Predictive role of interleukin-6 and CAT score in mechanical ventilation in patients with chronic obstructive pulmonary disease at the acute exacerbation stage in the emergency department

BACKGROUND:The study aimed to evaluate the predictive role of interleukin-6(IL-6)and chronic obstructive pulmonary disease(COPD)assessment test(CAT)score in mechanical ventilation(MV)in COPD patients at the acute exacerbation stage in the emergency department(ED).METHODS:For a one-year period,among adult patients in the ED who met the criteria of acute exacerbation of COPD,158 who received MV within 48 hours after admission were compared to 294 who didn't require MV within the same period after admission.IL-6 level and CAT score were compared between the two groups.The predicted value of IL-6 and CAT score was assessed by logistic regression analysis and a receiver operating characteristic(ROC)curve.RESULTS:The IL-6 and CAT scores in the 158 MV patients were much higher than those without.IL-6 and CAT scores were independent predictors of MV within 48 hours using logistic regression analysis(IL-6:odds ratio[OR]1.053,95%confidence interval[CI]1.039–1.067,P<0.001;CAT score:OR 1.122,95%CI 1.086–1.159,P<0.001).The combination of IL-6 and CAT scores(area under ROC curve[AUC]0.826,95%CI 0.786–0.866,P<0.001)improved the accuracy of predicting MV within 48 hours when compared with IL-6(AUC 0.752,95%CI 0.703–0.800,P<0.001)and CAT scores alone(AUC 0.739,95%CI 0.692–0.786,P<0.001).The sensitivity and specificity were 69.6%,74.1%,75.32%and 63.6%,respectively.CONCLUSION:The combined of IL-6 and CAT scores is useful for evaluating the risk of COPD patients at acute exacerbation in ED,and can provide a predictive value for MV or not within 48 hours.

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: How can patients be better selected?

Chronic thromboembolic pulmonary hypertension (CTEPH) comprises organizing thrombotic obstructions in the pulmonary arteries by nonresolving thromboemboli, formation of fibrosis and remodeling of pulmonary blood vessels. Surgical pulmonary endarterectomy (PEA) is the therapy of choice for patients with surgically accessible CTEPH, which leads to a profound improvement in hemodynamics, functional class and survival. Select- ing the candidates that will benefit from surgery is still a challenging task. Criteria for surgical suitability have been described but the decision-making for or against surgical intervention remains still subjective. The optimal characterization of the reciprocal contribution of large vessel and small vessel disease in the elevation of pulmonary vascular resistance is crucial for the indication and outcome of PEA. Recently, Toshner et al intended to validate the partition resistance into small and large vessels compartments (upstream resistance:Rup) by the occlusion technique in the preoperative assessment of PEA. We discuss the advantages and disadvantages of Rup and compare it with other hemodynamic predictor to evaluate operative risk in CTEPH patients.

Comparison of diagnostic accuracy between ^(18)F-FDG PET and PET/CT for pulmonary neoplasm

Aimed at comparing diagnostic accuracy of 18F-FDG PET with PET/CT for pulmonary neoplasm, a study based on multi-center clinical trial of the diagnoses, in randomized and semi-blind ways, was executed from January 2006 to June 2007. It included 55 patients, i.e. 16 with histopathologically proved lung tumors, 16 with tuberculosis and 23 with benign lesions (inflammation, pseudotumor, granuloma, fibrosis and others). The histopathologic and clinic results were served as reference standard. Statistical significances in pulmonary nodule diagnosis between 18F-FDG PET and PET/CT were determined with 95% confidence interval obtained by ROC analysis. The 18F-FDG PET detected lung neoplasm with a sensitivity of 87.5% (14/16), a specificity of 59.0% (23/39), an accuracy of 67.3% (37/55) and a positive-likelihood ratio of 2.13. The 18F-FDG PET/CT detected lung neoplasm with a sensitivity of 93.8% (15/16), a specificity of 61.5% (24/39), an accuracy of 70.9% (39/55) and a positive-likelihood ratio of 2.43. The area under curves (AUC) of 18F-FDG PET and PET/CT were 0.803±0.068 and 0.799±0.063, respectively. It can be concluded that the diagnostic accuracy for malignant pulmonary nodules between 18F-FDG PET and PET/CT was not statistically different.

