RESUMO
Objective To explore the value of minute ventilation recovery time (VERT) as a weaning predictor in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD).Methods A prospective study was performed from March 2008 to July 2012.Fifty-two COPD patients under mechanical ventilation for more than 48 hours in our RICU tolerated a spontaneous breathing trial (SBT) and were ready for planned extubation.After SBT,these patients were placed back on their pre-SBT ventilator settings for up to 25 minutes,during which VERT was obtained.VERT was defined as the time for minute ventilation to return to baseline measured before SBT.Respiratory rate,tidal volume,minute ventilation and respiratory rate/tidal volume ratio were also obtained before SBT and just after SBT.Arterial blood gas data were measured and recorded before weaning.According to the weaning outcome,the patients were classified as successful group (40 cases) or failed group (12 cases).VERT and other quantitative variables were compared using t test.A multiple logistic regression was performed to explore possible factors associated with the weaning outcome.The sensitivity and specificity of VERT for predictive capacity in weaning were assessed using ROC cure.Results VERT and respiratory rate after SBT were significantly different between two groups.Multiple logistic regression revealed that VERT was the only predictor associated with weaning outcome (b =0.282,P ＜0.001).The area under ROC curve for VERT was 0.957 (95％ CI:O.907-1.008).With a cut-off value of 10.5 minutes,the sensitivity and specificity of VERT for predicting weaning failure were 1.0 and 0.85,respectively.Conclusions VERT may be a new predictor for extubation and determination of mechanical ventilation weaning in patients with COPD.VERT is a variable to be easily measured thereby being conveniently used in clinical practice.
RESUMO
Objective To analyze the clinical and X-ray manifestations of sclerosing adenosis of the breast,and to evaluate the val-ue of preoperative differential diagnosis between the sclerosing adenosis and the breast cancer combined with pathology.Methods X-ray manifestations and clinical features of 25 patients with the sclerosing adenosis of the breast confirm by surgical pathology were analyzed retrospectively.Then the X-ray manifestations and clinical features were compared with the pathological results.Results Total 25 patients suffered from the sclerosing adenosis of the breast.Among them,2 cases were bilateral sclerosing adenosis,23 ca-ses were unilateral sclerosing adenosis,6 cases with epithelial atypical hyperplasia,4 cases with intraductal papilloma,7 cases with fibroadenoma nodule formation,and the rest with the pure sclerosing adenosis.X-ray manifestations:7 cases presented the medium density nodular shadows with blurred and irregular edges,1 6 cases showed the star-shaped shadows of which 6 cases were the“black stars”,3 cases of“white stars”.One in 7 cases can only see a star shadow,another was unclear or the form was varied.1 3 patients showed the calcification among 4 cases presented the small clusters of distribution with needlepoint-like calcification,2 cases of bulky curved calcification,and the rest with scattered and regional distribution of dot,needlepoint-like calcification.Conclusion Combined with clinical manifestations,the breast X-ray plays an important role in the differential diagnosis of sclerosing adenosis and the breast cancer.