目的 分析肺结核合并Ⅱ型呼吸衰竭患者经鼻高流量湿化氧疗期间应用多维度强化护理的效果。方法 纳入2022年12月—2025年1月在河北省胸科医院进行经鼻高流量湿化氧疗的肺结核合并Ⅱ型呼吸衰竭患者294例，随机分为强化护理组（147例，多维度强化护理）、对照组（147例，常规护理），测量比较两组患者在护理前后气道重塑指标、肺功能指标、血气分析指标，进行疗效评估。结果 护理后强化护理组气道壁面积、气道壁厚度低于对照组，气道腔面积高于对照组（P＜0.05）；护理后强化护理组第1秒用力呼气容积、用力肺活量高于对照组（P＜0.05）；护理后强化护理组动脉血氧分压高于对照组，动脉血二氧化碳分压低于对照组（P＜0.05）；强化护理组总有效率高于对照组（P＜0.05）。结论 肺结核合并Ⅱ型呼吸衰竭患者经鼻高流量湿化氧疗期间接受多维度强化护理可改善其气道重塑及肺功能，有利于血气分析指标恢复，应用效果显著。

       Objective To analyze the efficacy of multidimensional enhanced nursing during nasal high-flow humidified oxygen therapy in patients with pulmonary tuberculosis and type Ⅱ respiratory failure．Methods A total of 294 patients with pulmonary tuberculosis and type Ⅱ respiratory failure who received nasal high-flow humidified oxygen therapy at Hebei Chest Hospital between December 2022 and January 2025 were enrolled and randomly divided into an enhanced nursing group（147 patients，receiving multidimensional enhanced nursing）and a control group（147 patients，receiving conventional nursing）．Airway remodeling，pulmonary function，and blood gas analysis were measured and compared between the two groups before and after nursing，and the efficacy was evaluated．Results After nursing，the enhanced nursing group had lower airway wall area and airway wall thickness，and higher airway lumen area than the control group（P＜0.05）．The forced expiratory volume in 1 second and forced vital capacity in the enhanced nursing group were higher than those in the control group（P＜0.05）．The blood oxygen partial pressure（PaO₂）in the enhanced nursing group was higher than that in the control group，and the carbon dioxide partial pressure（PaCO₂）was lower than that in the control group（P＜0.05）．The total effective rate in the enhanced nursing group was higher than that in the control group（P＜0.05）．Conclusions Multidimensional enhanced nursing during nasal high-flow humidified oxygen therapy can improve airway remodeling and lung function in patients with pulmonary tuberculosis and type Ⅱ respiratory failure，and is beneficial for the recovery of blood gas analysis indicators．The application effect is significant．

目的 本研究通过检测吸入布地奈德治疗支气管哮喘患儿前、后气道重塑、肺功能及外周血TGF-β浓度的变化,探讨布地奈德在哮喘患儿气道重塑早期干预的作用。方法 将2013年1月—2014年10月在我院确诊为支气管哮喘患儿18例,给予规律吸入布地奈德治疗6个月,分别于治疗前、后检测肺功能、外周血TGF-β浓度以及通过高分辨CT(HRCT)测量支气管管壁厚度(T)并计算管壁面积(WA)、支气管管壁厚度与气管外径之比(WT%)、气道壁横截面面积占气道总截面积的的百分比(WA%)。结果 吸入布地奈德治疗治疗6个月后,哮喘患儿WT%、WA%、肺功能以及TGF-β浓度均明显改善,与治疗前比较差异有统计学意义(P<0.05)。结论 规律吸入布地奈德治疗能减轻支气管哮喘患儿早期气道重塑,改善肺功能,可能通过下调细胞因子TGF-β的表达有关。

Objective We detected the changes of Airway remodeling,lung function and peripheral blood concentrations of TGF-β in asthmatic children before and after inhaled budesonide, and explored the role of budesonide in airway remodeling before early intervention in asthmatic children. Methods 32 cases of children were diagnosed asthma in our hospital,and given treatment of inhaled budesonide for 6 months, and to detect lung function,pheral blood TGF-β concentration as well as measuring the bronchial wall thickness (T) and calculate the wall area (WA), the outer diameter of the trachea and bronchial wall thickness ratio (WT%), the cross-sectional area of the airway wall accounted for airway percentage (WA%) of the total cross-sectional area by high-resolution CT (HRCT) before and after treatment. Results After treatment with inhaled budesonide in six months, the asthma WT%, WA%, lung function, and TGF-β concentrations were significantly improved, the differences compared with that before treatment were statistically significant(P<0.05). Conclusion The treatment of inhaled budesonide can alleviate asthmatic airway remodeling in early, improve lung function,possibly related to down the expression TGF-β.