Objective To explore the characteristics of exercise ventilation function in patients with chronic duration of asthma, and the correlation of cardiopulmonary exercise test and control level and conventional lung function in patients with chronic duration of asthma. Methods Seventy-three patients with chronic duration of asthma admitted from December 2021 to December 2022 were recruited in the study. The asthma control level was assessed with the asthma control test (ACT) and the patients were divided into a well-controlled group and a poorly-controlled group. Routine pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) were performed in both groups, to analyze the difference of related parameters between the two groups and observe the correlation between CPET and PFT, ACT score in the patients with chronic persistent asthma. Results CPET results showed that the VE/VCO2 slope, anaerobic threshold carbon dioxide equivalent (EqCO2@AT), and physiologically ineffective peak during exercise (VD/VTpeak) were higher in the poorly-controlled group than those in the well-controlled group (all P<0.05). The peak minute ventilation (VEpeak) and tidal volume (VTpeak) of the patients in the poorly-controlled group were lower than those in the well-controlled group (both P<0.05). The peak respiratory rate (BFpeak) and respiratory reserve (BRpeak) of the two groups were not significantly different (both P>0.05). The results of correlation analysis showed that the VE/VCO2 slope, EqCO2@AT, VD/VTpeak were negatively correlated with ACT score, and VEpeak was positively correlated with FVC%pred and MMEF%pred in the patients with chronic persistent asthma. BRpeak was positively correlated with FEV1%pred, FEV1/FVC%pred, MMEF%pred in routine pulmonary function. Multivariate logistic regression analysis showed that the increase of VE/VCO2 slope and VD/VTpeak were independent risk factors for poor asthma control (P<0.05). Conclusions Patients with poorly-controlled asthma have decreased exercise ventilatory function, mainly showing decreased ventilation and tidal volume during peak exercise and decreased ventilatory efficiency. There is some correlation between exercise ventilatory function and conventional lung function of control level in patients with chronic duration of asthma. The relevant indicators of ventilation efficiency in CPET have suggestive significance for asthma that is not well controlled, so it is necessary to carry out CPET in patients with asthma to improve the comprehensive evaluation of asthma.
ObjectiveTo analyze the relationship between preoperative pulmonary function indexes and postoperative pneumonia (POP) in patients undergoing upper gastrointestinal surgery.MethodsThe clinical data of 303 patients who underwent lung function examination and upper gastrointestinal surgery in West China Hospital, Sichuan University from September 2020 to January 2021 were prospectively collected and analyzed. There were 217 males and 86 females, with an average age of 61.61±10.42 years. Pulmonary function was evaluated from four aspects including ventilatory function, pulmonary volume, diffusion function and airway resistance. Relevant pulmonary function indicators were displayed as the percentage of actual measured value to predicted value (%pred). The outcome index was pneumonia within 30 days after the surgery. Logistic regression was used to analyze the relationship between preoperative pulmonary function indicators and POP.ResultsA total of 196 patients with gastric cancer and 107 patients with esophageal cancer were included, and the incidence of POP in patients undergoing upper gastrointestinal surgery was 26.7% (81/303). Patients with preoperative low peak expiratory flow (PEF%pred) had a 3.094 times higher risk of developing POP than those with normal PEF%pred [OR=3.094, 95%CI (1.362, 7.032), P=0.007]. The incidence of POP had no correlation with the other preoperative indicators.ConclusionPreoperative PEF%pred may be an important indicator for predicting the occurrence of POP in patients undergoing upper gastrointestinal surgery.
