目的 探讨Stanford B型胸主动脉夹层腔内修复(TEVAR)术后不同类型内漏的产生机制及处理措施。方法 收集整理2008年9月—2017年2月间在我院诊断为Stanford B型胸主动脉夹层并接受TEVAR术治疗的105例患者的临床及影像资料,分析术中及术后出现内漏的原因,根据内漏来源及渗漏量给予不同处理,观察处理后内漏的变化情况。结果 术中出现急性内漏11例,包括Ⅰ型内漏8例(7.6%)和Ⅱ型内漏3例(2.8%);迟发内漏3例,包括Ⅰ型内漏1例(1.0%)和Ⅱ型内漏2例(1.9%),内漏总发生率为13.3%。术后患者未出现支架移位、截瘫、肾动脉缺血等严重并发症。结论 根据内漏产生的原因不同,内漏分为5型,其中Ⅰ型及Ⅱ型内漏较为常见,不同类型内漏处理方式不同,正确判断内漏类型是合理、有效处理内漏的前提。

Objective To investigate the causes of different types of endoleak after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection, and to discuss its management. Methods The clinical data and imaging data of 105 patients with Stanford type B aortic dissection, who were admitted to authors' hospital during the period from September 2008 to February 2017 to receive TEVAR, were collected and reviewed. Reasons of intraoperative endoleak or after operation were analyzed, different treatments for the source of endoleak and leakage were taken and the conversions followed were observed. Results Acute endoleak was occurred in 11 patients during operation, including endoleak typeⅠ (n=8,7.6%)and endoleak type Ⅱ (n=3,2.8%). Delayed endoleak was seen in 3 patients, including endoleak typeⅠ (n=1,1.0%)and endoleak type Ⅱ (n=2,1.9%). Both in-operative and postoperative endoleak occurred in 14 patients (13.3%). After TEVAR, no serious complications such as displacement of stent, paraplegia or renal artery ischemia occurred. Conclusion According to the different reasons, endoleak can be divided into five types, among them, type Ⅰ and type Ⅱ are most common. Different endoleak should be handle in different ways.Correct judgment of endoleak type is the premise of reasonable and effective treatment for endoleak.

目的 比较一线伊马替尼疗效欠佳的慢性髓性白血病慢性期(CML-CP)患者,继续伊马替尼原方案或转换为尼洛替尼治疗后的疗效及安全性。方法 收集伊马替尼疗效欠佳的 45 例患者,分为伊马替尼组22例及尼洛替尼转换组23例,22例伊马替尼组患者继续接受原方案伊马替尼治疗,剂量均为400 mg qd,又将尼洛替尼转换组分为早期尼洛替尼转换组7例,晚期尼洛替尼组转换有16例。尼洛替尼转换组的23例患者接受尼洛替尼的剂量均为400 mg,q12h。所有入组患者首诊时测定 Sokal 评分,在治疗过程中随访观察定期监测血液学、细胞遗传学及分子学缓解情况(FISH 和 RQ-PCR),并对患者用药后的基本情况、临床表现及不良反应进行记录。结果 转换尼罗替尼治疗3个月时,早期尼洛替尼转换组中国际标准化 BCR-ABL1融合基因转录本水平(BCR-ABL1^IS)＜10%的患者有 5 例(71.4%),晚期尼洛替尼转换组BCR-ABL1^IS＜10%的患者有6例(37.5%),差异无统计学意义(P＞0.05)。中位观察6(3～12)个月,尼罗替尼组中有17例(73.9%)获得部分细胞遗传学反应,9例(39.1%)患者获得主要分子学反应。伊马替尼组中有9例(40.9%)获得部分细胞遗传学反应,2例(9.1%)患者获得主要分子学反应,尼洛替尼组部分细胞遗传学反应、主要分子学反应患者优于伊马替尼组(P值分别为0.027、0.020)。45例患者中达到完全细胞遗传学反应的患者与未达到完全细胞遗传学反应相比,Sokal 评分偏低(P=0.032)。结论 尼洛替尼可使伊马替尼疗效欠佳的 CML-CP 患者达到更好的疗效,因此需要及时对伊马替尼疗效欠佳的 CML-CP 患者进行评估后及时更换为尼洛替尼等二代酪氨酸激酶抑制剂。

