黄芪注射液联合西药对支气管哮喘患者气道重塑及肺功能状态的影响研究

目的:探讨支气管哮喘患者应用黄芪注射液和舒利迭联合治疗后,患者的气道重塑情况与肺功能状态影响的研究效果。方法:将支气管哮喘患者114例作为研究对象,根据不同的给药方案分为两组,对照组患者共有59例,采用单纯西药制剂舒利迭进行治疗;研究组患者55例,在对照组用药基础上,加用黄芪注射液联合治疗。治疗24h内至治疗7d为治疗观察期,比较两组患者在治疗前后的气道重塑情况和肺功能指标。结果:研究组患者的支气管总管壁厚度Wai[6.51±1.96)μm]、气管内壁厚度Wai[(0.37±0.22)μm]及气道平滑肌厚度Wam[(1.03±0.19)μm]与常规组的Wat[(7.41±2.83)μm]、Wai[(0.76±0.54)μm]及Wam[(1.64±0.43)μm]比较明显降低,(P均<0.05);研究组患者的肺活量VC[(301.72±40.59)ml]、最大呼气流量PEF(301.72±40.59)L/min]、第一秒用力呼气容积FEV_1[(81.24±11.25)%]明显高于对照组(P均<0.05)。研究组患者的治疗总有效率(98.18%)比对照组(88.14%)显著提高(P均<0.05)。结论:治疗支气管哮喘病,应用黄芪注射液与舒利迭联合给药方案,能过增强患者的气道重塑能力,明显提高患者的肺功能。

深吸气量对400例慢性阻塞性肺疾病患者肺功能检测的临床意义

目的:探讨深吸气量对慢性阻塞性肺疾病(COPD)患者肺功能的检测临床意义。方法:选取收治的400例慢性阻塞性肺疾病患者,所有患者在吸入400mg沙丁胺醇后,对比观察治疗前后患者各项肺功能指标的变化情况。结果:在所检测的各项肺功能指标中,第一秒用力呼气量(FEV1)、深吸气量(IC)、用力肺活量(FVC)相较治疗前,均有显著性改善(P<0.05),其中IC的改善率最高,其改善率为40.00%。结论:深吸气量能够准确反映COPD患者肺功能的改善情况,值得在临床上进一步应用。

逐瘀通脉胶囊治疗慢性肺心病高凝状态及对肺功能疗效观察

目的:观察活益气血、祛瘀通脉类中药对慢性肺心病患者高凝状态和肺功能的影响。方法:采用逐瘀通脉胶囊(水蛭、桃仁、虻虫、大黄等)治疗本病160例,并设对照组观察。结果:治疗组疗效明显优于对照组,治疗组血液流变学、D一、二聚体等各项指标均有明显改善,与对照组比较,差异有统计学意义(P<0.05)。结论:逐瘀通脉胶囊能改善慢性肺心病的高凝状态和肺功能。

Tolerance of Lung Cancer Patients with Moderate Pulmonary Hypofunction to Open-Chest Operation

Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction （study group） and 62 patients with normal pulmonary function （control group） were reviewed. Statistical t test and χ^2 test were set to examine the data, and logistic regression was performed to find the associated factors. Results： In patients with moderate pulmonary hypofunction, hypoxemia （41.9%）, arrhythmia and cardiac dysfunction （25.8%）, and pulmonary inflammation （25.8%） were common postoperative complications, and respiratory failure and cardiac failure （9.2%） severe complications. In-hospital mortality rate was 3.2%. In the control group, the incidence of the above 4 postoperative complications was 16.1%, 8.1%, 9.6% and 3.2% accordingly, and no case died in hospital. Regression analysis showed that age and resection range were associated with the occurrence of the complications. Conclusion： Common postoperative complications （hypoxemia） in patients with moderate pulmonary hypofunction are remarkably higher than those in control group, but severe complications and in-hospital mortality rate are not significantly high. Patients with older age and larger resection range undergo higher complication rate.

