RESUMO
OBJECTIVE: Pulmonary hypertension (PAH) is a serious progressive and fatal pulmonary disease characterized by elevated pulmonary artery pressure. Mechanical sequential ventilation has been gradually applied in the treatment of patients with PAH complicated with RF, which can effectively reduce the incidence of VAP and better promote the recovery of respiratory function. This study is aimed to determine the efficacy of sequential ventilation and conventional invasive mechanical ventilation in the treatment of pulmonary hypertension (PAH) complicated with respiratory failure (RF). METHODS: A total of 198 patients with both PAH and RF admitted to our hospital were enrolled. Among them, 102 patients were treated with sequential ventilation as a study group (stu group), and 96 patients were treated with conventional invasive mechanical ventilation as a control group (con group). Then the two groups were compared in efficacy and related indexes before and after treatment. RESULTS: The stu group experienced significantly shorter invasive ventilation time, total mechanical ventilation time, and hospitalization time than the con group (all P<0.05), and showed a significantly lower complication rate than the con group (P<0.05). The reintubation rate, weaning failure rate, and ventilator-associated pneumonia (VAP) rate of the stu group were all significantly lower than those of the con group (all P<0.05), and the stu group showed significantly higher pondus hydrogenii (pH) and arterial partial pressure of oxygen (PaO2) and significantly lower arterial carbondioxide partial pressure (PaCO2) than the con group after treatment (all P<0.05). Additionally, after treatment, the level of brain natriuretic peptide (BNP) and pulmonary artery pressure in both groups declined significantly (P<0.05), and the decline of them in the stu group was more significant than that in the con group (P<0.05). Moreover, after treatment, endothelin (ET) and angiotensin II (Ang II) in both groups declined significantly, and the decline of them in the stu group was also more significant than that in the con group (P<0.05). CONCLUSION: Compared with conventional invasive mechanical ventilation, sequential ventilation can effectively minimize the treatment time of patients with PAH complicated with RF, reduce the incidences of adverse events and complications in them, and significantly improve the blood gas analysis indexes and BNP in them, so it is worthy of clinical promotion.
RESUMO
BACKGROUND: It has been proven that lung cancer in the youth exhibited rapid progression, thus timely and accurate diagnosis is crucial. The aim of this study is to explore the clinicopathological characteristics of lung cancer in the youth, so as to provide clues for diagnosis. METHODS: The study enrolled patients aged younger than 40 years with lung cancer diagnosed with histology or cytology in our hospital between 1995-2012. We retrospectively analyzed sex, age, symptoms, smoking history, histology, stage and misdiagnosis. RESULTS: One hundred and thirty patients with lung cancer in the youth were enrolled, which comprise 5.2% of all cases of lung cancer in that period. Among them, 68.5% were male; 53.8% were aged between 36 and 40 years. Common symptoms included cough and hemoptysis, and systematic symptoms were relatively uncommon; and 11.8% showed no symptoms. 63.3% had a smoking history, and the time between initial symptom and final diagnosis averaged 3.9 months. The misdiagnosis rate was 51.5%, with tuberculosis as the leading misdiagnosis. 85.4% were staged III/IV. Primary lesion often located in upper lobes. Adenocarcinoma was the commonest histology, and 72.3% of the whole group was poorly differentiated. CONCLUSIONS: Lung cancer in the youth showed some special clinicopathological characteristics. Doctors should consider the possibility of lung cancer in patients with seemly diagnosis of tuberculosis, especially in those without symptomatic symptoms, and perform histological or cytological examinations. The absence of smoking history cannot rule out the possibility of lung cancer in youth patients.
