慢性阻塞性肺疾病急性加重期临床路径应用效果评价

评价临床路径管理在慢性阻塞性肺疾病急性加重期（AECOPD）的应用效果。通过采用回顾性调查,比较进入临床路径（路径组）和没有进入临床路径（对照组）两组患者在住院费用、住院时间及治疗效果3项指标上的差别。结果显示实施临床路径患者（路径组）的平均住院费用、平均住院日等指标均有不同程度的下降,而治愈率有所上升。从而得出临床路径在AECOPD病种的应用能够规范医疗行为,提高医疗护理质量的结论。     

结核病防治中的人文关怀

结核病的防治不仅仅是公共卫生问题,更是一个社会问题。尽管在现阶段结核病防治中已体现了人文关怀的精神,在今后结核病防治中还需要进一步做到重视社会宣传教育,加强家庭督导作用,强化对流动人口中DOTS策略的实施,力争医疗保险参与防治减轻患者经济负担,研制新疫苗等,从而降低我国疫情,促进构建和谐社会。     

室间隔缺损合并重度肺动脉高压的外科手术治疗策略

探讨室间隔缺损伴重度肺动脉高压患者手术指征的判断标准和围术期的治疗策略。11例室间隔缺损伴重度肺动脉高压患者,在体外循环下行室间隔缺损修补术,围术期给予吸氧、前列腺素E1等降低肺动脉压力的综合治疗。结果11例手术患者全部治愈出院,经随访肺动脉压力有着不同程度的下降。术前全面检查、综合分析以明确手术指征是室间隔缺损合并重度肺动脉高压患者获得满意疗效的根本,其中肺血管纹理是一个最重要的判断指标。     

从社会医学角度看我国结核病的防治

结核病目前在我国仍是一个重大的公共卫生问题。针对目前我国结核病防治过程中存在的一些问题以及DOTS策略的实施,从社会医学的角度思考认为,结核病的防治不仅仅是公共卫生问题,更是一个社会问题。传统的结核病防治思路有待商榷和完善,DOTS策略的实施应当紧密结合社会各因素,这为今后更好开展结核病防治工作提供了参考。     

Nosology and Causal Necessity; The Relation BetweenDefining a Disease and Discovering its Necessary Cause

The problem of disease definition is related to theproblem of proving that a certain agent is thenecessary cause of a certain disease. Natural kindterms like rheumatoid arthritis and AIDS refer toessences which are discoverable rather thanpredeterminate. No statement about such diseases isa priori necessarily true. Because theories onnecessary causes involve natural kind semantics,Koch's postulates cannot be used to falsify or verifysuch theories. Instead of proving that agent A is thenecessary cause of disease D, we include A in atheoretical definition of D, take this to representthe real meaning of D, and discard thepretheoretical definition. This is illustrated byKoch's own attempt to prove he had discovered thenecessary cause of tuberculosis. Methodologicalarguments about disease causation require a clear viewof our use of diagnostic terms. Medical lexicographersshould do more to provide such a view.     

不同性．别的非吸烟COPD患者肺功能和疾病严重程度的比较

比较不同性别的非吸烟的COPD患者的肺功能和疾病严重程度。选择承德医学院附属医院门诊就诊的非吸烟的稳定期COPD患者93例,其中男性34例,女性59例。对两组患者的肺通气功能和弥散功能,过去一年的急性加重次数、改良的呼吸困难评分及疾病严重程度进行比较。非吸烟的COPD患者男性组和女性组在FEVl％pred,FVC％pred,PEF％pred,FEF25—75％pred,FEF25％pred,FEF75％pred,DOSE评分方面比较,差异有统计学意义（P〈0．05）;在DL—CO％pred和Raw％pred方面比较,差异无统计学意义（P〉0．05）。非吸烟的女性COPD患者较男性COPD患者肺通气功能和小气道功能差,疾病严重程度重,可能与女性患者对生物燃料、空气污染等危险因素易感有关。     

斑点追踪技术定量评价慢性肺源性心脏病患者右心室功能

应用斑点追踪技术（STE）定量评价慢性肺源性心脏病患者右心室功能的改变。在我院明确诊断为慢性肺源性心脏病患者39例作为病例组,健康体检人员30例作为对照组。应用STE测量右心室收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa）,计算舒张早期峰值应变率与舒张晚期峰值应变率的比值（SRe/SRa）;测量三尖瓣环游离壁舒张早期运动速度峰值（Ea）、舒张晚期运动速度峰值（Aa）并计算其比值（Ea/Aa）;计算右心室面积变化率（RVFAC）。病例组RVFAC、Ea/Aa、SRs、SRe、SRa、SRe/SRa均低于对照组（P〈0.05）。SRs与RVFAC呈显著正相关（r=0.725,P〈0.001）。SRs、RVFAC与PASP呈显著负相关（r1=-0.695,r2=-0.664,P〈0.001）。SRe/SRa与Ea/Aa呈显著正相关（r=0.701,P〈0.001）。慢性肺源性心脏病患者右心室收缩和舒张功能减低。STE可以定量评价慢性肺源性心脏病患者右心室功能的改变。     

睡眠呼吸暂停综合征与肺高血压

肺高血压是一类以肺血管阻力进行性升高为主要特征,并最终导致右心衰竭甚至死亡的恶性心血管疾病.多种疾病可导致肺高血压,其中第三大类肺高血压与肺部疾病及缺氧有关.已有许多研究得出结论睡眠呼吸暂停综合征是肺高血压的高危因素,但具体发病机制不详.本文目的是结合国外文献阐述睡眠呼吸暂停综合征致肺高血压的发病机制及干预睡眠呼吸暂停综合征对肺动脉高压的影响.     

Day-to-day living with severe chronic obstructive pulmonary disease: Towards a family-based approach to the illness impacts

Objective: This study explores the perspectives of both patients and family members regarding the impact of chronic obstructive pulmonary disease (COPD) in their family life.

Design: An exploratory qualitative study was conducted with patients and their family members in the chronic phase of COPD. Individual interviews were performed to explore participants’ perspectives and submitted to thematic analysis.

Results: Six major themes emerged from patients’ perspective: (1) impact of COPD symptoms on personal and family daily life; (2) (over)protective family support; (3) difficulties in couple communication; (4) sense of identity loss; (5) fear of COPD progression; and (6) coping resources. Five main themes emerged from the family members’ perspective: (1) restrictions in family’s social life; (2) emotional distress related to COPD exacerbations; (3) tension in couple relationship; (4) financial strain of COPD; and (5) coping resources.

Conclusions: The overall findings illustrate the complex interaction between the experience of living with COPD and communication patterns, emotional states, social support and social roles within the family. The results highlight the need to develop family-based interventions to facilitate a functional adjustment to COPD. However, these interventions in COPD remain undeveloped and empirical evidence is needed.