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Objective:To explore the feasibility of high-flow nasal cannula(HFNC)therapy for respiratory failure in elderly patients.Methods:A total of 300 patients with respiratory failure admitted to Peking University Shougang Hospital from December 2016 to March 2019 were enrolled in this prospective study.Patients were divided into three groups: the HFNC group, the conventional oxygen therapy(COT)group and the non-invasive positive pressure ventilation(NPPV)group(n=100 in each group). Arterial oxygen saturation(SPO 2), oxygen index(OI), heart rate(HR), respiratory rate(RR), mean arterial pressure(MAP), comfort level, discharge rate, tracheal intubation rate, rate of referral to ICU, mortality and rate of referral to another group after therapy were compared between the HFNC and COT groups and between the HFNC and NPPV groups. Results:SPO 2 after oxygen therapy for 30 minutes( t=-2.992, P=0.003), 1 hour( t=-2.884, P=0.005)and 6 hours( t=-3.196, P=0.002)and OI before discharge( t=-2.060, P=0.048)were higher in the HFNC group than in the COT group.The HR in the above two groups was lower before discharge than before therapy, and the HR in the COT group was even lower(73.1±25.1 beat per minute vs.75.1±25.9 beat per minute), but both were within the normal range.The discharge rate was higher( χ2=-1.969, P=0.049), while the rate of referral to another group was lower in the HFNC group than in the COT group( χ2=-3.115, P=0.002). There was no significant difference in the tracheal intubation rate, ICU transfer rate and mortality between the HFNC and COT groups.SPO 2 after oxygen therapy for 30 minutes( t=-2.026, P=0.046)and 6 hours( t=-2.101, P=0.040)were higher in the HFNC group than in the NPPV group, but there was no significant difference in OI and SPO 2 between the two groups before discharge.The HR in both HFNC and NPPV groups was lower before discharge than before therapy, and there was no statistical difference between the two groups.The mortality, discharge rate, tracheal intubation rate, ICU transfer rate and rate of referral to another group had no significant difference between the HFNC and NPPV groups.The comfort level was higher in the HFNC group than in the COT and NPPV groups( t=-3.758 and -19.180, both P=0.000). Conclusions:HFNC is a new type of oxygen therapy equipment introduced after COT and NPPV, and possesses more advantages for elderly patients with respiratory failure.
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Objective To investigate the effect of Chinese herbal medicine combined with acupuncture and massage on the treatment of knee osteoarthritis. Methods A total of 92 patients with osteoarthritis of the knee were enrolled in our hospital from September 2015 to March 2017, and were randomly divided into study group and control group (46 cases) by single and double numbers (admission order).The control group was treated with acupuncture and massage, and the study group was treated with acupuncture and massage on the basis of external use of Chinese medicine. The two groups of patients with knee osteoarthritis were treated with continuous treatment for 6 courses, the pain degree and the change of osteoarthritis index were recorded before and after the treatment. Results There was no significant difference in NRS and WOMAC scores between the two groups before treatment. The scores of NRS and WOMAC in patients with knee osteoarthritis after treatment were significantly lower than those in the control group, the difference was statistically significant(P<0.05). Conclusion The application of Chinese medicine, acupuncture and massage in the treatment of proliferative osteoarthritis of the knee can achieve more satisfactory clinical efficacy, and is conducive to protect the quality of life.
