慢性阻塞性肺疾病患者牙周病及外周血、龈沟液炎性标志物观察

目的观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者牙周病(牙周指标)及外周血、龈沟液(gingival crevicular fluid,GCF)炎性标志物情况。方法选取2012年1月—2013年10月在中国医科大学附属第四医院呼吸内科门诊和(或)住院治疗的COPD患者51例作为COPD组及同期健康体检的57例作为对照组。两组均行牙周检查及外周血、GCF白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α和超敏C反应蛋白(hsCRP)检测并进行比较。结果牙周病患病率COPD组、对照组分别为56.86%(29/51)、21.05%(12/57),差异有统计学意义(χ2=14.66,P0.01)。COPD组的牙周指标中临床附着丧失、牙周袋深度、牙龈指数、龈沟出血指数、菌斑指数、牙齿松动度、牙齿填充指数及简化口腔卫生指数均明显低于对照组(P均0.05);COPD组外周血IL-1β、IL-6、TNF-α、hs-CRP和GCF IL-1β、IL-6、TNF-α水平均显著高于对照组(P均0.05)。结论 COPD患者牙周卫生状况差,牙周病患病率高,外周血及GCF炎性标志物表达水平明显升高。     

牙周炎与慢性阻塞性肺疾病

牙周炎是影响牙齿支持组织的慢性感染性疾病,可引起牙周附着丧失、牙龈退缩,严重者可导致牙齿松动、脱落。牙周炎初期表现为牙龈红肿、出血;严重时,菌斑微生物将扩散至龈下,细菌及其毒性产物会刺激牙周支持组织,引发机体的慢性炎症,并且激活机体的防御系统,在导致牙齿支持组织破坏形成牙周炎的同时,毒性产物及其引发释放的炎性介质可以随血液循     

牙周干预对慢性阻塞性肺疾病急性发作频率的影响

目的通过比较慢性阻塞性肺疾病(COPD)伴慢性牙周炎患者在进行牙周干预治疗前后COPD急性发作(AECOPD)频率的变化,探讨牙周干预治疗对AECOPD的预防作用。方法对43例COPD伴慢性牙周炎的患者进行牙周干预治疗,分别记录干预前及干预一年后患者的菌斑指数(PLI)、出血指数(BI)及牙周附着丧失(AL);回顾性调查患者干预前一年并随访观察干预后一年患者AECOPD的次数、因AECOPD住院的次数以及累计住院天数。结果牙周干预治疗前后患者的PLI分别为2.24±1.16,1.36±0.73(P<0.05);BI分别为3.25±1.04,2.13±1.49(P<0.05);AL分别为(4.16±1.05)mm与(3.01±0.55)mm(P<0.05)。牙周干预治疗前一年及牙周干预治疗后一年患者的平均AECOPD次数分别为(4.1±0.9)次,(2.8±0.8)次;因AECOPD住院的平均次数分别为(2.2±0.8)次,(1.5±0.5)次;累计平均住院天数分别为(27.8±10.2)d,(20.3±7.9)d(P均<0.05)。结论牙周干预治疗促进了患者的口腔卫生及牙周健康状况,并降低了COPD伴慢性牙周炎患者AECOPD的发生频率,提示牙周干预治疗可能成为预防AECO-PD的新的辅助方法。     

慢性阻塞性肺疾病急性加重期的护理

我院2004-01~2005-12对慢性阻塞性肺疾病(COPD)34例采用呼吸道护理辅助治疗,效果效好,现总结如下。1临床资料1.1一般资料我院呼吸内科住院患者66例,男44例,女22例,年龄50~86(68±8.4)岁。病程4~34(15.2±7.1)a。全部病例均符合COPD诊治标准,并存在急性加重期的临床表现:(1)呼吸困难加重;(2)咳嗽次数增多或加重;(3)痰量增加或出现脓性痰;(4)喘息加重至少持续3 d。1.2治疗方法66例随机按住院顺序前34例分为治疗组和后32例分为对照组,2组性别、年龄、病程、病情等指标比较差异无显著性,具有可比性。对照组常规吸氧、应用抗生素、止咳、祛痰…     

老年慢性阻塞性肺疾病急性加重期162例分析

对老年慢性阻塞性肺疾病（COPD）急性加莺期162例分析如下。 1临床资料 1．1一般资料 本组COPD急性加蕈期（AECOPD）患者162例，诊断符合中华医学会呼吸病学分会《慢性阻塞性肺疾病（COPD）诊治规范（草案）》标准。其中男93例，女69例，年龄60～92（平均74．6）岁。合并肺心病87例，高血压病50例．冠心病35例，2型糖尿病19例，脑血管病9例，肺癌4例，胸腔积液4例，气胸2例。     