Long-Term Outcome and Risk Factor Analysis of Surgical Pulmonary Valve Replacement in Congenital Heart Disease

Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020.We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs.The previous surgical history of patients who underwent PVR during the study period was also included.Patients who underwent the Rastelli operation,and those who underwent single PVR without previous open-heart surgery were excluded.Results:The median age of the patients at the time of surgical PVR was 14.9 years(Interquartile range,IQR,11.0–22.0).The median follow-up duration was 10.5 years(IQR,5.5–14.8 years).There were 3 patients with operative mortality(1.0%)and 15 patients with overall mortality(5.1%).The survival rate was 95.1%over 20 years follow-up period.Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR,older age at the first operation,longer cardiopulmonary bypass(CPB)time and longer intensive care unit(ICU)stay were predictors for overall mortality.Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times(P<0.001).Age younger than 10 years,male,multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis.Conclusions:Though surgical PVR has excellent long-term outcome,it should be performed with caution for those who previously underwent multiple open-heart surgeries,especially if patient received more than 3 times of open-heart surgeries.

Pulmonary cavernous hemangioma: a case report

We report a rare case of pulmonary cavernous hemangioma in a 51-year-old female. A computed tomographic scan of the chest showed an ill-defined mass measuring 2.3 cm × 2.2 cm in the right lower lobe. Surgical resection was performed and postoperative histological examination revealed cavernous hemangioma. We reviewed the clinical features and therapeutic methcds of hemangioma.

The Effect Analysis of Different Experimental Methods for the Diagnosis of Invasive Pulmonary Aspergillosis in a Rat Model

Background: Consensus on the most reliable assays to detect invasive aspergillosis from minimally or noninvasive samples has not been reached. In this study, we compared the efficacy of an enzyme-linked immunosorbent assay (ELISA) for galactomannan (GM) detection and quantitative real-time PCR assay (qRT-PCR) for the diagnosis of invasive pulmonary aspergillosis in a rat model. Methods: Neutropenic, male Sprague-Dawley rats (specific pathogen free;8 weeks old;weight, 200 ± 20 g) were immunosuppressed with cyclophosphamide and infected with Aspergillus fumigatus intratracheally. Tissue and whole blood samples were harvested on days 1, 3, 5, and 7 post-infection and examined with GM ELISA and qRT-PCR. Results: On day 7, A. fumigatus DNA was amplified from 14 of 48 whole blood samples from immunosuppressed infected rats: day 1 (0/12), day 3 (0/12), day 5 (6/12), day 7 (8/12) post infection. The sensitivity and specificity of the qRT-PCR assay were 29.2% and 100%, respectively. Receiver operating characteristic curve (ROC) analysis indicated a Ct cut-off value of 15.35, and the area under the curve (AUC) was 0.627. The GM assay detected antigen in sera obtained on day 1 (5/12), day 3 (9/12), day 5 (12/12), and day 7 (12/12) post-infection, and thus had a sensitivity of 79.2% and a specificity of 100%. The ROC of the GM assay indicated that the optimal cut-off value was 1.40 (specificity, 100%;AUC, 0.919). Conclusions: The GM assay was more sensitive than qRT-PCR assay in diagnosing invasive pulmonary aspergillosis in rats.

超声心动图在矫正型大动脉转位患儿二期双调转术中的应用价值

目的 探讨超声心动图在矫正型大动脉转位(CTGA)患儿二期双调转术(DS)中的应用价值。方法 选取于外科行二期DS的17例CTGA患儿,分析超声心动图对其肺动脉环扎(PAB)术前诊断情况,比较PAB术前、后左心室形态及血流动力学情况;应用超声心动图观察DS术前、后左心室血流动力学变化。结果 17例CTGA患儿,PAB术前超声心动图准确诊断15例(88.24%);误诊2例(11.76%),均误诊为房室连接不一致型右心室双出口。PAB术后肺动脉内径、三尖瓣反流束宽均缩小,左心室舒张末期内径、左心室收缩末期内径、左心室后壁舒张末期厚度、室间隔舒张期厚度、左心室质量及肺动脉血流速度均明显增大,反流程度减轻,与PAB术前比较差异均有统计学意义(均P<0.05)。DS术后左心室心肌做功指数(MPI)明显增大,右心室MPI、左心室射血分数均明显减低,与DS术前比较差异均有统计学意义(均P<0.05);6例合并心功能不全(3例死亡,3例随访中)患儿中,室间隔完整3例,合并室间隔缺损3例(缺损直径分别为0.13 cm、0.15 cm、0.18 cm);11例心功能正常患儿室间隔缺损直径平均(0.37±0.18)cm。结论 超声心动图可准确诊断CTGA,CTGA患儿PAB术后左心室质量明显提高,可行DS;DS术后近期易合并心功能不全及主动脉瓣反流。

