慢性阻塞性肺疾病合并慢性心衰高龄患者的临床护理

目的探讨分析慢性阻塞性肺疾病合并慢性心衰高龄患者的临床护理。方法：选取我科收治的慢性阻塞性肺疾病合并慢性心衰高龄患者随机分为对照组和观察组，对照组实施常规护理，观察组患者则实施综合康复护理，并对护理前后2组患者的临床指标进行对比分析。结果：护理干预后，观察组患者的心肺功能、生活自理能力（Barthel指数）显著高于对照组（P〈0．05），观察组患者的住院时间明显少于对照组，观察组患者的心率、左室舒张末径、脑钠肽（BNP）均明显低于对照组，观察组左室射血分数、E／A比值、用力肺活量（FVC）、第一秒用力呼出量占肺活量比值（FEV1．0／FVC）均明显高于对照组，差异均有统计学意义（P〈0．05）。结论：对慢性阻塞性肺疾病合并慢性心衰高龄患者实施综合护理干预措施，达到了更好的治疗效果。

贯序无创通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者的观察及护理

目的探讨贯序无创通气治疗COPD合并呼吸衰竭患者的临床疗效及临床护理。方法将COPD合并呼吸衰竭患者20例随机分为观察组和对照组各10例,所有患者均给予糖皮质激素、抗感染剂、β2受体兴奋剂、营养支持药物、纠正水及电解质失衡、祛痰等基础药物进行治疗,对照组在基础治疗的基础上给予有创通气治疗,治疗组在基础治疗的基础上给予贯序无创通气进行治疗。比较两组患者治疗前后的血气分析变化、心率、呼吸频率、血压等的变化,观察贯序无创通气的治疗效果。结果治疗结束后,观察组患者的各项病症指标的恢复状况及总体治疗疗效显著优于治疗前及同期治疗的对照组患者(P<0.05)。结论贯序无创通气治疗COPD合并呼吸衰竭具有较好的治疗效果,有助于改善患者的各项临床指标。

肺心愈合剂治疗慢性阻塞性肺疾病合并肺心病心衰的临床疗效观察

目的观察在慢阻肺与肺心病心衰合并症治疗中应用肺心愈合剂所呈现出的治疗效果。方法纳入绥阳县中医院2019年4月~2020年6月接收的慢阻肺与肺心病心衰合并症患者(n=82)作为观察研究对象,以随机抽签法为基本方法,分为观察组(n=41,在通气改善、抗感染、吸氧、止咳、平喘、化痰、强心、利尿、扩血管、纠正酸碱平衡与电解质紊乱等综合治疗效果欠佳的情况下加用肺心愈合剂进行治疗),对照组(n=41,运用抗感染、改善通气、吸氧、化痰、止咳、利尿、强心、平喘、血管扩张、电解质、酸碱紊乱和失衡进行纠正等),对82例患者临床总有效率、N-端脑利纳肽前体、心功能进行评估。结果观察者临床总有效率高于对照组(P<0.05)。N-端脑利纳肽前体优于对照组(P<0.05)。结论肺心愈合剂对慢阻肺与肺心病心衰合并症进行治疗可获得满意的治疗效果,可明显降低N-端脑利纳肽前体指标、从而改善心功能,值得借鉴。

慢性阻塞性肺疾病急性加重与细菌感染的相关性研究

目的:探究不同类型、不同程度的慢性阻塞性肺疾病急性加重(AECOPD)与细菌感染相关性。方法选取我院2014年7月~2015年9月治疗的AECOPD患者70例,依据相关标准并结合患者病情将所有患者分为Ⅰ型,Ⅱ型,Ⅲ型三种类型,并根据FEV1(一秒用力呼气容积)占FVC(用力肺活量)的比值,将AECOPD患者肺功能严重程度进行分级,分为<50%与≥50%两组。结果Ⅰ型、Ⅱ型与Ⅲ型三种类型的AECOPD患者痰菌阳性率分别为76.20%、33.33%、23.07%,Ⅰ型痰菌阳性率均高于Ⅱ型、Ⅲ型痰菌阳性率,差异显著(<0.05),Ⅱ型与Ⅲ型痰菌阳性率相比,无明显差异(﹥0.05);当患者FEV1(FEV1/FVC)<50%时,痰菌阳性率为34.09%,FEV1(FEV1/FVC)≥50%时,痰菌阳性率为65.38%,两组痰菌阳性率相比,差异显著(<0.05)。结论慢性阻塞性疾病加重与细菌感染严重程度密切相关,不同类型、不同程度AECOPD的感染细菌程度存在明显差异,病情加重、肺功能下降程度高均易加重细菌感染程度。

