Early tracheotomy for acute severe asthma

BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS：The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS： They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION：Early tracheotomy could be a valuable approach in certain patients with severe asthma.

Impact of Air Pollutants on Lung Function and Inflammatory Response in Asthma in Shanghai

Objective Air pollution is a leading public health issue.This study investigated the effect of air quality and pollutants on pulmonary function and inflammation in patients with asthma in Shanghai.Methods The study monitored 27 asthma outpatients for a year,collecting data on weather,patient self-management[daily asthma diary,peak expiratory flow(PEF)monitoring,medication usage],spirometry and serum markers.To explore the potential mechanisms of any effects,asthmatic mice induced by ovalbumin(OVA)were exposed to PM_(2.5).Results Statistical and correlational analyses revealed that air pollutants have both acute and chronic effects on asthma.Acute exposure showed a correlation between PEF and levels of ozone(O_(3))and nitrogen dioxide(NO_(2)).Chronic exposure indicated that interleukin-5(IL-5)and interleukin-13(IL-13)levels correlated with PM_(2.5)and PM_(10)concentrations.In asthmatic mouse models,exposure to PM_(2.5)increased cytokine levels and worsened lung function.Additionally,PM_(2.5)exposure inhibited cell proliferation by blocking the NF-κB and ERK phosphorylation pathways.Conclusion Ambient air pollutants exacerbate asthma by worsening lung function and enhancing Th2-mediated inflammation.Specifically,PM_(2.5)significantly contributes to these adverse effects.Further research is needed to elucidate the mechanisms by which PM_(2.5)impacts asthma.

Analysis of effect of terbutaline sulfate combined with shunning on acute attack of asthma complicated with lobar pneumonia in children

Objective:To explore the effect of terbutaline sulfate combined with shunning on acute attack of asthma complicated with lobar pneumonia in children.Methods:One hundred and fifty children with acute attack of asthma and lobar pneumonia were randomly divided into routine group(seventy-five cases)and combined group(seventy-five cases).The routine group was given routine treatment.The study group was treated with routine therapy plus terbutaline sulfate plus shunning.The changes of pulmonary function and serum inflammatory factors before and after treatment,clinical effect and safety were compared between the two groups.Results:Respiratory time/inspiratory time(Ti/Te),peak time ratio(TPTEF/TE),peak volume ratio(VPEF/VE),tidal volume per kilogram(Vt/kg)were increased in both groups after treatment(P<0.05),which in the combined group were higher than the routine group after treatment(P<0.05).After treatment,serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)in both groups decreased significantly(P<0.05),and those in the combined group were lower than those in the routine group(P<0.05).There was a significant difference in clinical effect distribution between the two groups(P<0.05).The total effective rate of the combined group was higher than that of the routine group(P<0.05).The incidence of adverse reactions in the combined group was slightly higher than that in the routine group(P>0.05).Conclusion:On the basis of routine treatment,terbutaline sulfate combined with shunning can significantly improve pulmonary function and serum inflammatory factors in children with acute attack of asthma and lobar pneumonia,with ideal effect and safe.

Clinical effect of interferon combined with inhalant therapy for acute attack of bronchial asthma

Objective:To investigate the clinical effect of interferon combined with inhalant therapy for acute attack of bronchial asthma.Methods: A total of 56 patients with acute attack of bronchial asthma who were treated in our hospital between January 2015 and January 2018 were selected as the research subjects, and the therapies were reviewed and used to divide the patients into the control group (n=30) who received conventional inhalant therapy and the interferon group (n=26) who received interferon combined with inhalant therapy. Control group received salbutamol aerosol inhalation, and interferon group received interferon combined with salbutamol aerosol inhalation. The differences in serum levels of inflammatory factors, airway remodeling indexes and immunoglobulins were compared between the two groups immediately after admission and after 48 h of treatment.Results:Immediately after admission, the differences in serum levels of inflammatory factors, airway remodeling indexes and immunoglobulins were not statistically significant between the two groups of patients. After 48 h of treatment, serum inflammatory factors IL-8, IL-17, IL-18, IL-25, IL-27 and IL-33 levels of interferon group were lower than those of control group;airway remodeling indexes VEGF, MMP-9 and TIMP1 levels were lower than those of control group;immunoglobulins IgA, IgG and IgM levels were higher than those of control group whereas IgE level was lower than that of control group.Conclusion:interferon combined with inhalant therapy can effectively reduce systemic inflammatory response, inhibit airway remodeling and optimize humoral immune function in patients with acute attack of bronchial asthma.