四君补肺汤治疗NSCLC根治术后咳嗽的疗效及对肺功能、炎性因子的影响

目的:观察四君补肺汤治疗非小细胞肺癌(NSCLC)根治术后咳嗽的疗效及对肺功能、炎性因子的影响。方法:选取2021年1月~2023年1月我院收治的NSCLC根治术后咳嗽患者150例,以随机数表法分为研究组与对照组,各自75例,给予对照组患者术后常规治疗,研究组则在对照组基础上予以四君补肺汤治疗。比较两组临床疗效,治疗前后的莱斯特咳嗽量表(LCQ-MC)评分、肺功能[1秒用力呼气容积(FEV 1 )、用力肺活量(FVC)、呼气峰值流速(PEF)]、炎性因子[白介素-4(IL-4)、白介素-6(IL-6)、白介素-10(IL-10)、γ干扰素(IFN-γ)]水平,并统计治疗期间患者不良反应的发生情况。结果:治疗后研究组临床疗效的总有效率为90.67%,高于对照组的77.33%( P <0.05)。治疗后两组患者LCQ-MC各维度评分、FEV 1 、FVC、PEF、IFN-γ水平较治疗前增加,且研究组高于对照组( P <0.05);同时日间咳嗽与夜间咳嗽评分、IL-4、IL-6及IL-10水平较治疗前减少,且研究组低于对照组( P <0.05)。此外,两组患者不良反应发生率之间的差异不显著( P >0.05)。结论:四君补肺汤改善NSCLC患者根治术后咳嗽的临床疗效确切,能有效缓解患者咳嗽症状,同时能改善肺功能与机体炎性反应,值得推荐。

法洛四联症合并肺动脉闭锁的先天性心脏病1例并文献复习

法洛四联症(TOF)是最常见的紫绀型先天性心脏病,肺动脉闭锁(PA)也是一种较为复杂的先天性心脏畸形。本文对滨州医学院附属医院收治的1例TOF合并PA的先天性心脏病进行报道,手术方案采用外科生物补片进行肺动脉瓣的重建,缝至右心室切口到原肺动脉瓣处以抗肺动脉瓣反流,最后总结TOF/PA的临床表现、影像诊断、手术方案及未来的治疗前景等。

高尿酸血症与慢性肺源性心脏病的相关性研究:基于LASSO回归与倾向性评分匹配法

背景近年来众多研究表明高尿酸血症(HUA)是某些疾病的影响因素,然而HUA是否为慢性肺源性心脏病(CPHD)的影响因素仍需进一步研究。目的探讨HUA与CPHD的相关性,旨在为CPHD患者血尿酸(SUA)水平的管理提供理论依据。方法纳入2019—2023年新疆医科大学第一附属医院收治的1171例慢性阻塞性肺疾病(COPD)患者为研究对象,根据其是否患有CPHD分为CPHD组(470例)和COPD组(701例)。收集患者一般资料和实验室检查及超声心动图检查结果。采用LASSO回归法对变量进行筛选,采用倾向性评分匹配法(PSM)排除混杂因素影响。采用多因素Logistic回归分析探究COPD患者合并CPHD的影响因素。结果CPHD组女性、汉族、吸烟、饮酒、特发性肺纤维化、慢性支气管炎、支气管哮喘比例、淋巴细胞百分比、左心室舒张末期内径、左心室收缩末期内径、心输出量、左心室射血分数低于COPD组,心功能3~4级、HUA、肺栓塞、先天性心脏病比例、红细胞计数、中性粒细胞百分比、SUA、血尿素氮、D-二聚体、N末端-B型利钠肽前体、右心房内径、右心室内径、左心房内径、右心室流出道内径、肺动脉内径高于COPD组,差异有统计学意义(P<0.05)。LASSO回归筛选出变量后进行PSM,最终得到COPD组469例、CPHD组469例。匹配后CPHD组心功能3~4级、HUA占比、右心房内径、右心室内径、右心室流出道内径、肺动脉内径大于COPD组,支气管哮喘、淋巴细胞百分比低于COPD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HUA升高、心功能3~4级、右心房内径、右心室内径、肺动脉内径增加是COPD患者合并CPHD的危险因素(P<0.05),患有支气管哮喘、左心室舒张末期内径增加为COPD患者合并CPHD的保护因素(P<0.05)。将SUA水平按四分位数分层,多因素Logistic回归分析结果显示,与Q1(SUA<237.31μmol/L)比较,Q4(SUA>381.29μmol/L)患者患有CPHD的风险增加1.421倍。结论HUA是CPHD疾病发生、发展的影响因素,积极控制SUA水平有助于预防CPHD的发生、发展。