比索洛尔对老年慢性阻塞性肺疾病合并慢性心衰的心肺功能影响老年吸入性肺炎的临床诊治分析

探究比索洛尔治疗老年慢性阻塞性肺疾病合并慢性心衰临床效果及对心肺功能的影响。方法:将时间范围锁定在2018年6月-2020年10月之间,从本时间段内我院收治的研究疾病患者80例进行调查,并将80例研究疾病患者按照随机信封分组法的方式分为两个独立小组,每组40例。给予常规治疗的研究疾病患者作为参考组,在此基础上给予比索洛尔进行治疗的研究疾病患者作为实践组,对两组患者治疗前后心肺功能指标进行比较分析。结果:实践组研究疾病患者治疗后的心肺功能指标低于参考组(P<0.05),且实践组较参考组的慢性阻塞性肺疾病年急性加重次数无明显增加。结论:在老年慢性阻塞性肺疾病合并慢性心衰治疗过程中应用比索洛尔能够有效改善患者心肺功能,且具有较高安全性以及应用价值。

Prevalence of cardiovascular disease in subjects hospitalized due to chronic obstructive pulmonary disease in Beijing from 2000 to 2010

Objectives To investigate the overall prevalence of cardiovascular disease （CVD） in subjects hospitalized for chronic obstructive pulmonary disease （COPD）,and explore the prevalence of the major CVD complications and trends in patients with COPD over a 10-year period.Methods Medical records in the PLA General Hospital,Beijing Union Medical College Hospital,and Beijing Hospital from 2000/01/01 to 2010/03/03 were retrospectively reviewed.A total of 4960 patients with COPD were reviewed in the study （3570 males,mean age,72.2 ± 10.5 years; 1390 females,mean age,72.0 ± 10.4 years）.Results The prevalence of CVD in COPD patients was 51.7％.The three most prevalent CVDs were ischemic heart disease （28.9％）,heart failure （19.6％）,and arrhythmia （12.6％）.During the 10-year study period,the prevalence of various CVDs in COPD patients showed a gradual increasing trend with increasing age.There was higher morbidity due to ischemic heart disease （P ＜ 0.01） in male COPD patients than in the female counterparts.However,heart failure （P ＜ 0.01）and hypertension （P ＜ 0.01） occurred less frequently in male COPD patients than in female COPD patients.Furthermore,the prevalence of ischemic heart disease decreased year by year.In addition to heart failure,various types of CVD complications in COPD patients tended to occur in younger subjects.The prevalence of all major types of CVD in women tended to increase year by year.Conclusions The prevalence of CVD in patients hospitalized for COPD in Beijing was high.Age,sex and CVD trends,as well as life style changes,should be considered when prevention and control strategies are formulated.

Cardiac catheterisation in nonagenarians： Single center experience

Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ≥ 90 years （93.0 ± 1.2 years） who underwent cardiac catheterisation in a tertiary specialist hospital （0.2% of 14,892 procedures during three years）. The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diabetes （P 〈 0.001）, chronic obstructive pulmonary disease （P 〈 0.04）, previous myocardial infarction （P 〈 0.02）, and complex coronary anatomy （SYNTAX score 33 vs. 19） in nonagenarians. Patients 〈 90 years of age showed more hyperlipidemia （P 〈 0.01） and previous percutaneous coronary interventions （P 〈 0.015）. Nonagenarians underwent coronary angiography more often for acute coronary syndrome （ACS） （P 〈 0.003）, were presented more often in cardiogenic shock （P 〈 0.003）, and were transferred faster to coronary angiography in cases ofACS （P 〈 0.0001）. The observed in-hospital mortality rate （13% study group vs. 1% control group; P 〈 0.003） in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction （TIMI） and global registry of acute cardiac events （GRACE） mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. Conclusion Despite the common scepticism that cardiac catheterisation exposes patients 〉 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.

Effect of Bufei granule on stable chronic obstructive pulmonary disease: a randomized, double blinded, placebo-controlled, and multicenter clinical study

OBJECTIVE: To study the therapeutic effect Bufei granule, which is a traditional Chinese drug that can enhance the immune function of the lung, on patients with stable chronic obstructive pulmonary disease(COPD).METHODS: This is a randomized, double blinded,placebo-controlled, and multicenter clinical study.Three medical centers in Tianjin, China, participated in the trial. A total of 140 patients with stable COPD were enrolled and randomized into two groups, with 70 patients in each. The treatment group was treated with Bufei granule, while the control group received Bufei placebo. The pharmacological treatment lasted for 12 weeks from the date of enrollment. Then, the indexes of patients were observed. Data were analyzed to study the effect of Bufei granule, with the frequency of acute exacerbation as the primary outcome. Traditional Chinese Medicine syndromes,Modified British Medical Research Council dyspnea scale score, St.George's respiratory questionnaire scores, pulmonary function, and serum inflammatory marker levels [including interleukin-6(IL-6), interleukin-8, tumor necrosis factor-α, and transformation growth factor-β1]were the secondary outcomes.RESULTS: During the 12-week treatment, treatment and control groups had no adverse reactions.The analysis of the indexes obtained from all patients showed that the therapeutic effect in the treatment group was significantly better than that in the control group because most of the similar probabilities of primary and secondary outcomes were less than 0.05,except for the level of IL-6.CONCLUSION: Bufei granule can treat patients with stable COPD by lowering the frequency of acute exacerbation, improving the quality of life,and alleviating the severity of inflammation.