慢性阻塞性肺疾病急性加重期患者的院前急救护理

目的观察慢性阻塞性肺疾病急性加重期（acute exacerbations of chronic obstructive pulmonary disease,AECOPD）患者的院前急救护理经验。方法对实施院前急救护理的80例AECOPD患者的临床资料进行回顾性分析和总结。结果经院前急救护理,80例患者病情程度评分为（1.27±0.50）分,为轻～中度。死亡1例（1.25%）,无1例患者发生呼吸道阻塞。结论院前急救护理有助于改善AECOPD症状,降低病死率,提高救护效果。     

机械通气在慢性阻塞性肺疾病急性加重期的应用

慢性阻塞性肺疾病 (COPD)急性加重期是临床上最常见的应用机械通气的原因 ,COPD急性加重期患者病情复杂 ,肺部感染、气道阻塞、呼吸肌疲劳轻重不一、交错存在 ,应针对病人具体情况采取不同的通气策略。本文对 46例COPD急性加重期的患者在常规治疗的基础上应用不同的通气策略 ,取得良好疗效 ,分析如下。1　临床资料1.1　一般资料　 1999年 3月～ 2 0 0 2年 9月COPD急性加重期患者 46例 ,其中男 3 9例 ,女 7例 ;年龄 3 7～ 84岁 ,平均 5 9.9岁。COPD急性加重期患者的诊断符合 2 0 0 2年中华医学会呼吸病学分会制定的COPD诊断标准[3 …     

慢性阻塞性肺疾病急性加重期病原学分析

目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者感染病原菌分布情况,为提高临床诊治水平提供依据。方法回顾性收集2013年6月至2014年6月在南海医院就诊并收治入院的AECOPD患者200例,其中男124例、女76例,对患者的血培养、痰培养和血清学检测结果进行分析。结果病原体检出率为68.0%(136/200),其中血培养阳性率为3.5%(7/200),以大肠埃希菌、肺炎链球菌检出为主;痰培养阳性率为37.5%(75/200),以铜绿假单胞菌、大肠埃希菌、肺炎链球菌检出为主;尿液肺炎链球菌抗原阳性率为2.5%(5/200);非典型病原体阳性率为7.5%(15/200),以肺炎支原体检出为主;呼吸道病毒血清检查阳性率17.0%(34/200),主要是乙型流感病毒和副流感病毒。结论该地区AECOPD患者感染病原体主要以革兰阴性杆菌为主,其次为病毒感染。     

慢性阻塞性肺疾病急性加重期的呼吸道护理

目的探讨慢性阻塞性肺疾病急性加重期呼吸道护理的临床效果。方法将79例患者随机分为2组,对照组给予常规治疗,治疗组在对照组的基础上采用正确的体位及引流、有效咳嗽、雾化吸入等呼吸道护理。结果治疗组临床疗效优于对照组(P<0.05)。结论慢性阻塞性肺疾病急性加重期加强呼吸道护理有助于病情的恢复。     

慢性阻塞性肺疾病急性加重期患者并发高血糖的护理

总结32例慢性阻塞性肺疾病急性加重期并发高血糖患者的护理,实施血糖规范化管理,采取有效的心理护理,合理用药及给氧改善机体缺氧状态,制定个性化的饮食计划,可明显改善患者的高血糖反应,提高疾病治疗效果。     

糖皮质激素辅助用于急性加重期慢阻肺对患者动脉血气指标的影响分析

目的分析急性加重期慢阻肺治疗中应用糖皮质激素的效果及对患者动脉血气指标的影响。方法选取我院2011年1月至2013年12月间收治的急性加重期慢阻肺患者84例,随机分为对照组和观察组,对照组给予特布他林,观察组在对照组基础上给予丙酸氟替卡松气雾剂,比较两组治疗效果。结果观察组治疗总有效率95.24%,明显高于对照组的73.81%;治疗后患者FEV1/FVC、FEV1预计值、PEF改善程度均明显优于对照组;PaO2、PaCO2指标结果优于对照组(P均0.05)。结论急性加重期慢阻肺治疗中加用糖皮质激素可有效改善患者肺功能及动脉血气指标,提高治疗效果,值得临床推广应用。     

High-frequency oscillatory ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

Purpose

High-frequency oscillatory ventilation (HFOV) is usually considered not indicated for treatment of patients with chronic obstructive pulmonary disease (COPD) because of the theoretical risk of air trapping and hyperinflation. The aim of our study was to establish whether HFOV can be safely applied in patients with acute exacerbation of COPD and hypercapnic respiratory failure.