Values of high-resolution computed tomography and pulmonary function tests in managements of patients with chronic hepatitis C virus infection

AIM:To investigate pulmonary involvement via pulmonary function tests (PFT) and high-resolution computed tomocjraphy (HRCT) in patients with chronic hepatitis C virus (HCV) infection. METHODS:Thirty-four patients with chronic HCV infection without diagnosis of any pulmonary diseases and 10 healthy cases were enrolled in the study,PFT and HRCT were performed in all cases. RESULTS:A decrease lower than 80% of the predicted value was detected in vital capacity in 9/34 patients,in forced expiratory volume in one second in 8/34 patients,and in forced expiratory flow 25-75 in 15/34 patients,respectively.Carbon monoxide diffusing capacity (DLCO) was decreased in 26/34 patients.Findings of interstitial pulmonary involvement were detected in the HRCT of 16/34 patients.Significant difference was found between controls and patients with HCV infection in findings of HRCT (X^2=4.7,P=0.003).Knodell histological activity index (KHAI) of 28/34 patients in whom liver biopsy was applied was 9.0±4.7.HRCT findings,PFT values and DLCO were not affected by KHAI in patients with HCV infection.In these patients,all the parameters were related with age. CONCLUSION:We suggest that chronic hepatitis C virus infection may cause pulmonary interstitial involvement without evident respiratory symptoms.

Fulminant hepatic failure resulting from small-cell lung cancer and dramatic response of chemotherapy

Prompt treatment in tumor-associated encephalopathy may prolong survival. We describe a 69-year-old male patient who was presented with fulminant hepatic failure, secondary to small-cell lung carcinoma with rapidly progressing encephalopathy. Both symptoms remitted following chemotherapy, suggesting swift diagnosis and administration of chemotherapy to be effective in treatment of fulminant hepatic failure and encephalopathy.

The St.George's Respiratory Questionnaire in Lymphangioleiomyomatosis

Objective To examine the correlation between the health-related quality of life measured by the St.George's Respiratory Questionnaire(SGRQ) and the commonly used physiological measures in lymphangioleiomyomatosis(LAM).Methods This study retrospectively analyzed the SGRQ scores and other measures(the Borg scale of breathlessness at rest,6-minute walking distance,blood oxygen levels,and pulmonary function) of patients diagnosed and confirmed with LAM.Altogether 38 patients between June 2007 and November 2009 were included.Results The mean values of the SGRQ three components(symptoms,activity,and impacts) and total scores in the LAM patients were 46.95±28.90,58.47±25.41,47.89±29.66,and 51.11±26.35,respectively.The SGRQ total or component scores were correlated well with the Borg scale of breathlessness,6-minute walking distance,partial pressure of oxygen in arterial blood,spirometry and diffusion capacity of lung.There were poor correlations between SGRQ score and residual volume or total lung capacity.In our preliminary observation,sirolimus improved the SGRQ total and three component scores and the Borg scale of breathlessness significantly after 101-200 days of treatment(n=6).Conclusions The SGRQ score in LAM is correlated well with physiological measures(Borg scale of breathlessness,6-minute walking distance,blood oxygen levels,and pulmonary function tests).The SGRQ could therefore be recommended in baseline and follow-up evaluation of patients with LAM.Treatment with sirolimus,an inhibitor of mammalian target of rapamycin,may improve the quality of life and patient's perception of breathlessness in LAM.

Effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients infected with hepatitis B virus

AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of antituberculosis.METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded.RESULTS: The rate of hepatotoxicity occurred in 26 (59%)TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P＜0.01).CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.

Relationship between tea dust exposure and lung function: a systemic literature review

Background:During the production of tea,tea dust has been viewed as a risk factor that may cause the suffering of changes of lung function and respiratory symptoms.Objective:To review whether the occupational exposure to tea dust may lead to the changes of lung function and respiratory symptoms.Methods:We searched the literatures in March 2012 in the databases of Medline,EMBase,Web of Science,Wan-Fang Database and CNKI.The search condition is"(herb OR tea)AND(lung function OR ventilatory function OR pulmonary function OR spirometric measurement)".The paper should be pubished in Enghish or Chinese,with internal or external controls.Results:Totally 17 papers were included.Both acute and chronic changes of lung function were referred.In addition,the respiratory symptoms such as cough,tightness and etc.were also reported and discussed.Conclusion:We concluded that the exposure of tea dust may lead to the changes of lung function and respiratory symptoms.

Surgical Treatment and Prognosis of Synchronous Double Primary Lung Cancer： a Report of 31 Cases

