阻塞性睡眠呼吸暂停综合症的咽部解剖分析

目的：对阻塞性睡眠呼吸暂停综合症（OSAS）咽部解剖途径进行分析。方法：探讨咽部解剖的方法,并从2012年1月到2013年1月这一年的时间段里,抽选出36例此类病患者进行多项检测并与36位无病史的人进行对照分析。结果：抽取的36例此类病患者均具有腭咽部狭窄的症状,其中大部分患者还合并有口咽部阻塞。结论：阻塞性睡眠呼吸暂停综合症的产生,与腭咽腔与口咽腔狭窄密切相关。     

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment (RMCA) in Individuals with Chronic Spinal Cord Injury

During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination is disrupted by spinal cord injury (SCI), control of respiratory muscles innervated below the injury level is compromised^1,2 leading to respiratory muscle dysfunction and pulmonary complications. These conditions are among the leading causes of death in patients with SCI³. Standard pulmonary function tests that assess respiratory motor function include spirometrical and maximum airway pressure outcomes: Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), Maximal Inspiratory Pressure (PI_max) and Maximal Expiratory Pressure (PE_max)^4,5. These values provide indirect measurements of respiratory muscle performance⁶. In clinical practice and research, a surface electromyography (sEMG) recorded from respiratory muscles can be used to assess respiratory motor function and help to diagnose neuromuscular pathology. However, variability in the sEMG amplitude inhibits efforts to develop objective and direct measures of respiratory motor function⁶. Based on a multi-muscle sEMG approach to characterize motor control of limb muscles⁷, known as the voluntary response index (VRI)⁸, we developed an analytical tool to characterize respiratory motor control directly from sEMG data recorded from multiple respiratory muscles during the voluntary respiratory tasks. We have termed this the Respiratory Motor Control Assessment (RMCA)⁹. This vector analysis method quantifies the amount and distribution of activity across muscles and presents it in the form of an index that relates the degree to which sEMG output within a test-subject resembles that from a group of healthy (non-injured) controls. The resulting index value has been shown to have high face validity, sensitivity and specificity^9-11. We showed previously⁹ that the RMCA outcomes significantly correlate with levels of SCI and pulmonary function measures. We are presenting here the method to quantitatively compare post-spinal cord injury respiratory multi-muscle activation patterns to those of healthy individuals.     

金双歧联合茵桅黄口服液治疗母乳性黄疸疗效观察

目的探讨治疗新生儿母乳性黄疸的有效方法。方法将185例新生儿母乳性黄疸分为治疗组和对照组,治疗组的新生儿在出生后24 h内开始口服金双歧(0.5 g/次,3次/d,温水冲服),同时口服茵桅黄口服液(5 mL/次,2次/d),疗程5～7 d。对照组不采取任何干预措施。结果治疗组胆红素日均下降值为(42.31±16.12)μmol/L显著高于对照组的(22.26±11.25)μmol/L(P<0.05);观察组胆红素下降至119.5μmol/L以下的天数为(4.2±1.9)d,显著短于对照组的(7.8±3.5)d(P<0.05)。结论金双歧联合茵桅黄口服液应用于母乳性黄疸,可迅速降低胆红素水平,缩短治疗时间,无副作用,值得临床推广应用。     

孟鲁斯特钠对儿童OSAHS治疗效果的初步研究

目的：探讨孟鲁斯特钠对儿童阻塞性睡眠呼吸暂停低通气综合征（obslructivesleepapneahypopneasyndrome,OSAHS）治疗疗效。方法：对经电子鼻咽喉镜检查腺样体Ⅲ、Ⅳ级经多导睡眠监测为OSAHS的儿童96例,分成两组：药物治疗组48例,使用孟鲁斯特钠,连续使用1个月以上;未用药物组48例。对其家长进行相关临床表现的问卷调查。结果：两组患儿在年龄、病程、伴有鼻部疾病情况以及临床问卷分值间均无显著性差异（P〉0．05）。3个月后随访情况为,药物治疗组经治疗后在“响鼾”、“不安宁的睡眠或频繁醒觉”、“鼻阻塞而张口呼吸”以及“鼻腔很多鼻涕”4个症状的改善有统计学差异（P〈0．05）。未用药物组随访前、后问卷调查,差异均不具有显著性（P〉0．05）。结论：孟鲁斯特钠对儿童OSAHS治疗有一定疗效,可先行药物治疗。症状仍无明显改善的再考虑选择手术治疗。     