Expression and Significance of ECP, 25-(OH)D3 and M2 receptors in Children with Acute Attack of Asthma

Objective:To study the expression and significance of ECP, 25-(OH)D3 and M2 receptors in children with acute attack of asthma.Methods: Seventy children with bronchial asthma who first visited our hospital from September 2016 to September 2018 were divided into chronic persistence group, remission group and acute attack group. Thirty healthy children who underwent physical examination in our hospital were selected and divided into control group. The levels of ECP, 25-(OH) D3 and M2 receptors were analyzed by ELISA, and Pearson correlation analysis was performed.Results: Compared with the control group, the levels of ECP and M2 receptors in chronic persistence group, remission group and acute attack group increased, while the levels of 25-(OH)D3 decreased, with statistical difference (P<0.05). The levels of ECP and M2 receptors in acute attack group were higher than those in chronic persistence group, and the levels of 25-(OH)D3 were lower than those in chronic persistence group (P<0.05). The levels of ECP and M2 receptors in acute attack group were higher than those in remission group, and the levels of 25-(OH)D3 were lower than those in remission group (P<0.05). Compared with mild children, the levels of ECP and M2 receptors increased and 25-(OH)D3 decreased in moderate and severe children (P<0.05). Compared with moderate children, the levels of ECP and M2 receptors increased and 25-(OH)D3 decreased in severe children (P<0.05).There was a negative correlation between ECP and 25-(OH)D3 (r=-0.380, P=0.038);a negative correlation between 25-(OH)D3 and M2 receptor (r=-0.448,P=0.013);and a positive correlation between ECP and M2 receptor (r=0.450,P=0.013).Conclusions:The expression of ECP and M2 receptors increased during the acute attack of bronchial asthma in children, while the expression of 25-hydroxyvitamin D3 decreased during the acute attack of bronchial asthma in children. The correlation among ECP, 25-(OH) D3 and M2 receptors is significant in the clinical diagnosis of acute attack of bronchial asthma in children.

Effects of Suhuang Zhike Capsules on Pulmonary Function and Peripheral Blood Eosinophil Count and Exhaled Nitric Oxide in Patients with Acute Attack of Bronchial Asthma

OBJECTIVE: To observe the effects of Suhuang Zhike Capsules on lung function and peripheral blood eosinophil count (EOS) and exhaled nitric oxide (eNO) in patients with acute asthma attack.METHODS: A total of 80 patients with acute exacerbation of bronchial asthma admitted to Huai'an Cancer Hospital from January 2017 to January 2018 were randomly divided into an observation group and a control group,with 40 cases in each group.The control group was given conventional treatment with western medicine,and the observation group was given Suhuang Zhike Capsules on the basis of the treatment method of the control group.After 1 week of treatment,the improvement of individual symptoms (cough,wheezing,wheezing rale),lung function [1 second forced expiratory volume (FEV1),forced expiratory volume occupational capacity of vital capacity (FVC) in 1 second and peak expiratory flow (PEF)] and peripheral blood EOS and eNO levels and efficacy before and after the treatment were observed and assessed.RESULTS: The total effective rate of the observation group was 92.5%,which was significantly higher than the total effective rate of the control group (75.0%)(P < 0.05).The cough,wheezing and wheezing scores of the 2 groups were significantly decreased after treatment (P < 0.05).The scores of the above symptoms were significantly lower in the observation group than in the control group (P < 0.05).The FEV1,FVC and PEF were significantly increased after treatment (P < 0.05),and the above lung functions in the observation group were significantly higher than the control group (all P < 0.05).The EOS and eNO levels in the peripheral blood of the 2 groups were significantly decreased after treatment (P < 0.05),and the EOS and eNO levels in the peripheral blood in the observation group were significantly lower than those in the control group (P < 0.05).CONCLUSION: Suhuang Zhike Capsules can reduce the levels of EOS and eNO in peripheral blood of patients with acute asthma attack,improve the lung function of patients,relieve the clinical symptoms and improve the prognosis.

