支气管舒张试验在咳嗽变异型哮喘中的诊断意义

支气管舒张试验是使用一定剂量的支气管扩张药物使痉挛的支气管舒张,来判断气道阻塞的可逆程度,作为支气管哮喘的辅助诊断方法。本研究探讨咳嗽变异型哮喘（CVA）患者气道阻塞的可逆性、支气管舒张试验多项指标的改变率及临床应用价值,现报告如下。     

慢性阻塞性肺疾病与哮喘患者吸入支气管扩张剂后流速和容积反应的差异

目的 探讨慢性阻塞性肺疾病(COPD)和哮喘患者在支气管舒张试验中的流速和容积反应差异.方法 纳入患者分为COPD组(295例)和哮喘组(577例),将其按吸入沙丁胺醇后第1秒用力呼气差FEV1变化值(AFEV1)每变化0.05L和用力肺活量FVC变化值(AFVC)每变化0.10L分别分层,分析△HEV1和AFVC的分布差异.将两组患者按吸入沙丁胺醇前FEV1占预计值的百分比(pre-BD FEV1%pred)每减少10%分层,分析支气管舒张试验阳性率和△FEV1、△FVC的差异,并分析△FEV1与△FVC的相关性.结果 △FEV1在COPD组中呈近似正态分布,但在哮喘组中呈非正态分布,前者的分布范围小于后者.△FVC在两组的分布均呈近似正态分布.COPD组支气管舒张试验阳性率均低于哮喘组(P<0.001).COPD组内部各层间△FEV1无显著差异,但哮喘组内部各层间差异显著(P<0.01).两组患者的总△FEV1与△FVC呈正相关,但分层分析显示,pre-BD FEV1%pred为79.9～70.0和69.9～60.0时,COPD组的△FEV1与△FVC无相关性.结论 COPD患者吸入支气管扩张剂后的流速反应和容积反应明显不同于哮喘患者,提示两组患者存在不同的病理和呼吸生理改变.     

血清总IgE、TGF-β1及IL-6在哮喘 慢性阻塞性肺疾病重叠综合征患者的表达及临床意义

目的 探讨血清总免疫球蛋白E（immunoglobulin E,IgE）、转化生长因子β1（transforming growth factor-β1,TGF-β1）及白介素-6（interleukin-6,IL-6）在哮喘-慢性阻塞性肺疾病重叠综合征（asthma-chronic obstructive pulmonary disease overlap syndrome,ACOS）患者的表达及临床意义。方法 将眉山市人民医院收治的ACOS患者45例、哮喘患者70例、慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者52例分别纳入ACOS组、哮喘组、COPD组,另选取同期健康体检者65例纳入对照组,比较各组血清总IgE、TGF-β1、IL-6水平及第1用力秒呼气容积占预计值百分比（FEV1%pred）、第1秒用力呼气容积与用力肺活量比值（FEV1/FVC）、支气管舒张实验FEV1改善率。结果 ACOS组、COPD组、哮喘组血清总IgE、TGF-β1及IL-6水平均高于对照组（P<0.05）;ACOS组、哮喘组血清总IgE水平均高于COPD组（P<0.05）,而哮喘组又高于ACOS组（P<0.05）;ACOS组、COPD组血清TGF-β1水平均高于哮喘组（P<0.05）,但ACOS组与COPD组组间差异比较无统计学意义（P>0.05）;ACOS组、COPD组、哮喘组3组间血清IL-6水平差异比较无统计学意义（P>0.05）;ROC曲线分析显示：IgE、TGF-β1、IL-6单独检测及联合检测诊断ACOS的AUC分别为0.948、0.776、0.737、0.948;ACOS组、COPD组、哮喘组FEV1%pred、FEV1/FVC均低于对照组（P<0.05）,FEV1改善率均高于对照组（P<0.05）;ACOS组、COPD组FEV1%pred、FEV1/FVC均低于哮喘组（P<0.05）,但ACOS组与COPD组组间差异比较无统计学意义（P>0.05）;ACOS组、哮喘组FEV1改善率均高于COPD组（P<0.05）,但ACOS组与哮喘组组间差异比较无统计学意义（P>0.05）;血清总IgE、TGF-β1水平与FEV1/FVC、FEV1改善率均呈负相关（P<0.05）,血清IL-6水平与FEV1%pred、FEV1改善率呈负相关（P<0.05）。结论 IgE、TGF-β1及IL-6均参与了ACOS患者的气道炎症反应和肺损伤,在该病的病理生理过程中发挥重要作用。     