Objective To assess the clinical efficacy and safety of original scheme or switching to nilotinib in patients with chronic myeloid leukemia in chronic phase(CML-CP)with suboptimal response of first-line imatinib. Methods 45 patients with suboptimal response of imatinib were collected and divided into 22 patients who continued to use original scheme and 23 patients who switched to nilotinib therapy. All the 22 patients of imatinib group received imatinib 400 mg once a day. And the 23 patients of nilotinib group were divided into early switch group and late switch group. Early switch group had 7 patients, late switch group had 16 patients. Both early and late switch to nilotinib group were subsequently to nilotinib 400 mg q12h. Sokal scores of all the enrolled patients were measured at the first diagnosis. Hematology, cytogenetics and molecular remission (FISH and RQ-PCR)were monitored, and the patients' basic information, clinical manifestations and adverse reactions were recorded regularly during the treatment. Results After switching to nilotinib for 3 months,there were 5 patients (71.4%)whose BCR-ABL1^IS<10% in the early nilotinib switch group, while 6 patients (37.5%)in the late nilotenib switch group.There was no statistical difference(P>0.05).With a median observation period of 6(3～12)months,there were 17 (73.9%)patients achieved partial cytogenetic response and 9 (39.1%)patients achieved major molecular response in the nilotinib group,there were 9 patients (40.9%)achieved partial cytogenetic response and 2 patients (9.1%)achieved major molecular response in the imatinib group. Patients who achieved partial cytogenetic response and major molecular response in the nilotinib group were more than those in the imatinib group (P values were 0.027 and 0.020, respectively).Sokal scores of 45 patients who had achieved complete cytogenetic response were lower than those who had achieved it (P=0.032). Conclusion Early switch to nitotinib is feasible and effective to patients who didn't have optimal response to imatinib. It is necessary to assess patients regularly in order to have the proper timing switching patients to nilotinib therapy.

目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.

目的 探讨替罗非班联合丁苯酞应用于进展性脑梗死的疗效与安全性。方法 选取2016年1月—2018年1月广州医科大学附属第三医院神经内科收治的进展性脑梗死患者98例。对照组采用硫酸氢氯吡格雷加阿司匹林（双抗）治疗,观察组采用替罗非班（静脉治疗48 h）联合丁苯酞序贯双抗治疗。结果 替罗非班联合丁苯酞序贯双抗治疗组的神经功能缺损（NIHSS）评分、日常生活能力评定量表（Barthel指数）、改良 Rankin 量表评分优于对照组,血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）与凝血酶时间（TT）水平高于对照组,两组有差异。两组患者药物不良反应发生率无差异。结论 替罗非班联合丁苯酞序贯双抗治疗可明显改善进展性脑梗死的神经功能,为时间窗外的进展性脑梗死提供了治疗方法,疗效显著。

Objective To observe the effect and safety of triofiban combined with butylphthalide in treatment of progressive cerebral infarction. Methods A total of 98 patients with progressive cerebral infarction in the department of neurology from January 2016 to January 2018.The control group was treated with clopidogrel hydrogen sulfate plus aspirin（dual antiplatelet）. The observer group was treated with Tirofiban（48 h intravenous treatment） combined with butylphthalide on the basis of the treatment of the control group. Results The score of National Institutes of Health Stroke、 Barthel Index and mRS in the triofiban combined with butylphthalide group were better than that of the control group. There were statistical differences between the two groups. PT,APTT and TT were higher than that in the control group .There was no significant difference in drug adverse reactions between the two groups. Conclusion Triofiban combined with butylphthalide may improve the neurologic function of progressive cerebral infarction and provide treatment for progressive cerebral infarction outside the time window.