Comparative analysis of early and middle outcomes of the arterial switch operation in children with complete transposition of the great arteries with ventricular septal defect and severe pulmonary artery hypertension

Background The best age for the arterial switch operation （ASO） in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months. This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes. There are few reports on ASO surgery in children older than three years old. Methods We studied 41 children, including 24 males and 17 females, from January 2010 to December 2011. They were divided into three groups by operation age; 15 patients were 〈1 year old, 13 were 1-3 years old, and 13 were 〉3 years old. Associated cardiac abnormalities included patent ductus arteriosus in six cases, atrial septal defect in five cases, and mitral regurgitation in two cases. All the patients had echocardiography before the operation. Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization. All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass. Results Three operative deaths occurred. Two were in the 〈1 year old group, who died from severe postoperative low cardiac output. The other was two years old and died of postoperative multiple organ failure. There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups. Thirty-eight cases were followed up for an average of 11.2 months, ranging 6-20 months. One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning. Three patients more than three years old still had residual pulmonary arterial hypertension. Conclusion Children older than three years old can still undergo the ASO procedure, but residual pulmonary hypertension is present.

基于Nomogram模型鉴别肺腺癌病理亚型的临床价值

目的 探讨基于最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)回归分析构建Nomogram模型预测原位腺癌(AIS)、微浸润腺癌(MIA)及浸润性腺癌(IAC)的价值。方法 选取本院97例经手术病理证实且病理亚型明确的肺腺癌患者,将AIS和MIA归为第1组,IAC为第2组,比较两组患者年龄、性别、吸烟史、长径、短径及免疫组化Ki-67等临床医学特征差异,采用3D Slicer软件进行图像分割,特征提取与选择,通过LASSO算法对特征进行降维,筛选影像组学特征构建预测模型。再采用R软件的rms工具包构建Nomogram模型,计算ROC曲线下面积(AUC),以评价Nomogram模型鉴别肺磨玻璃结节病理亚型的效能。结果 1)性别、吸烟史、长径、短径及免疫组化Ki-67等临床医学特征均差异无统计学意义(P>0.05);2)筛选7个CT影像组学特征:平面度、大依赖低灰度强调、小波变换LHL第十百分位、小波变换HLL第十百分位、小波变换最小值、小波变换均值及小依赖低灰度强度比较,差异均有统计学意义(P均<0.05);3)基于CT影像组学特征建立预测肺磨玻璃结节病理亚型的Nomogram模型,训练集中AUC为0.863,准确率为87.9%,灵敏度为67.9%,特异度为91.1%;验证集中AUC为0.792,准确率为75.0%,灵敏度为66.7%,特异度为90.5%,可见此Nomogram模型具有较好的预测效能。结论 对于预测肺腺癌浸润程度,Nomogram模型具有明显优势,可作为一种鉴别手段。