Objective To explore the effects of different intensity of inspiratory muscle training on pulmonary function, hospitalisation time and quality of life of critically ill patients. Methods A total of 42 patients were included in the intensive care ward, high dependency ward, and cardiac surgery ward of the Southern Theatre General Hospital from January 2023 to June 2023, and were randomly divided into 14 cases in the control group, 14 cases in the low-intensity inspiratory muscle training group, and 14 cases in the moderate-intensity inspiratory muscle training group; conventional treatment was used for the control group, and 20% of the maximum inspiratory pressure (MIP) was added as the starting threshold load for inspiratory muscle training for the patients of the low-intensity inspiratory muscle training group on the basis of conventional treatment. In the control group, conventional treatment was used; in the low-intensity inspiratory muscle training group, 20% of the maximum inspiratory pressure (MIP) was added to the conventional treatment as the starting threshold load for inspiratory muscle training; in the medium-intensity inspiratory muscle training group, 40% of the MIP was added to the conventional treatment as the starting threshold load for inspiratory muscle training; and the maximal inspiratory pressure, exertional lung capacity, diaphragm thickness and mobility, hospital stay and quality of life were evaluated after 6 weeks of training. Results A total of 40 patients completed the training, and the three groups showed statistically significant differences in MIP (P<0.05) and statistically significant differences in exertional lung capacity (P<0.05). There was no statistically significant difference in diaphragm thickness (P=0.566), and diaphragm mobility was lower in the control group than in the low-intensity inspiratory muscle training group (P=0.021), and there was also a difference between the low-intensity inspiratory muscle training group and the moderate-intensity inspiratory muscle training group (P=0.036); there was a difference in the length of stay in the care unit among the three groups (P=0.034), and there was no statistically different (P=0.149), and the duration of hospital stay was significantly shorter in the moderate intensity inspiratory muscle training group compared to the control group (P=0.016). Medium-intensity inspiratory muscle training can significantly improve patients' quality of life compared with the control group and low-intensity inspiratory muscle training group (P<0.05). Conclusions Both low-intensity inspiratory muscle training and moderate-intensity inspiratory muscle training can enhance the lung function of critically ill patients, improve their diaphragm mobility, and promote their pulmonary rehabilitation. Medium-intensity inspiratory muscle training was significantly better than low-intensity inspiratory muscle training in improving the lung function of patients. Moreover, moderate-intensity inspiratory muscle training may have positive significance in improving patients' quality of life and shortening their hospitalisation time.
Objective To investigate the clinical significance of changes in cardiopulmonary function, degree of hypoxia and inflammatory factors in obstructive sleep apnea hypopnea syndrome (OSAHS) patients combined chronic obstructive pulmonary disease (COPD). Methods A retrospective case-control study was conducted on 209 patients with OSAHS admitted from October 2015 to April 2022. The OSAHS patients were divided into an OSAHS-only group, an OSAHS combined with mild COPD group, an OSAHS combined with moderate COPD group, and an OSAHS combined with severe and very severe COPD group based on pulmonary function test. The characteristics of cardiopulmonary function [(pulmonary artery pressure, N terminal pro B type natriuretic peptide (NT-proBNP), forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), percent predicted value of FEV1 (FEV1%pred)], hypoxia indexes [night lowest saturation of pulse oxygen (NL-SpO2), night medial saturation of pulse oxygen (NM-SpO2), saturation of pulse oxygen less than 85% of the time (TS85), diurnal lowest saturation of pulse oxygen (DL-SpO2)], inflammatory factor indicators [procalcitonin (PCT), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR)], and other characteristics were compared separately. The partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD. Results There were statistically significant differences in age, days of hospitalization, cardiopulmonary function indexes, hypoxia indexes and inflammatory factor indexes between the OSAHS combined with COPD group and the OSAHS-only group (all P<0.05). And pulmonary artery pressure, NT-proBNP, TS85, IL-6, and NLR were higher and DL-SpO2, NL-SpO2, and NM-SpO2 were lower in the OSAHS combined with severe and very severe COPD group compared with the OSAHS combined with mild COPD group (all P<0.05). In the partial correlation analysis, FEV1%pred was negatively correlated with pulmonary artery pressure, NT-proBNP, TS85, IL-6, hs-CRP and NLR, and positively correlated with DL-SpO2, NL-SpO2 and NM-SpO2 (all P<0.05). In regression analysis, NLR and TS85 were the main risk factors for OSAHS combined with COPD (all P<0.05). Conclusions OSAHS patients combined with COPD have longer hospital days, greater burden of hypoxia, cardiopulmonary function and inflammation compared with patients with OSAHS alone, especially more significant in patients with poorer pulmonary function, and higher incidence of pulmonary heart disease, atrial fibrillation, and lower limb edema. NLR and TS85 are the main risk factors in patients with OSAHS combined with severe and very severe COPD.
Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance not only affects the function of thoracic organs, but also affects the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.
ObjectiveThe pleural injury caused by harvesting internal mammary artery (LIMA) can significantly increase the possibility of early pleural effusion after off-pump coronary artery bypass grafting (OPCABG). We compared the differences in pleural effusion, pain severity, and early lung function in different treatments to find the optimal strategy.MethodsA total of 300 patients receiving OPCABG using LIMA with left pleural lesion were selected (176 males and 124 females, mean age of 63.1±8.7 years). After bypass surgery, patients with pleural rupture were randomly divided into three groups: group A (n=100) received a pericardial drainage tube and a left chest tube inserted from the midline (subxyphoid); group B (n=100) had a pericardial drainage tube and a tube placed in the sixth intercostal space at the midaxillary line; group C (n=100) with the broken pleura sutured, had a pericardial drainage tube and a mediastinal drainage tube inserted. All patients underwent pulmonary function testing and arterial blood gas analysis on postoperative days (PODs) 5. The three methods were analyzed and evaluated.ResultsTotal drainage: group B (852±285 ml)>group C (811±272 ml)>group A (703±226 ml); there was no significant difference between the group B and group C, but they were statistically different from the group A (P<0 05="" patients="" with="" pleural="" effusion="" after="" removal="" of="" drainage="" tubes:="" group="" a="" 13="" patients="">group B (7 patients)>group C (3 patients), and there was significant difference among the three groups (P<0 05="" pain="" sensation="" the="" day="" after="" extubation:="" group="" b="" 2="" 4="" 0="" 8="" 3="" 8="" 0="" 9="">group A (1.9±0.7, 3.3±0.8)>group C (1.1±0.6, 2.5±0.8), there was significant difference among the three groups (P<0 05="" pain="" sensationon="" on="" postoperative="" days="" 5:="" group="" b="" 0="" 3="" 0="" 2="" 0="" 6="" 0="" 5="">group A (0.3±0.3, 0.5±0.4)>group C (0.2±0.2, 0.5±0.3), and there was no significant difference among the three groups. Vital capacity on postoperative days 5: there was no significant difference between the group B and group C, and both groups were greater than group A (P<0.05). There was no difference in FEV1 and PCO2 among the three groups. Group C was better than group A in PO2 on postoperative day 5 (P<0.05).ConclusionSuturing the broken pleura during the operation can not only reduce the degree of postoperative pain but also have less pleural effusion and better pulmonary function. It can be used as the preferred method.
ObjectiveTo investigate the correlation between brain natriuretic peptide (BNP) and cardiopulmonary function, as well as explore prognostic value of BNP in patients with interstitial lung disease(ILD).
MethodsThe clinical data of ILD patients admitted between February 2010 and April 2013 were retrospectively analyzed.The relationship between serum BNP level and cardiopulmonary function was analyzed by Pearson's or Spearman's rank correlation test.Meanwhile, the patients were divided into a survivor group and a death group, as well as a pulmonary hypertention (PH) group and a normal group respectively.Clinical data were compared between two groups.
ResultsThere were 38 patients included in the study.BNP concentration was correlated with echocardiographic indices of right heart function, including systolic pressure of pulmonary artery, right atrial inlet diameter, right ventricular inlet diameter, and right ventricular end-diastollc diameter (P < 0.05), but not correlated with echocardiographic parameters of left heart function (P > 0.05).BNP was also correlated with DLCO%pred.BNP and right heart function parameters except right atrial inlet diameter were significantly higher, and DLCO%pred, were significantly lower in the death group and the PH group than those in the survivor group and the normal group (P < 0.05).
ConclusionsSerum BNP concentration can reflect right heart function appropriately, suggesting pulmonary vascular impairment in ILD patients contributes to increased pulmonary vascular resistance.Elevated BNP levels are associated with increased mortality and poor prognosis in patients with ILD.