n-3多不饱和脂肪酸对运动性哮喘豚鼠气道炎症和气道高反应性的影响

目的:探讨n-3多不饱和脂肪酸(n-3PuFA)对运动性哮喘(EIA)豚鼠支气管肺灌洗液(BALF)、肺组织病理学、气道阻力和动态肺顺应性的影响及其可能机制。方法:20只豚鼠随机分为正常对照组(n=6)、EIA模型组(n=7)和EIA+n-3PuFA干预组(n=7)。实验第1、14天对照组腹腔注射生理盐水,其它两组腹腔注射脂多糖(Lipopolysaccharide,LPS)+甲双吡丙酮(Metyrapon1,MET)。n-3PuFA干预组每天给予n-3PuFA液灌胃(0.04g/kg),对照组和EIA模型组补充同剂量的蒸馏水。各组豚鼠在第21天测试气道阻力(RL)和动态肺顺应性(Cydn),建立运动性哮喘模型后麻醉处死,取豚鼠肺组织观察BALF细胞总数及分类、豚鼠气道反应性及肺组织形态学的变化。结果:EIA模型组豚鼠BALF中细胞总数、嗜酸性粒细胞(EOS)显著高于对照组(P<0.01);RL显著性增高,Cydn明显下降(P<0.05);肺组织可见嗜酸性粒细胞、中性粒细胞和淋巴细胞等炎性细胞浸润。EIA+n-3PuFA干预组豚鼠BALF中细胞总数、EOS显著低于EIA模型组(P<0.05),气道阻力RL呈下降趋势,Cydn表现出升高趋势;支气管粘膜上皮伴少许炎性细胞浸润。结论:运动性哮喘存在气道粘膜的炎症改变和气道高反应性,n-3PuFA可以通过减少气管粘膜炎性介质的产生改善EIA的通气情况。     

机械通气下支气管肺灌洗治疗重症呼吸衰竭

机械通气是救治呼吸衰竭的重要方法,但在临床使用中患者的呼吸道分泌物难以消除,影响呼衰和抗感染的治疗效果.支气管肺灌洗可有效地清除支气管分泌物,减轻气道炎症.我们对11例重症呼衰患者在机械通气下行支气管肺灌洗局部治疗,取得满意的疗效,报告如下. 1 资料与方法 1.1 临床资料:男8例,女3例;年龄34～81岁,平均(55.5±13.6)岁.基础疾病为慢性阻塞性肺疾病(COPD),重症哮喘,肺部感染,胰腺炎,呼吸道烧伤等.Ⅰ型呼衰5例(急性呼吸窘迫综合征:ARDS),Ⅱ型呼衰6例.均行气管切开机械通气治疗,ARDS者给予PEEP.     

低剂量CT扫描及肺功能检查对COPD小气道参数的研究

目的探讨低剂量CT扫描和肺功能检查在评价COPD患者气道重塑方面的作用和关系。方法选取COPD患者60例为观察组,同时选择与观察组患者年龄匹配的健康体检者30例为对照组。应用低剂量CT扫描并观察患者肺部影像学表现,运用后处理软件测量COPD患者气道壁厚度(T)、气道壁面积(WA)及气道外径(D)等参数,评估气道重塑的程度。结果1)实验组支气管管壁厚度与外径比值的2倍(2T/D)和管壁横断面积占支气管总面积的百分比(WA%)显著高于对照组(P<0.01),差异有统计学意义;2)对照组肺功能指标(FEV1/预计值)%、(FEV1/FVC)%显著大于观察组(P<0.01),差异具有统计学意义;3)经直线相关分析,观察组患者FEV1%与(2T/D)成负相关(P<0.01);与WA%成负相关(P<0.01)。结论低剂量CT扫描在评估COPD气道重塑方面具有非常高的准确性,肺功能指标(FEV1/预计值)%、(FEV1/FVC)%与COPD患者气道重塑关系密切。     