阻塞性睡眠呼吸暂停低通气综合征患者血浆CF6水平及其与血压的关系

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆线粒体偶联因子6(CF6)水平并探讨其与OSAHS患者血压的关系。方法:对45名OSAHS患者、20名高血压患者以及15名健康体检者进行研究。所有受试者接受整夜多导睡眠监测以及血压测量。根据有无高血压分为OSAHS合并高血压组(Ⅰ组)以及单纯OSAHS组(Ⅱ组),单纯高血压组(Ⅲ组)以及健康对照组(Ⅳ组)。分析比较多导睡眠监测结果,将Ⅰ组中12例首诊高血压且未服药物的OSAHS患者作为OSAHS合并初诊高血压组(A组)。匹配年龄、性别、是否吸烟以及体重指数,从Ⅱ组和Ⅲ组中分别随机选择11名OSAHS血压正常患者和11名初诊高血压且未服用药物患者分别作为单纯OSAHS组(B组)以及单纯高血压组(C组),选择10例健康体检者作为健康对照组(D组)。四组共44例研究对象均于次日清晨采空腹肘静脉血,采用酶联免疫吸附法检测血浆CF6水平。结果:健康对照组(D组)、单纯OSAHS组(B组)和单纯高血压组(C组)、OSAHS合并高血压组(A组)血浆CF6水平明显递增,且OSAHS合并高血压组血浆CF6水平明显高于单纯OSAHS组和单纯高血压组,但单纯OSAHS组和单纯高血压组之间无明显差别。结论:OSAHS患者血浆CF6水平显著升高,其可能通过减少前列环素I2(PGI2)的合成导致OSAHS患者继发高血压。     

自噬对慢性间歇性低氧大鼠颏舌肌损伤的作用及机制

目的:探讨自噬在慢性间歇性低氧状态下大鼠颏舌肌损伤中的作用及其机制。方法:将36只SD大鼠随机均分为对照组,慢性间歇性低氧组(chronic intermittent hypoxia,CIH组),慢性间歇性低氧+氯喹组(CIH+CQ组)。苏木素-伊红(HE)染色观察颏舌肌组织形态学变化;激光共聚焦显微镜下观察自噬标记物LC3在颏舌肌中的表达;免疫组织化学染色法观察组织中细胞色素c(cytochrome,Cyt c)的表达。结果:激光共聚焦结果显示,对照组颏舌肌中未见明显LC3表达,CIH组中LC3的平均荧光强度较对照组明显增强(P0.05),CIH+CQ组中LC3的平均荧光强度较CIH组显著增加(P0.05)。免疫组织化学结果显示:CIH组中Cyt c的阳性表达较对照组增加(P0.05),CIH+CQ组中Cyt c表达与CIH组相比显著增加(P0.05)。结论:慢性间歇性低氧引起颏舌肌线粒体损伤,触发细胞凋亡,同时诱发自噬。抑制自噬加重线粒体损伤,促进细胞凋亡。说明自噬可能通过抑制凋亡而在慢性间歇性低氧状态下的大鼠颏舌肌中起维护肌肉功能的作用。     

Mediators and mechanisms of heat shock protein 70 based cytoprotection in obstructive nephropathy