Methods

Ten patients (age, 63-83 years) requiring intensive care treatment who failed on noninvasive ventilation were studied. After initial conventional mechanical ventilation (CMV) of less than 72 hours, all patients were transferred to HFOV for 24 hours and then back to CMV. Arterial blood gases, spirometry, and hemodynamic parameters were repeatedly obtained in all phases of CMV and HFOV at different settings. Regional lung aeration and ventilation were assessed by electrical impedance tomography.

Results

High-frequency oscillatory ventilation was tolerated well; no adverse effects or severe hyperinflation and hemodynamic compromise were observed. Effective CO₂ elimination and oxygenation were achieved. Ventilation was more homogeneously distributed during HFOV than during initial CMV. Higher respiratory system compliance and tidal volume were found during CMV after 24 hours of HFOV.

Conclusions

Our study indicates that short-term HFOV, using lower mean airway pressures than recommended for acute respiratory distress syndrome, appears safe in patients with COPD while securing adequate pulmonary gas exchange.     

Value of refined care in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUNDUnder physiological conditions, sputum produced during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can move passively with the cilia in the airway; the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway. However, when the sputum is thick, the cough is weak, or the tracheal cilia are abnormal, sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung. Furthermore, the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients, which is the main factor leading to AECOPD. Therefore, promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.AIMTo explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.METHODSWe selected 126 patients with AECOPD and difficulty of expectoration at our hospital, and divided them into a refined care group and a routine care group, with 63 cases each, using a random number table. The two groups of patients were treated with expectorant, anti-infection, oxygen inhalation, and other basic treatment measures; patients in the refined care group were given refined nursing intervention during hospitalization, and the routine care group received conventional nursing intervention. The differences in sputum expectoration, negative pressure suction rate, blood gas parameters, dyspnea score measured through the tool developed by the Medical Research Council (MRC), and quality of life were compared between the two groups. RESULTSAfter 7 d of intervention, the sputum expectoration effect of the refined care group was 62.30%, the effective rate was 31.15%, and the inefficiency rate was 6.56%. The sputum expectoration effect of the routine care group was 44.07%, the effective rate was 42.37%, and the inefficiency rate was 13.56%. The refined care group had better sputum expectoration than the routine care group (P < 0.05). The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment (22.95% vs 44.07%, P < 0.05). Before the intervention, the arterial oxygen saturation (PaO₂) and arterial carbon dioxide saturation (PaCO₂) values were not significantly different between the two groups (P > 0.05); the PaO₂ and PaCO₂ values in the refined care group were comparable to those in the routine care group after 7 d of intervention (P > 0.05). Before the intervention, there was no significant difference in the MRC score between the two groups (P > 0.05); the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention, but the difference was not statistically significant (P > 0.05). Before intervention, there was no significant difference in the symptoms, activities, disease impact, or St. George’s Respiratory questionnaire (SGRQ) total scores between the two groups (P > 0.05). After 7 days of intervention, the symptoms, activities, and total score of SGRQ of the refined care group were higher than those of the routine care group, but the difference was not statistically significant (P > 0.05).CONCLUSIONAECOPD with thick sputum, weak coughing reflex, and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung. Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration, alleviate clinical symptoms, and improve the quality of life.     

住院急性加重期慢性阻塞性肺疾病患者病死率的影响因素研究

目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者在住院期间或出院1天内导致死亡的危险因素,为降低AECOPD病死率提供科学的建议。方法选择我院就诊的AECOPD患者126例,根据住院期间是否发生死亡分为死亡组(36例)和好转组(90例)。比较两组患者人口学特征、血常规、肺功能、血气分析、C反应蛋白(CRP)和并发疾病等相关指标;分析影响AECOPD患者住院病死率的因素。结果 APOPD患者126例中,死亡36例,好转90例。两组患者COPD综合评级高风险比例、CRP水平、血红蛋白、白蛋白、淋巴细胞计数、二氧化碳分压(PaCO2)、缺血性心脏病和肺源性心脏病比较,差异具有统计学意义(P0.05)。高CRP(OR=3.126,95%CI=1.345~7.265)、高碳酸血症(OR=3.012,95%CI=1.234~7.352)、低淋巴细胞计数(OR=2.341,95%CI=1.084~5.056)、慢性肺源性心脏病(OR=2.510,95%CI=1.203~5.237)是住院APOPD患者发生死亡的独立危险因素。结论高CRP、高碳酸血症、低淋巴细胞计数、并发慢性肺源性心脏病是影响住院AECOPD患者发生死亡的独立危险因素。     

Administration of acute exacerbation of chronic obstructive pulmonary disease

We have to consider the exacerbation of chronic obstructive pulmonary disease(COPD) may be caused not only by infection, but also by acute exacerbation of chronic heart failure, pulmonary embolism, pneumothorax, or other cardiopulmonary complications. Because it is characteristic that the exacerbation of COPD is often recurensive, the most important thing is the administration during stable status. Approximately 40% of pathogens of the acute infectious exacerbation of COPD are Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Echelisia coli. Also, approximately 15% is exacerbated by atypical pathogens such as Chlamydia pneumoniae and approximately 30% is by viral infection. We should contemplate the possibility of pathogens according to the statistics, when we choose antibiotics empirically.     