低剂量CT扫描及定量分析对慢性阻塞性肺疾病气道病变的应用研究

目的：探讨低剂量 CT 扫描及定量分析在慢性阻塞性肺疾病(COPD)患者气道病变中的应用价值。方法122例研究对象(其中正常对照组34例,稳定期 COPD 88例)均行低剂量 CT 扫描,88例 COPD 同时行肺功能检查。采用定量 CT 气道分析软件分别测量右上叶尖段、两下叶后基底段第3级支气管气道相关参数。结果中度组、重度组及极重度组 COPD 管壁面积百分比(WA %)、气道内周径为10 mm 时的管壁厚度(hypothetical airway with internal perimeter of 10 mm,Pi10)均大于正常对照组(P 均<0.05),极重度组 COPD WA%、Pi10大于轻度组 COPD(P 均<0.05)。重度组 COPD 管壁厚度(T)与体表面积比值(T/BSA)、管壁面积与体表面积比值(WA/BSA)均大于正常对照组及中度组 COPD(P 均<0.05)。COPD WA%、Pi10分别与肺通气功能指标、小气道功能指标呈负相关(r 值范围为-0.34~-0.51,P 均<0.01),且 Pi10与肺容积指标呈正相关(r 值范围为0.32~0.33,P 均<0.05)。结论低剂量 CT 扫描定量分析可为 COPD 气道病变提供客观定量评价信息,气道参数 WA%、Pi10是2个客观评价指标;随着COPD 肺功能程度加重,支气管厚度逐渐增厚。     

呼吸系统疾病用药误区与应对策略

急慢性支气管炎、支气管哮喘、支气管扩张、慢性阻塞性肺疾病（COPD）及肺源性心脏病等均是呼吸系统常见病,虽然其发病原因不同,但共同症状均表现为咳嗽、咳痰及喘息等。目前,临床上常采用祛痰、镇咳及平喘等药物治疗,以改善气道通气功能、减轻呼吸困难、防止并发症的发生。现就呼吸系统疾病用药误区及合理安全使用策略探讨如下。     

幼年哮喘气道重塑大鼠的病理学改变

目的:探讨幼年哮喘气道重塑大鼠的病理学改变。方法:幼年SD大鼠随机分为哮喘2、4、6、8周组及同期对照组,每组8只,计数BALF中白细胞总数,应用碱水解法测定羟脯氨酸含量,采用HE染色和计算机图像分析系统观察测定支气管壁及平滑肌面积。结果:①哮喘各组大鼠发作评分均明显高于同期对照组,有显著性差异(P<0.05);②哮喘各组大鼠支气管肺泡灌洗液中白细胞总数均高于对照组(P<0.05);③哮喘各组肺组织羟脯氨酸含量高于同期对照组,且随抗原时间的增加也呈逐渐上升趋势,以哮喘8周组羟脯氨酸含量为最高(P<0.01);④哮喘各组Wat/Pbm及Wam/Pbm均较对照组增加,差异有显著性(P<0.01)。结论:OVA激发2周,即出现气道重塑的表现,并随抗原激发时间的延长上述表现加重,OVA激发8周时,气道重塑表现最为明显,提示早期干预尤为重要。     

支气管哮喘的致死病因及预防

支气管哮喘的定义一般包括以下3点：（1）具有弥漫性气道阻塞的气道高反应性；（2）气道阻塞的明显可逆性，可经治疗或自行缓解；（3）是一种以嗜酸细胞、肥大细胞和T淋巴细胞反应为主的气道慢性炎症。支气管哮喘常被认为是年青人的病，而阻塞性肺疾病（COPD）则被认为是老年人的疾病，结果老年支气管哮喘常常被忽略。经研究表明，哮喘的发病率逐年增加（为4％-10％），近10多年，哮喘的死亡率也在上升，尤其是老年哮喘死亡率增加明显。为了进一步减少哮喘的死亡率，提高对老年支气管哮喘的复杂性及致死病因的认识，现综述如下。[第一段]     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.