胃癌腹腔镜根治术后肺部感染的Clavien-Dindo分级、高危因素及预防措施分析

目的 探讨胃癌腹腔镜根治术后肺部感染的Clavien-Dindo分级情况、危险因素及预防措施,并构建预测模型。方法 回顾性选取2021年7月至2023年7月于本院接受腹腔镜根治术治疗的268例胃癌患者。以其术后肺部感染情况分为感染组与未感染组,分别为33例、235例。采用单因素、多因素分析其术后发生肺部感染的高危因素,根据所筛选出的高危因素进行预测模型构建,并绘制受试者工作特征曲线(ROC),对该模型的胃癌患者腹腔镜根治术后肺部感染预测价值进行分析,获取其曲线下面积(AUC)、敏感度、特异度。结果 268例胃癌患者中33例发生术后肺部感染,感染率为12.31%。Clavien-Dindo分级主要集中为Ⅱ级。经单因素、多因素分析,胃癌患者腹腔镜根治术后肺部感染的高危因素为年龄≥65岁、胃管留置时间≥3 d、术前血清白蛋白水平低(OR分别为3.449、3.180、2.824,P<0.05)。构建回归模型并按照预测概率logit(P)绘制ROC曲线,当logit(P)>12.95时,AUC值为0.897,敏感度为84.85%,特异度为78.72%,预测价值良好。结论 年龄≥65岁、胃管留置时间≥3 d、术前血清白蛋白水平低为胃癌患者腹腔镜根治术后肺部感染的危险因素,据此构建回归模型的预测价值较高,临床可对发生术后肺部感染的高危群体进行针对性干预以降低其感染风险。

熵指数联合保护性肺通气对老年腹腔镜结肠癌根治术患者肺功能、血流动力学及血气指标的影响

目的观察熵指数联合保护性肺通气对老年腹腔镜结肠癌根治术患者肺功能、血流动力学及血气指标的影响。方法以回顾性分析为法,观察对象为2020年10月至2023年2月山西白求恩医院入院的70例老年腹腔镜结肠癌根治术患者,参考治疗方式不同分为常规组(n=23)、保护组(n=23)和联合组(n=24)。常规组给予常规肺通气治疗,保护组给予保护性肺通气治疗,联合组给予熵指数联合保护性肺通气治疗。比较3组患者不同时间段[气管插管后(T_(0))、气腹后30 min(T_(1))、气腹后1.5 h(T_(2))、气腹停止后10 min(T_(3))]的肺功能指标(呼吸指数、氧合指数)、血流动力学指标[平均动脉压(MAP)、心率]、血气指标[动脉血二氧化碳分压(PCO_(2))、动脉血氧分压(PaO_(2))]、呼吸力学指标[肺顺应性(CL)、气道峰压(Ppeak)、平均气道压(Pmean)]与术中麻醉药用量(罗库溴铵、舒芬太尼)、术后苏醒时间、拔管时间、呼吸恢复时间及并发症(呼吸衰竭、肺栓塞、肺不张、低氧血症)发生率。结果3组患者T_(1)、T_(2)、T_(3)的呼吸指数、氧合指数、MAP、PaO_(2)、Ppeak、Pmean均明显高于T_(0),T_(1)、T_(2)、T_(3)的CL明显低于T_(0),差异均有统计学意义(P<0.05);保护组、联合组T_(1)、T_(2)、T_(3)的呼吸指数、氧合指数、PaO_(2)、CL均明显高于常规组,Ppeak、Pmean均明显低于常规组,差异均有统计学意义(P<0.05);且联合组T_(1)、T_(2)、T_(3)的呼吸指数、氧合指数、PaO_(2)、CL均明显高于保护组,Ppeak、Pmean均明显低于保护组,差异均有统计学意义(P<0.05)。3组患者心率、PCO_(2)组间、组内比较,差异均无统计学意义(P>0.05)。保护组、联合组患者麻醉药用量明显少于常规组,苏醒、拔管及呼吸恢复时间均明显短于常规组,差异均有统计学意义(P<0.05);且联合组患者麻醉药用量明显少于保护组,苏醒、拔管及呼吸恢复时间均明显短于保护组,差异均有统计学意义(P<0.05)。保护组、联合组的麻醉药用量明显少于常规组,苏醒、拔管及呼吸恢复时间均明显短于常规组,并发症发生率明显低于常规组,差异有统计学意义(P<0.05),保护组、联合组比较差异有统计学意义(P<0.05)。保护组、联合组患者总并发症发生率分别为17.39%、0,明显低于常规组(47.83%),且联合组患者并发症发生率明显低于保护组,差异均有统计学意义(P<0.05)。结论熵指数联合保护性肺通气用于老年腹腔镜结肠癌根治术中的临床效果显著,可改善患者肺功能、血气及呼吸力学,还可减少麻醉药用量,缩短患者苏醒、拔管及呼吸恢复时间,且并发症少,安全性高。

