小气道病变曾经是全球呼吸界研究的热点，许多肺功能测定方法和指标被用于小气道功能的诊断，其后热度骤减，最近又引起一些学者的重视。
COPD是以不完全可逆性气流受限为特征的进展性肺疾病， 与肺部对香烟烟雾等有害气体或有害颗粒的异常炎症反应有关。病理改变存在于外周气道、中央气道、肺实质和肺血管系统等， 也可引起肺外的不良效应， 但外周气道病变和功能异常是导致不完全可逆气流受限的主要原因。国内外采用吸入支气管舒张剂后一秒率( FEV1／FVC) 小于70％来进行定性诊断。
Objective To observe the feature of post-operative hyperglycemia after coronary artery bypass grafting(CABG) surgery in department of intensive care unit（ICU） patients.Methods Patients who had CABG surgery in Zhongshan Hospital from January 2005 to December 2005 were enrolled.Data were collected including the history of diabetes，pre-operative and post-operative blood glucose(BG) levels，and the time that post-operative hyperglycemia and peak BG occurred.The patients were divided into diabetic and non-diabetic groups according to the diabetic history.The data were compared and analyzed between the two groups.Results 200 patients were enrolled in this study.The incidence of post-operative hyperglycemia was 77%，and about 99.4% occurred in the first 24 hours admitted to ICU，which was independent on diabetic history (χ2=2.58，P=0.108)，but was related to the BG level above 6.1 mmol/L (χ2=12.31，P=0.000).In 80% of the patients，peak BG occurred in the first 24 hours admitted to ICU，which was significantly earlier in the non-diabetic group compared with the diabetic group (8.5 h vs 18.5 h，P=0.02 ).In the patients who had post-operative hyperglycemia，the median time of the BG peak is 10 hours，and 75.3% of the BG peak occurred in the first 24 hours admitted to ICU.Conclusion There is a high incidence of post-operative hyperglycemia in post-CABG patients which always occur within 24 hours after operation and relate to pre-operative high BG.
Objectives To study the role of the kidney in the maintenance of metabolic alkalosis of critically ill patients during perioperative period.Methods The patients who had metabolic alkalosis in the surgical intensive care unite（SICU） from Nov 2004 to Feb 2005 were enrolled in the alkalosis group；and the control group were the perioperative patients in the department of hepatic surgery at the same time，those who had acid-base imbalance were excluded.The enrolled patients underwent routine tests and some parameters such as creatinine clearance rate（Ccr，to evaluate glomerular filtration rate），titratible acid，ammonium ion，urinary bicarbonate，net acid excretion were calculated.Results The Ccr of the alkalosis group and control group was（76.2±37.1）mL/min vs（98.5±31.9）mL/min，respectively（P=0.042） with a decrement of 22% in the alkalosis group.The titratible acid was（25.2±19.4）mmol/24 h vs（49.9±26.4）mmol/24 h，respectively（P=0.002）；the net acid excretion was（156.5±84.3） mmol/24 h vs（117.5±32.1）mmol/24 h，respectively（P=0.047）；the ammonium ion was（140.6±81.6） mmol/24 h vs（78.7±16.3）mmol/24 h，respectively（P=0.002）.The postoperative electrolytes of the alkalosis group and control group：[K+] was（3.51±0.67）mmol/L vs（4.14±0.59）mmol/L，respectively（P=0.002）；[Cl－] was（98.4±8.3）mmol/L vs（102.8±3.0）mmol/L，respectively（P=0.035）；[Ca2+] was（2.14±0.21）mmol/L vs（2.25±0.14）mmol/L，respectively（P=0.049）；[P] was（0.83±0.34）mmol/L vs（1.11±0.23）mmol/L，respectively（P=0.004）；[Na+] was（139.6±7.7）mmol/L vs（140.8±4.6）mmol/L，respectively（P=0.535）；[Mg2+] was（0.94±0.15）mmol/L vs（0.90±0.16）mmol/L，respectively（P=0.338）.Conclusions Decreased glomerular filtration rate and enhanced renal acidification function are the important factors that maintain the metabolic alkalosis during perioperative period.Potassium，chloride，calcium and phosphorus are decreased during metabolic alkalosis，while sodium and magnesium has no significant change.
Objective To assess the value of pulmonary ventilation test in evaluating the prognosis of cardiac surgery patients. Methods Data were collected retrospectively from consecutive patients with coronary heart disease or valvular disease, who were prepared for cardiac surgery in Zhongshan Hospital from January 2007 to December 2008. The main outcome indices were mortality of surgery, the prolonging time of using artificial airway ( ≥3 days) , and the prolonging time in intensive care units ( ICU) ( ≥5 days) . Then the relationship between the poor outcome and ventilation disorder was analyzed. Results In the 422 cases,the incidence of ventilation disorder was 55% , included 27. 5% restrictive ventilation disorder, 15. 6% obstructive ventilation disorder, and 11. 8% mixed ventilation disorder. And the severity of pulmonaryventilation disorder was mild of 34. 6% , moderate of 15. 2% , and severe of 5. 2% . Among the 42 patients who gave up surgery,50% were due to ventilation dysfunction, and the patients were prone to give up surgery with the deterioration of pulmonary function( P lt; 0. 001) . But comparing with the patients with normal pulmonary function, the risk of poor outcome after surgery did not significantly increase in the patients with ventilation disorder ( P gt; 0. 05 ) . The logistic regression analysis indicated that cardiopulmonary bypass ( CPB) was an absolute risk factor ( P lt; 0. 05) . Conclusions The incidence of ventilation disorder in patients with cardiac disease is quite high. Severe pulmonary ventilation disorder is the significant cause of giving up surgery, but may be not the absolute contraindication of cardiac surgery.