OBJECTIVE The concept of double primary lung cancer （DPLC） has been generally accepted. Recently, an increasing incidence of synchronous DPLC has been reported, while the diagnostic standard and treatment strategies remain to be improved. This study was conducted to investigate effective surgical treatment and prognosis of synchronous DPLC. METHODS From January 1983 to April 2004, 31 patients with synchronous DPLC were operated in our department. Clinical data, such as surgical pattern, postoperative complications, and survival status, of all these patients were reviewed retrospectively. RESULTS The 31 patients with synchronous DPLC accounted for 0.67% of all the 4,649 patients operated for primary lung cancer in our department during the same period. Both tumors of the synchronous DPLC were resected with Iobectomy or pneumonectomy in 12 patients, while among the other 19 patients at least 1 tumor was treated with partial pulmonary resection. The postoperative morbidity was 29%（9/31）, including 1 case of respiratory insufficiency, 3 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of haemoptysis, 1 case of pleural effusion, and 1 case of wound fat necrosis. No deaths occurred during the operations or within 30 days postoperatively. The postoperative 1 -, 3-, and 5-year survival rates were 52%, 29%, and 20%, respectively. CONCLUSION The incidence of synchronous DPLC is low. An aggressive and reasonable surgical approach can achieve a satisfactory outcome in patients with synchronous DPLC. The postoperative morbidity is low. Some patients might achieve long-term survival.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPOINT APPLICATION OF FAR-INFRARED ASTHMA-RELIEVING PLASTER FOR ASTHMA

Objective To observe the clinical effect of acupoint application of Yuanhongwai Xiaochuankang Plaster （Far-infrared Asthma-relieving Plaster, FIRARP） for prevention and treatment of asthma. Methods Three hundred and sixty-six cases of bronchial asthma were randomly divided into treatment group （n = 185） and control group （n = 181 ）. Patients of treatment group were treated with FIRARP and those of control group treated with external application of traditional ＂Sonfu （Dog-days） moxibustion＂ （herbal-paste-cake separated moxibustion） and acupoints used were Dazhui（大椎 GV14）, Feishu（肺俞BL13）, Tiantu （天突 CV22）, etc. which were given to the patients. Forced expiratory volume in 1 second （FEV1） and peak expiratory flow （PEF） of the pulmonary function were determined and the changes of main symptoms and signs were observed before and after the treatment. Results The pulmonary functions were effectively improved, the symptoms were controlled, and the asthma attack was reduced in the two groups with no significant difference between the two groups （P 〉0.05）. Conclusion There is no significant difference between Yuanhongwai Xiaochuonkong Plaster and traditional ＂Sanfu moxibustion＂ on bronchial asthma. It may substitute for traditional ＂Sonfu moxibustion＂.

EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

Objective To evaluate the effect of the cardiopulmonary bypass ( CPB) on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect ( VSD). Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded- duration for mechanical ventilation ( Tmv) and staying in the cardiac intensive care unit ( Tcicu) after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group (P < 0. 01). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group (P <0. 05), especially at 6, 9, and 15h after CPB (P < 0. 01). In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB (P < 0. 05). There was a similar change in pulmonary function between two groups at 21, 24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.

DETECTION OF LUNG INVOLVEMENT BY HRCT IN SYSTEMIC LUPUS ERYTHEMATOSUS

Objective To assess the sensitivity of high-resolution CT (HRCT) in detecting pulmonary involvement attributed to systemic lupus erythematosus (SLE). Methods Plain chest radiography, HRCT, and pulmonary function testing of 36 patients with SLE were analyzed. Results The sensitivity of the pulmonary involvement by HRCT, plain chest radiography and pulmonary function testing were 88.9%,36.1%,and 33.3%, respectively. Conclusion HRCT played an important role in detecting pulmonary involvemen due to SLE, especially in early and mild cases.

REFLUX ESOPHAGITIS AND AIRWAY HYPERRESPONSIVENESS

Objectives’ To observe the effects of reflux esophagitis(RE) on the lung function and alrway reactivity,and study the mechanism of airway hyperresponsiveness(AHR) in patients with RE.Methods. Lung function measurements and airway provocation tests were performed in 31 RE patientsand 35 control subjects’ TXB, and PGF,. were determined in 20 cases of each group.Results. In RE patients the lung function was lower and the rate of AHR was higher than control sub-jects (P<0. 05). Among RE patients 25 % had higher airway sensitivity (Dminr 3u ). The TXB2 of REpatients with AHR was higher than those without AHR’ Dmin correlated significantly with TXB2 (r=0. 653, P<0. 05).Concluswhs’ RE could damage the lung function. The rate of AHR was 61 %, the high airway sensltivity was probably potential asthma, and TXB2 may play a role in the pathogenesis of AHR.

Which prognostic factors should be used in pulmonary arterial hypertension in elderly patients？

In recent times, the prevalence of pulmonary arterial hypertension creased prevalence of hypertension, diabetes, obesity, arterial stiffness, （PAH） is more commonly seen among elderly populations. The inas well as diastolic dysfunction, may cause endothelial dysfunction and affect pulmonary vasculature. Furthermore, older patients have certain differences in clinical characteristics and outcomes. In this article the special characteristics of aging in PAH patients have been reviewed, while the risk predictors of elderly patients are also discussed.