Reconstruction of a new pulmonary artery in arterial switch operation

Background:This study was undertaken to evaluate the new method for the reconstruction of the pulmonary artery in arterial switch operation(ASO).Methods:A total of 108 consecutive infants with congenital heart disease were treated with ASO in our department between January 2004 and June 2012.The new pulmonary arterial root was reconstructed with a fresh autologuos pericardium which was clipped pants­like with continuous mattress suture of 6-0 Prolene thread.Patients were reexamined consecutively at 3 and 6 months and 1,2 and 6 years after discharge.The pulmonary arterial blood velocity was measured by continuous Doppler during systole.The pulmonary flow of healthy children of same age was also measured in the control group.Simplified Bernoulli formula was used to calculate the pressure gradient via the pulmonary artery for determining whether there was pulmonary stenosis.Results:In this series,96 infants survived after the surgery and 88 were followed up with a mean peirod of(22±4)months.No pulmonary stenosis was detected with the simplified Bernoulli formula.Conclusion:No pulmonary stenosis was detected with the simplified Bernoulli formula.

老年肺癌患者术前气道定植菌及术后肺部并发症发生的相关因素研究

目的探讨老年肺癌患者术前定植菌及术后肺部并发症发生的危险因素。方法回顾性分析80例老年肺癌患者的临床资料。所有患者术前均行气道定植菌筛查,依据是否存在气道定植菌分阳性组与阴性组,分析老年肺癌患者术前气道定植菌的危险因素;术后依据是否发生肺部并发症分为发生组与未发生组,分析影响老年肺癌患者术后肺部并发症的危险因素。结果80例老年肺癌患者中气道定植菌阳性率为37.50%(30/80),术后肺部并发症发生率为36.25%(29/80);单因素分析显示,SP-D、吸烟史与老年肺癌患者术前气道定植菌有关(P<0.05);多因素显示,SP-D<30 ng/ml、吸烟为影响老年肺癌术前气道定植菌的高危因素(P<0.05且OR>1);单因素显示,年龄、SP-D、吸烟史、气道定植菌、手术时间与老年肺癌术后肺部并发症的发生有关(P<0.05);多因素显示,年龄≥70岁、SP-D<30 ng/ml、吸烟、气道定植菌阳性、手术时间≥2 h为老年肺癌术后肺部并发症发生的高危因素(P<0.05且OR>1)。结论老年肺癌患者受SP-D<30 ng/ml、吸烟等影响,术前气道定植菌阳性较高,而年龄≥70岁、SP-D<30 ng/ml、吸烟、气道定植菌阳性、手术时间≥2 h为老年肺癌术后肺部并发症发生的高危因素,临床据此在围术期采取针对性干预措施,以降低术后肺部并发症风险。

重型颅脑损伤的手术室护理方法及效果

目的:浅析重型颅脑损伤的手术室护理方法及效果.方法:选取我院2019年8月—2020年6月收治的60例重型颅脑损伤患者为研究对象,用奇偶数列法1∶1分组,研究组患者运用综合性手术室护理,对照组患者运用传统手术室护理,比较2组抢救效果.结果:研究组生存率比对照组高,并发症发生率比对照组低,组间差异有统计学意义(P<0.05);研究组手术准备时间、住院时间均短于对照组,格拉斯哥昏迷评分高于对照组,组间差异有统计学意义(P<0.05).结论:在重型颅脑损伤治疗中综合性手术室护理有着良好的应用效果,值得推广应用.