ObjectiveTo explore the application effects of hand-sewn layered anastomosis (HS) and circular stapled anastomosis (CS) in inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer. MethodsPatients who underwent inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer in Huaihe Hospital of Henan University from 2018 to 2019 were retrospectively included. Patients were divided into a HS group and a CS group according to the anastomosis methods, and propensity score matching was used to match patients at a ratio of 1:1. The baseline clinical characteristics, perioperative indicators, CD4+/CD8+ immune index comparison, pain, various lung function indicators, incidence of short-term and long-term postoperative complications, and quality of life were compared between the two groups. ResultsA total of 153 patients were included, including 108 males and 45 females, with an average age of (61.81±5.18) years. After propensity score matching, 70 patients were included in each group. Compared with the CS group, the operation time was longer in the HS group [(107.10±8.25) min vs. (97.65±6.85) min, P<0.001]; the CD4+/CD8+ level was lower in the HS group 1-3 days after surgery; the pain score was higher, and various lung function indicators (forced expiratory volume in the first second, forced vital capacity, and one-second rate) were lower in the HS group 1-7 days after surgery; within 6 months after surgery, the incidence of anastomosis-related complications (anastomotic stenosis, anastomotic fistula, and gastroesophageal reflux) was lower in the HS group; and the quality of life score was higher in the HS group from 14 days to 6 months after surgery (P<0.05). ConclusionHS can reduce the incidence of postoperative anastomotic fistula, anastomotic stenosis, and gastroesophageal reflux, and improve the short-term quality of life of patients, but it has a longer operation time, more intense short-term postoperative pain, and may affect the early recovery of lung function. HS and CS are complementary, and the appropriate surgical method should be chosen according to the individual situation of the patient to achieve the maximum clinical benefit.
ObjectiveTo explore the effects of Baduanjin combined with breathing exercises and bedside cycle training on the recovery of lung function in patients after thoracoscopic surgery for lung cancer. MethodsPatients who underwent thoracoscopic radical surgery for lung cancer at the Huaihe Hospital of Henan University from January 2024 to January 2025 were selected. Through the random number table method, patients were randomly divided into a Baduanjin combined with breathing exercises group (experimental group) and a bedside cycle group (control group). The changes in lung function indicators, pain levels, exercise endurance, cellular immunity, and inflammatory factor levels before and after rehabilitation training in both groups were compared to evaluate the clinical effects of the two rehabilitation methods. ResultsA total of 100 patients were included, with 52 in the experimental group, including 28 males and 24 females, with an average age of (57.50±7.15) years; and 48 in the control group, including 26 males and 22 females, with an average age of (57.80±6.40) years. There was no statistical difference in baseline data between the two groups (P＞0.05). In the experimental group, the forced expiratory volume in one second (FEV1) [(2.48±0.32) L vs. (2.00±0.27) L, P＜0.001], forced vital capacity (FVC) [(3.55±0.42) L vs. (2.95±0.34) L, P＜0.001], and FEV1/FVC (69.9%±3.8% vs. 67.8%±3.6%, P=0.006) were higher, pain scores were lower [(1.4±0.4) points vs. (2.0±0.5) points, P＜0.001], 6-minute walking distance was longer [(432.35±30.84) m vs. (411.82±33.75) m, P=0.002], CD4+/CD8+ ratio was higher (1.72±0.32 vs. 1.52±0.29, P=0.002), and levels of tumor necrosis factor-α [(8.1±1.8) pg/mL vs. (9.2±2.1) pg/mL, P=0.006] and interleukin-6 [(8.3±2.1) ng/L vs. (10.1±2.7) ng/L, P＜0.001] were lower. ConclusionThe combination of Baduanjin and breathing exercises is superior to bedside stationary bike training in improving lung function, reducing pain levels, enhancing exercise endurance, decreasing pro-inflammatory factor levels, and boosting immune function in patients post-thoracotomy for lung cancer. As a equipment-free, low-cost, and easy-to-implement rehabilitation method, it holds high clinical application value, offering a more scientific and economical option for postoperative lung cancer patients' pulmonary rehabilitation.