慢性阻塞性肺疾病急性加重合并肺栓塞血液相关风险因素分析

目的分析慢性阻塞性肺疾病(COPD)急性加重(AECOPD)合并急性肺栓塞血液相关风险因素及其相关性分析,为发病机制研究、治疗提供参考。方法纳入2015年5月至2016年4月入院的AECOPD可疑肺栓塞患者73例,检测其血常规、C反应蛋白(CRP)、白细胞介素-8(IL-8)、红细胞沉降率(ESR)、降钙素原(PCT)、内皮素-1(ET-1)、D-二聚体、纤维蛋白原、心肌酶、动脉血气、乳酸脱氢酶(LDH)等指标,并进行胸部肺动脉造影(CTPA)检查,分析AECOPD合并肺栓塞患者与未合并肺栓塞患者血液相关风险因素的关系。结果 73例患者中,有15例为AECOPD合并肺栓塞,58例为AECOPD未合并肺栓塞。AECOPD合并肺栓塞患者的Neu%、PCT、NT-proBNP、D-二聚体、LDH、cTnI、CRP、IL-8、ET-1水平整体高于未合并肺栓塞患者(P0.05)。AECOPD合并肺栓塞患者血CRP与IL-8相关系数为0.457(P=0.087),与ET-1相关系数为0.598(P=0.019),IL-8与ET-1相关系数为0.695(P=0.004)。结论 AECOPD合并肺栓塞与体内炎症严重程度相关,炎性反应越重,对心肌损伤也相应增加,发生肺栓塞的风险增加。     

慢性阻塞性肺疾病急性加重期患者血压昼夜节律特点的观察

目的 观察慢性阻塞性肺疾病急性加重期(AECOPD)患者的血压昼夜节律变化特点.方法 入选100例AECOPD、经急性生理和慢性健康评分Ⅱ(APACHEⅡ)大于10分的入住重症医学科的患者,根据动态血压变化将血压类型分为杓型、非杓型、反杓型及超杓型.结果 所有患者中正常血压节律者25例(25.0％),异常血压节律者75例(75.0％),其中非杓型15例(15.0％),反杓型为55例(55.0％),超杓型节律者5例(5.0％).结论 AECOPD患者异常血压节律者占多数,在治疗慢性阻塞性肺疾病的同时,应加强患者血压节律的监测,及时纠正其异常节律,减少对机体的损伤,减少此类患者心血管事件的发生.     

慢性阻塞性肺疾病急性加重期患者营养风险与临床结局的关系研究

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者营养风险与临床结局的关系,以期利用较准确方法进行营养风险评估,及时实施营养干预,改善临床结局.方法 测定177例AECOPD患者入院时体质指数(BMI)、血清白蛋白(Alb)、前清蛋白(PA)、血红蛋白含量(Hb)及淋巴细胞计数(LY),记录机械通气、死亡或出院情况、住院时间(LOS).采用NRS2002营养风险筛查工具进行营养风险筛查评分,进行AECOPD患者不同营养风险状态与机械通气、病情转归和LOS关系分析;LOS与NRS2002评分以及各营养指标的相关性分析.结果 重度营养风险组患者实施机械通气概率和死亡率高于轻微营养风险组患者,差异具有统计学意义(χ2=5.657,P=0.017;χ2=10.413,P=0.001),其机械通气和死亡的概率比(OR)分别为轻微营养风险组的6.093和9.792倍(95% CI:1.18～31.446,1.985～48.298),重度营养风险与机械通气概率和死亡率有较强关联度.中度营养风险患者LOS延长(≥13 d)概率较轻微营养风险组患者高,有统计学意义(χ2=6.701,P=0.001),其OR为轻微营养风险组的2.618倍(95% CI:1.252～5.477);中度营养风险状态与LOS延长有较强关联度.患者LOS与NRS2002评分、年龄及BMI具有相关关系(r=0.319,P=0.000;r=0.182,P=0.022;r=-0.165,P=0.039).结论 NRS2002评分所示的营养风险状态与临床结局具有较好的关联性,可用于入院AECOPD患者的营养风险筛查.