油服用不规律是RRTIs儿童VitD缺乏的危险因素,应加强儿童保健的科普教育,降低RRTIs儿童VitD缺乏的发生率。

基于循证理论的集束化护理结合预见性护理策略对新生儿肺炎康复进程及呼吸力学指标的影响

目的探讨基于循证理论的集束化护理结合预见性护理策略在新生儿肺炎中的应用效果。方法选取2020年1月至2022年6月我科收治的68例新生儿肺炎患儿,以随机数字表法将其分为对照组和观察组,各34例。对照组实施常规护理,观察组实施基于循证理论的集束化护理结合预见性护理策略。比较两组的干预效果。结果观察组的咳嗽缓解时间、呼吸困难消失时间、哮鸣音消失时间、痰鸣音消失时间及住院时间均短于对照组(P<0.05)。干预后,观察组的用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))及呼气峰值流速(PEF)均高于对照组(P<0.05)。观察组的不良事件总发生率低于对照组(P<0.05)。观察组家属的护理满意度高于对照组(P<0.05)。结论基于循证理论的集束化护理结合预见性护理策略能加快新生儿肺炎康复进程,改善呼吸力学指标,降低不良事件发生率,提高家属的护理满意度,值得推广。

急性呼吸窘迫综合征的右心功能评估与保护策略研究进展

中重度急性呼吸窘迫综合征往往合并右心功能损伤,急性右心功能障碍破坏血流动力学的稳定,是ARDS死亡的主要风险因素。右心不仅是连接体循环和肺循环的通路,而且具有储器功能和泵功能,在血液循环中始终发挥着不可忽视的作用。急性呼吸窘迫综合征发生时,只有综合分析右心功能及其前后负荷变化、维持右室收缩力、优化右室充盈压和降低右心后负荷,才能更好地预防和处理ARDS合并急性右心衰竭。