变态反应性支气管肺曲菌病患者血清IgE和嗜酸粒细胞水平及其临床意义

目的探讨变态反应性支气管肺曲菌病(ABPA)患者临床特征及血清免疫球蛋白E(IgE)、嗜酸粒细胞水平变化,分析其对ABPA的诊断效能。方法回顾性分析2016年3月至2024年3月收治的210例ABPA患者(观察组)和200例同期体检健康志愿者(对照组)的临床资料,比较2组血清IgE、嗜酸粒细胞计数、嗜酸粒细胞百分比。分析ABPA患者的肺功能、影像学特征,比较不同临床特征ABPA患者血清IgE、嗜酸粒细胞计数、嗜酸粒细胞百分比,并分析血清IgE与嗜酸粒细胞计数相关性。受试者工作特征曲线分析血清IgE、嗜酸粒细胞计数对ABPA的诊断效能。结果ABPA患者临床表现主要为咳嗽、咳痰、喘息;肺功能主要表现为阻塞性通气功能障碍,影像学特征以支气管扩张、黏液栓为主。ABPA患者血清烟曲霉特异性IgE为(8.76±2.97)kU/L、特异性免疫球蛋白G为(2294.85±654.13)U/mL。观察组血清IgE、嗜酸粒细胞计数、嗜酸粒细胞百分比高于对照组(P<0.05)。病程≥12个月ABPA患者血清IgE水平明显高于病程<12个月患者,有支气管扩张、黏液栓影像学征象ABPA患者嗜酸粒细胞计数水平高于无支气管扩张、黏液栓影像学征象患者(P<0.05)。ABPA患者血清IgE与嗜酸粒细胞计数呈正相关(P<0.05)。血清IgE、嗜酸粒细胞计数诊断ABPA的曲线下面积分别为0.885(95%CI:0.822,0.947)、0.829(95%CI:0.754,0.905)。结论咳嗽、咳痰、喘息是ABPA患者的主要临床症状,肺功能多表现为阻塞性通气功能障碍,影像学特征以支气管扩张和黏液栓为主,患者血清IgE、嗜酸粒细胞水平存在明显异常,可能与支气管扩张、有黏液栓及病程有关,二者对ABPA均有一定诊断价值。

肺部术后患者早期肺功能恢复的护理进展研究

肺部手术是治疗多种肺部疾病的常用方式,治疗效果显著。但此法具有一定损伤性,术后患者疼痛明显,常伴不良情绪,影响心理健康恢复。因此,对肺部术后患者采取适当的护理方式可有效促进肺功能恢复,加快术后康复进程。本文通过总结肺部术后患者早期肺功能恢复的影响因素,分析术后护理具体措施,以期为肺部疾病患者的术后康复贡献一份力量,帮助患者更快地重拾健康,享受高质量的生活。

FEV_1和DLCO对非小细胞肺癌患者胸腔镜肺叶切除术后肺部并发症的预测价值

目的 评估第1秒用力呼气容积(FEV_(1))、肺一氧化碳弥散量(DLCO)对非小细胞肺癌(NSCLC)患者经胸腔镜肺叶切除术后肺部并发症(PPC)及短期预后的预测价值。方法 前瞻性对2019年2月—2023年1月在保定市第二中心医院行电视胸腔镜手术肺叶切除术的150例NSCLC患者进行分析,根据术后30 d内的PPC发生情况,将患者分为PPC组(n=26)及无PPC组(n=124),并记录患者的院内死亡情况。结果 PPC组患者FEV_(1)%术后预测值(ppoFEV_(1)%)、DLCO%术后预测值(ppoDLCO%)和DLCO更低,而住院时间和院内病死率,吸烟史比例更高,年龄更大(P<0.05)。通过受试者(ROC)曲线分析显示,ppoFEV_(1)%和ppoDLCO%预测肺叶切除术患者发生PPC的曲线下面积(AUC)分别为0.850(95%CI:0.771~0.930)、0.858(95%CI:0.779~0.936),最佳截断值分别为59.26%、53.25%。Lasso回归和逐步回归分析显示,年龄(β=0.074,OR=1.077),ppoFEV_(1)%(β=-0.036,OR=0.964)和ppoDLCO%(β=-0.103,OR=0.902)是具有统计学意义的预测因素(P<0.05)。通过Pearson相关性分析,PPC组患者的ppoFEV_(1)%、ppoDLCO%与住院时间呈负相关(r=-0.473,P=0.015;r=-0.434,P=0.027)。经ROC曲线分析,ppoFEV_(1)%、ppoDLCO%对肺叶切除术患者院内死亡的预测AUC分别为0.850(95%CI:0.771~0.930)、0.926(95%CI:0.871~0.982)。结论 ppoFEV_(1)%<59.26%、ppoDLCO%<53.25%的行电视胸腔镜手术肺叶切除术的NSCLC患者具有更高的PPC发生风险,检测患者的ppoFEV_(1)%、ppoDLCO%有助于临床医生对NSCLC患者进行风险分层、预后预测。