Urinary heat shock protein 70 (Hsp70) is rapidly increased in patients with clinical acute kidney injury, indicating that it constitutes a component of the endogenous stress response to renal injury. Moreover, experimental models have demonstrated that Hsp70 activation is associated with the cytoprotective actions of several drugs following obstruction, including nitric oxide (NO) donors, geranylgeranylacetone, vitamin D, and rosuvastatin. Discrete and synergistic effects of the biological activities of Hsp70 may explain its cytoprotective role in obstructive nephropathy. Basic studies point to a combination of effects including inhibition of apoptosis and inflammation, repair of damaged proteins, prevention of unfolded protein aggregation, targeting of damaged protein for degradation, and cytoskeletal stabilization as primary effectors of Hsp70 action. This review summarizes our understanding of how the biological actions of Hsp70 may affect renal cytoprotection in the context of obstructive injury. The potential of Hsp70 to be of central importance to the mechanism of action of various drugs that modify the genesis of experimental obstructive nephropathy is considered.     

经鼻高流量湿化氧疗与无创正压通气在改善AECOPD患者二氧化碳潴留临床疗效的比较

目的:经鼻高流量氧疗(HFNC)已广泛应用于缺氧性呼吸衰竭患者的治疗。本研究分析了HFNC治疗对慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的治疗效果。方法:本研究前瞻性观察分析了2017年1月至2019年1月入住我院呼吸科和重症医学科,诊断为AECOPD且合并有中度II型呼吸衰竭(血气分析PaO₂/Fi O2<200 mm Hg,PaCO₂>45 mm Hg,pH7.25~7.35)的患者44例,随机平均分为两组,参照组22例患者采纳无创正压通气(NIV)技术治疗,实验组22例患者予以HFNC治疗。观察两组患者治疗效果(治疗失败改为有创通气、28天死亡率)、血气分析对比血pH、PaCO₂、PaO₂。结果:HFNC组患者(22例,平均年龄73岁,男性占63.6%)同NIV组患者(22例,平均年龄77岁,男性占54.5%)相比,血pH、PaCO₂、PaO₂等血气分析指标两组无显著统计学差异。治疗失败率分别为22.7%(5/22)和27.2%(6/22),P=0.857。28天死亡率无统计学差异(HFNC组为13.6%,NIV组为18.2%,P=0.845)。结论:在AECOPD合并Ⅱ型呼吸衰竭的患者中,HFNC在改善氧合缓解CO2潴留方面具有同NIV相似的效应,因其具有更好的舒适性和耐受性,可成为NIV的有益补充。     

梗阻性黄疸患者经内镜逆行胰胆管造影术后胆道感染的病原菌分布、耐药性及影响因素分析

目的:探讨梗阻性黄疸患者经内镜逆行胰胆管造影(ERCP)术后胆道感染病原菌分布、耐药性以及导致术后胆道感染的影响因素。方法:选择2016年3月至2019年10月我院收治的310例行ERCP治疗的梗阻性黄疸患者,根据ERCP术后是否发生胆道感染将其分为感染组(50例)和未感染组(260例)。检测胆道感染患者病原菌种类及其耐药性,多元Logistic回归分析影响梗阻性黄疸患者ERCP术后胆道感染的影响因素。结果:ERCP术后胆道感染发生率为16.13%,大肠埃希菌、铜绿假单胞菌、粪肠球菌、屎肠球菌是主要致病菌,检出率分别为40.79%、13.16%、9.21%、6.58%。大肠埃希菌、铜绿假单胞菌对头孢类、氨基糖苷类抗生素耐药率高,粪肠球菌、屎肠球菌对利福平、喹诺酮类抗生素耐药率高,大肠埃希菌、铜绿假单胞菌、粪肠球菌、屎肠球菌均对利奈唑胺、亚胺培南敏感。多元Logistic回归分析结果显示,恶性病变、ERCP2次及以上、胆胰管汇流异常、术后胆管引流不畅是梗阻性黄疸患者ERCP术后胆道感染的危险因素(P0.05),术后预防性使用抗生素是保护因素(P0.05)。结论:梗阻性黄疸患者ERCP术后存在一定胆道感染风险,革兰氏阴性菌是主要致病菌,临床应注重对高危因素预防,有必要术后选择敏感抗生素预防性治疗。