What are the benefits of a minimally invasive approach in frail octogenarian patients undergoing aortic valve replacement？

A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting： which is better in patients with chronic obstructive pulmonary disease？

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

吸入用布地奈德混悬液治疗重症肺炎患儿的临床研究

目的观察吸入用布地奈德混悬液治疗重症肺炎患儿的临床疗效及安全性。方法将100例重症肺炎患儿随机分为对照组50例和试验组50例。对照组予以机械通气、化痰、解痉和抗感染治疗;试验组在对照组治疗的基础上,给予布地奈德雾化吸入治疗,每次2 mg,每次10~15 min,bid。2组患儿均治疗14 d。比较2组患儿的临床疗效,肺功能,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为96.00%(48例/50例)和86.00%(43例/50例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的第1秒用力呼气容积(FEV1)分别为(49.98±6.44)%和(45.94±7.12)%,FEV1/用力肺活量分别为(64.88±4.88)%和(55.69±9.80)%,氧分压分别为(70.06±7.52)和(65.02±6.33)mm Hg,二氧化碳分压分别为(44.94±5.23)和(54.06±5.88)mm Hg,差异均有统计学意义(均P<0.05)。2组患儿治疗期间均未发生药物不良反应。结论吸入用布地奈德混悬液治疗重症肺炎患儿的临床疗效较好,且安全性较高。

Normative values of pulmonary function testing in Chinese adults

Objectives To compare the difference in pulmonary function between Caucasians and Chinese and assess the best reference values of pulmonary function for Chinese adults.Methods Values for pulmonary function were predicted by tests on 4773 Chinese healthy subjects (male: 2560, female: 2213, aged 15-78 years) in six parts (north, northeast, northwest, east, southwest and south) of China. Prediction equations of the European Community for Steel and Coal (ECSC), other equations for overseas Chinese or for Caucasians were also selected. The regression coefficients of forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), FEV 1/FVC, total lung capacity (TLC) and residual volume (RV) were summarized. Results ECSC predictions were closer to the Chinese ones than other selected equations. Comparison with ECSC predictions showed that on average the values for FVC, FEV 1 were 5.3% smaller in Chinese males and 3.3% smaller in Chinese females, with the maximal differences in south China and the minimal differences in North China. RV and TLC in Chinese were lower than in Caucasians (males 4.8%, 5.5%, respectively; females 8.7% and 6.0%, respectively). Conversion factors were given for adjusting ECSC equations to fit Chinese. Conclusions For predicting values of pulmonary function in Chinese, we suggest to use the equations reported here. Alternatively, ECSC regression equations may be used with appropriate conversion factors.

Effect of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease

Objective To observe the therapeutic effects of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease. Method Eighty elderly patients with stable chronic obstructive pulmonary disease were divided randomly into an acupuncture group and a drug group, with forty cases in each group. The patients in the acupuncture group were treated with warming needle moxibustion on specific acupoints. Main acupoints include Zusanli （足三里 ST 36）, Feishu （肺俞 BL 13） and Dingchuan （定喘 EX-B 1）. Matching acupoints include Gaohuang （膏肓 BL 43）, Xinshu （心俞 BL 15）, Dazhui （大椎 GV 14） and Fangmen （风门 BE 12）. The acupoints were punctured with even reinforcing and reducing method. Meanwhile, two moxa stick of warming needle moxibustion were applied separately at the acupoints at back and ST 36. The needles were retained for approximately 0.5 h each time. The treatment was given every other day, 3 times a week and the course of treatment was 8 weeks. Patients in the drug group were treated by seretide inhalation （50 μg salmeterol and 250 μg fluticasone propionate）, twice a day for 8 weeks. The improvement in pulmonary function and the symptom of chills and fever were compared between the two groups. Results After treatment, pulmonary function indices [forced expiratory volume in one second （FEV1）, forced expiratory volume in one second to forced vital capacity （FEVl/FVC）, forced expiratory volume in one second to predicted value ratio （FEV1%） and peak expiratory flow （PEF）] of the patients in both groups were improved significantly compared with that before treatment （P〈0.05）. There was no statistically significant difference between the two groups （all P〉0.05）. Improvement in comprehensive scores of the symptom of chill and fever in the acupuncture group was significantly superior to that in the drug group after 4 and 8 weeks of the treatment, respectively （P〈0.05）. Conclusion Warming needle moxibustion was obviously effective on the improvement in pulmonary function of elderly patients with stable chronic obstructive pulmonary disease.