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Objective To explore relationship between the plasma calcitonin-gene related peptide(CGRP) level and brain damage in neonatal asphyxia. Methods Dynamic variation of plasma CGRP level was monitored in 62 asphyxiated newborn infants and 21 normal infants by radioimmunoassay, and the relation between the brain damage and CGRP in neonatal asphyxia was analyzed. Results Plasma CGRP level markedly elevated at acute stage of neonatal asphyxia(P
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To explore th e role of nitric oxide(NO), nitric oxide synthetase (NOS)and prolactin (PRL) in the pathogenesis,progress and prognosis of neonatal hypoxic-ischemia encephalop athy (HIE),plasma NO, NOS and serum PRL were determined by radioimmunoassay(RIA) and colorimetry in 68 newbom infants with HIE and 30 normal control neonates, r espectively. The results showed that the levels of NO, NOS and PRL were signific antly higher in all neonates with HIE than that in the control group (P＜0.05).There were in particular more higher levels of NO,NOS an d PRL in infants with either moderate or severe HIE(P＜0 .01). It was noticed that the level of PRL was much higher in HIE infants with seizures than that in HIE infants without seizures. There was a positive relati onship between the levels of PRL and the duration of seizure attack( P＜0.01). It is suggested that the levels of NO, NOS and PRL is ass ociated with HIE.The determination of these parameters will be valuable clinical ly for the diagnosis, judgement of prognosis and estimation of seizure attack in newborn infants with HIE.
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Objective To study the criteria and technique of transsphenoidal microsurgery on pituitary adenoma invaded cavernous sinus Methods 42 patients with pituitary adenoma underwent 45 transsphenoidal operations Sellar base was opened as large as possible under C arm X ray fluoroscopy or neuronavigation monition Dura matter was cut open under microscope Tumors were removed through the direction and tunnel they in invade Bromocriptine was administered to those with little remains Partial remains and those have no response to bromocriptine were given radiotherapy Results No modality 21 tumors were nearly totally removed, 18 tumors were subtotally resected, 3 were partially resected MRI scanned in 2～3 months after the operation showed that 19 tumors disappeared, 20 tumors had little residul, 3 tumors partially remained Conclusion Pituitary adenomas invading the cavernous sinus with enlarged sella turcica and shown soft in MRI can be submitted to transsphenoidal operation Microsurgical technique can ease tumor removal and protection of the sellar and internal carotid artery
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Objective To report the microsurgical separation of the protruded cerebral tissue in the case of complex craniopagus twins and evaluate the role of the neuronavigation system in this operation Methods After the multiple bone flap were made,register again and then separate the cerebral tissue along the arachnoid plane under the guiding of the neuronavigation system(SNN) until the straight sinus was exposed Results The protruded cerebral hemisphere and cerebellar hemisphere of the twins were successfully separated Unfortunately,part of the occipital lobe of twin B(right) had to be removed because of the brain swelling Conclusion In the case of complicated craniopagus,the neuronavigation system is valuable in positioning the deep common sinus To separate the cerebral tissue along the arachnoid plane under surgical microscope can reduce the cerebral injury
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Objective To study the factors that limited the microsurgical total resection on meningiomas of tentorium and confluence of sinuses Methods Twenty three cases of meningiomas on tentorium and confluence of sinuses,which were removed by application of microsurgery from 1983 to 2001,were analysed retrospectly and reviewed. Results In all 23 cases,tumors in 17 cases were removed totally,and 6 cases were removed subtotally In the 6 cases whose tumors were resected subtotally,there were 4 cases related with major sinus and its venous flow uncompleted compensation, 2 cases related with adhering compactly to the brain stem invaded by tumors,major vessels or cranial nerves Conclusions Heading factors restricting microsurgical total resection of menigiomas on tentorium and confluence of sinuses may be related with major sinus invaded by tumor and its venous flow uncompleted compensation, tumors adhering compactly to the brain stem,major vessels or cranial nerves
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Objective To explore the microsurgical skills and clinical value of endoscope-assisted transsphenoidal approach for middle and lower clival extension of pituitary adenomas. Methods The sublabial transseptal,transsphenoidal approach assisted by endoscope were applied in 16 cases which invasive middle and lower clivus.CT or/and MRI and pituitary hormones were detected after microsurgery. Results The tumor was achieved approximately total removal in 13 cases and subtotal removal in 3 cases.There were 8 functioning pituitary adenomas and the pituitary hormones decreased to normal level in 3 cases.PRL level decreased more than 80% in 4 cases and less than 80% in 1 cases. Conclusion Endoscope-assisted transsphenoidal approach for middle and lower clival extension of pituitary adenomas can achieve satisfactory effect.