目的 观察腹腔镜下胆总管切开取石术中胆管一期缝合治疗胆总管结石的临床效果。方法 研究对象选取我院2016年3月—2017年3月术前诊断为胆总管结石且符合纳入标准的患者92例,采用随机法,将其分为一期缝合术组和T管引流术组各46例,两组患者均行腹腔镜下胆总管切开取石术,一期缝合术组行术中胆管一期缝合,T管引流术组行术中胆管T管引流。比较两组手术相关指标,住院时间,住院费用,术后并发症的发生率。结果 一期缝合术组在减少手术出血量、促进切口恢复、预防切口感染的发生率上优于T管引流术组（P < 0.05）;在住院时间、住院费用以及术后并发症的发生率上低于T管引流术组（P < 0.05）。结论 本次研究结果表明腹腔镜下胆总管切开取石术中胆管一期缝合的临床效果优于T管引流,可有效减少手术并发症,缩短病人的住院时间,是治疗胆总管结石理想的选择。

Objective To observe the clinical effect of primary suture in the treatment of common bile duct stones under laparoscopic common bile duct incision. Methods The subjects were enrolled in our hospital from March 2017 to March 2018. 92 patients with choledocholithiasis and met the inclusion criteria, were randomly divided into one-stage suture group and T-tube drainage group. Surgery-related indicators,length of hospital stay,hospitalization costs,and incidence of postoperative complications were compared. Results In the first-stage suture group,the incidence of surgical bleeding reduction,postoperative incision recovery,and prevention of wound infection were better than those in the T-tube drainage group （P < 0.05）. The incidence of hospitalization,hospitalization,and postoperative complications were lower in the first-stage suture group than in the T-tube drainage group（P < 0.05）. Conclusion The clinical effect of one-stage suture in laparoscopic common bile duct incision and stone removal is better than T-tube drainage,which may effectively reduce surgical complications and shorten the hospitalization time of patients. It is an ideal choice for the treatment of common bile duct stones.

目的 探讨鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿的临床疗效。方法 选择2014年8月-2017年8月我院收治的60例鼻前庭囊肿患者为研究对象,根据手术方式不同分为两组,每组各30例。对照组采用传统唇龈沟径路鼻前庭囊肿切除术进行治疗,观察组采用鼻内镜鼻前庭囊肿揭盖术治疗;评价两组手术情况、术后疼痛程度及并发症发生情况,术后随访1年,观察两组患者的复发情况。结果 对照组手术时间、术中出血量、术后住院时间分别为（44.78±8.13）min、（37.09±7.11）mL、（7.27±1.45）d均高于观察组的（17.91±4.26）min、（8.85±3.12）mL、（5.02±1.06）d,差异有统计学意义（P<0.05）;对照组术后24 h、48 h、72 h的VAS评分分别为（3.53±1.07）分、（2.84±1.12）分、（2.34±0.69）分均高于观察组的（2.92±1.14）分、（2.21±1.00）分、（1.73±0.76）分,差异有统计学意义（P<0.05）;对照组术后并发症发生率为26.67%,复发率为20.00%,高于观察组的6.67%、0.00%,差异有统计学意义（P<0.05）。结论 鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿疗效显著,具有手术时间短、出血量少的优点,可减轻患者术后疼痛,减少术后并发症的发生,利于加速患者恢复,预后较好。

Objective To investigate the clinical efficacy of nasal endoscopic nasal vestibular cyst uncovering for nasal vestibular cyst. Methods Sixty patients with nasal vestibular cysts admitted to our hospital from August 2014 to August 2017 were enrolled in the study. They were divided into two groups according to different surgical methods,30 in each group. The control group was treated with traditional sacral sulcus cystectomy. The observation group was treated with nasal endoscopic nasal vestibular cyst uncovering for nasal vestibular cyst. The operation status,postoperative pain degree and complications were evaluated. After one year,the recurrence of the two groups of patients was observed. Results The operation time,intraoperative blood loss and postoperative hospital stay were （44.78±8.13） min,（37.09±7.11） mL,and （7.27±1.45）d,respectively,which were higher than the observation group （17.91±4.26） min. （8.85±3.12） mL,（5.02±1.06） d,the differences were statistically significant （P<0.05）;the VAS scores of the control group at 24h,48h,72h were （3.53±1.07） points,（2.84±1.12）. The scores of （2.34±0.69） were higher than those of the observation group （2.92±1.14）,（2.21±1.00）,and （1.73±0.76）,the differences were statistically significant （P<0.05）. The postoperative complication rate was 26.67%,and the recurrence rate was 20.00%,which was higher than that of the observation group （6.67%,0.00%）. The differences were statistically significant （P<0.05）. Conclusion Endoscopic nasal vestibular cyst is a significant treatment for nasal vestibular cyst. It has the advantages of short operation time and less bleeding. It may reduce postoperative pain,reduce postoperative complications,and accelerate the recovery of patients. It is good at prognosis.

目的 分析促红细胞生成素（EPO）及促红细胞生成素受体（EPOR）在肝细胞癌（NCC）以及正常组织中的表达规律,以及它们和肝细胞癌微血管密度（MVD）之间的关系。方法 选取我院手术切除的肝细胞肝癌的标本30例,取肿瘤边缘2.0 cm的肝组织作为对照,同时取正常肝脏组织10例做为阴性对照。利用酶联免疫吸附实验（ELISA）检测各组织中EPO及EPOR表达水平,利用免疫组织化学方法染色检测微血管密度（MVD）。对比癌组织和癌旁组织EPO、EPOR及MVD差异,分析NCC中EPO、EPOR、MVD与肿瘤病理特征的关系,分析EPO、EPOR表达水平与MVD之间的关系。结果 HCC组织中,EPR、EPOR、MVD均高于癌旁组织和正常组织,差异有统计学意义（P<0.001）,EPR、EPOR、MVD在癌旁组织和正常组织中,差异无统计学意义（P>0.05）。肿瘤大小>5 cm、存在包膜侵犯、存在远处转移以及高中分化的HCC中,EPR、EPOR、MVD水平高于肿瘤大小≤5 cm、无包膜侵犯、无远处转移以及低分化的水平,差异有统计学意义（P<0.05）。Person相关分析结果显示,EPO表达水平与MVD的相关系数r=0.651（P<0.001）,EPOR表达水平与MVD的相关系数r=0.620（P<0.001）。结论 EPO、EPOR、MVD在HCC中呈现高水平,且与肿瘤大小、局部侵犯、远处转移及分化程度有关,其机制可能与EPO、EPOR增加MVD有关。

Objective To analyze the expression of erythropoietin （EPO） and erythropoietin receptor （EPOR） in hepatocellular carcinoma （NCC） and normal tissues,and their relationship with hepatocyte microvessel density （MVD）. Methods Thirty specimens of hepatocellular carcinoma hepatectomy were selected from our hospital. The liver tissue at the edge of the tumor was taken as a control,and 10 cases of normal liver tissue were used as a negative control. The expression levels of EPO and EPOR in each tissues were detected by enzyme-linked immunosorbent assay （ELISA）,and microvessel density （MVD） was detected by immunohistochemistry. The differences of EPO,EPOR and MVD between each tissues were compared. The relationship between EPO,EPOR,MVD and tumor pathological features in NCC was analyzed. The relationship between EPO and EPOR expression levels and MVD was analyzed. Results In HCC tissues,EPR,EPOR and MVD were higher than those in adjacent tissues and normal tissues. The difference was statistical difference （P<0.001）. EPR,EPOR and MVD were not statistically significant in adjacent tissues and normal tissues. P>0.05）. The levels of EPR,EPOR,and MVD in tumors with tumor size >5 cm,invasion of the capsule,distant metastasis,and high-differentiation were higher than those of tumor size ≤ 5 cm,no capsule invasion,no distant metastasis,and poor differentiation. The difference was statistical difference （P < 0.05）. Person correlation analysis showed that the correlation coefficient between EPO expression level and MVD was r=0.651 （P<0.001）,and the correlation coefficient between EPOR expression level and MVD was r=0.620 （P<0.001）. Conclusion EPO,EPOR and MVD are highly expressed in HCC,and are related to tumor size,local invasion,distant metastasis and differentiation. The mechanism may be related to EPO and EPOR increasing MVD.

目的 研究加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎的临床疗效。方法 将100例慢性萎缩性胃炎患者随机分为对照组和观察组各50例,对照组患者给予三联疗法而观察组在对照组基础上辨证使用加减香砂六君子汤加减进行治疗。对临床疗效进行评估,观察两组患者临床症状并测定血清中超氧化物歧化酶（SOD）、丙二醛（MDA）水平的变化,统计两组的幽门螺杆菌（Hp）转阴率及复发率、根除率。结果 治疗以后统计有效率,观察组为92%,而对照组仅有76%,胃胀、胃痛、痞满、反酸、饮食减少等症状均缓解,各症状的积分治疗后均降低,两组相比其差异有统计学意义,观察组的Hp转阴率为92.0%,对照组Hp转阴率为68.0% ,两组Hp转阴率比较,差异有统计学意义。两组SOD水平均较治疗前上升,MDA水平均较治疗前下降,SOD水平高于对照组,MDA水平低于对照组,差异均有统计学意义（P<0.05）。结论 加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎可显著改善患者的临床症状,有良好的应用前景。

Objective To observe the clinical effect of Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis. Methods We selected 100 cases of patients with chronic atrophic gastritis of intertwined,and divided them into the control group and the observation group randomly with 50 cases in each group. The control group was given triple therapy for treatment,while the observation group was additionally given Jiajianxiangshaliujunzi decoction based on the syndrome differentiation for treatment. We observed the changes of clinical symptoms and levels of superoxide dismutase（SOD） and malondialdehyde（MDA） in serum of both groups. The negative conversion rate,recurrence rate and eradication rate of Helicobacter pylori （Hp） in 2 groups were statistically analyzed,in both groups and the clinical effect. Results After treatment,the total effective rates were counted: the observation group was 92%,and the control group was only 76%. The symptoms such as stomach distention,stomachache,distention and fullness,acid reflux,and diet reduction were reduced after the treatment. The difference between the two groups had statistical significance. In the two groups of stomachache,fullness and boredom,low appetite and acid regurgitation scores were all lower than those before treatment,and the differences were statistically significant. The negative rate of Hp in the observation group was 92%,while the negative rate of Hp in the control group was 68%. There was difference between the two groups in the negative rate of Hp. The levels of SOD in both groups were higher than those before treatment,and the levels of MDA were lower than those before treatment,differences being significant（P< 0.05）;the level of SOD in the observation group was higher than that in the control group,and the level of MDA was lower than that in the control group. Difference was statistically significant. （P< 0.05）. Conclusion Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis may improve clinical symptoms of patients,and promote the negative rate of Hp as well as the clinical effect.

目的 观察并比较注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（益塞普）剂量递减方案与标准剂量维持方案治疗强直性脊柱炎（AS）的疗效及安全性。方法 选择2015年1月—2016年6月共18个月在我院治疗的80例AS患者为研究对象,随机分为两组,A组40例,给予益塞普递减方案治疗,B组40例,给予益塞普标准剂量维持方案治疗,比较两组的用药疗效及安全性。结果 治疗后,两组的BASDAI、BASFI评分,腰背痛VAS评分,血清CRP、ESR水平均低于治疗前（P<0.05）,但两组组间比较未见统计学意义（P>0.05）;在治疗期间,A组与B组的不良反应发生率（32.50%、55.00%）及复发率（27.50%、22.50%）比较均无统计学意义（P>0.05）;经统计,A组的年平均药物费用为（47 391±4 830）元,少于B组（82 038±5 127）元（P<0.05）。结论 采用益塞普剂量递减方案治疗AS安全有效,能在短时间内控制疾病活动及改善临床症状,且花费更低,患者接受度更高。

Objective To observe and compare the clinical effect and safety of dose reduction scheme for recombinant human tumor necrosis factor receptor antibody fusion protein （hTNFR：Fc,etanercept） for injection and standard dose maintenance scheme in treatment of ankylosing spondylitis （AS）. Methods 80 cases of patients with AS and who were treated in our hospital from January 2015 to June 2016 for 18 months were selected as the research objects,and were randomly divided into two groups.The group A of 40 cases were treated with etanercept of degressive scheme therapy,while the group B of 40 cases were treated with etanercept of standard dose maintenance therapy. Then,the clinical effect and safety of drug use of two groups were compared. Results The BASDAI,BASFI score,VAS score of low back pain,serum CRP and ESR levels of two groups after treatment were lower than those before the treatment （P < 0.05）,but there was no statistical significance between the two groups （P > 0.05）. During the treatment,there was no significant difference in the incidence of adverse reactions （32.50%,55%） and recurrence rate （27.50%,22.50%） between group A and group B （P > 0.05）. By statistics,the average annual drug cost in group A was RMB （47 391±4 830） yuan,which was less than that in group B of RMB （82 038±5 127） yuan （P < 0.05）. Conclusion The etanercept of degressive scheme therapy in treatment of AS are safe and effective,which may control disease activity and improve clinical symptoms in a short time,and low costs. The patient will receive higher degree of acceptance.

目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.