Clinical Observation of Dingchuan Decoction(定喘汤)Combined with Omazumab in Treating Acute Attack of Bronchial Asthma(Heat Asthma Syndrome)

Objective:To explore the therapeutic effect of Dingchuan Decoction combined with omazumab on acute attack of bronchial asthma.Methods:From January 2020 to November 2021,90 patients with acute asthma were treated in our hospital,which belonged to heat asthma syndrome according to TCM syndrome differentiation in our hospital.They were divided into control group and observation group with 45 cases in each group.The control group was treated with omazumab,while the observation group was treated with omazumab combined with Dingchuan Decoction.The changes of lung function,exhaled nitric oxide(FeNO),blood gas indexes and hematological indexes were observed before and after treatment,and the adverse reactions and asthma recurrence within 3 months were observed.At the same time,animal experiments were carried out to verify the curative effect of Dingchuan.Results:After treatment,the total effective rate,FeNO,pulmonary function,partial pressure of blood oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),interleukin-6(IL-6),interleukin-5(IL-5),immunoglobulin E(IgE)and asthma recurrence in 3 months in the observation group were better than those in the control group;There was no significant difference in pulse oxygen saturation(SaO_(2))and the incidence of adverse reactions between the two groups.Animal experiments show that Dingchuan Decoction can effectively improve lung inflammation.Conclusion:The combination of Dingchua Decoction and omazumab has a good curative effect in the treatment of acute attack of bronchial asthma,which can effectively improve the lung function and blood gas index of patients,reduce the levels of inflammatory factors and IgE,and has no obvious increase in adverse reactions,and effectively control the recurrence of asthma within 3 months.It can be used as an auxiliary maintenance treatment for patients with mild and moderate acute attack and clinical remission of asthma,thus reducing the utilization rate of hormones and having high application value.

Acute myocardial infarction induced by eosinophilic granulomatosis with polyangiitis:A case report

BACKGROUND Eosinophilic granulomatosis with polyangiitis(EGPA)is a multisystem disease characterized by allergic rhinitis,asthma,and a significantly high eosinophil count in the peripheral blood.It mainly involves the arterioles and venules.When the coronary arteries are invaded,it can lead to acute myocardial infarction(AMI),acute heart failure,and other manifestations that often lead to death in the absence of timely treatment.CASE SUMMARY A 69-year-old man was admitted to the emergency department due to chest pain for more than 1 h.He had a past history of bronchial asthma and chronic obstructive pulmonary disease and was diagnosed with AMI and heart failure.Thrombus aspiration of the left circumflex artery and percutaneous transluminal coronary angioplasty were performed immediately.After surgery,the patient was admitted to the intensive care unit.The patient developed eosinophilia,and medical history taking revealed fatigue of both thighs 1 mo prior.Local skin numbness and manifestations of peripheral nerve involvement were found on the lateral side of the right thigh.Skin biopsy of the lower limbs pathologically confirmed EGPA.The patient was treated with methylprednisolone combined with intravenous immunoglobulin and was discharged after 21 d.On follow-up at 7 d after discharge,heart failure recurred.The condition improved after cardiotonic and diuretic treatment,and the patient was discharged.CONCLUSION Asthma,impaired cardiac function,and eosinophilia are indicative of EGPA.Delayed diagnosis often leads to heart involvement and death.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

布地奈德福莫特罗粉吸入联合孟鲁司特钠治疗支气管哮喘急性发作的效果及对免疫功能的影响

目的探讨布地奈德福莫特罗粉吸入联合孟鲁司特钠治疗支气管哮喘急性发作的效果及对免疫功能的影响。方法选取2020年1月至2023年1月收治的80例支气管哮喘急性发作患者为研究对象,随机将其分为对照组(布地奈德福莫特罗粉吸入治疗)和观察组(布地奈德福莫特罗粉吸入联合孟鲁司特钠治疗),各40例。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,观察组的第1秒用力呼气容积(FEV_(1))、呼气峰值流速(PEF)、第1秒用力呼气容积占用力肺活量的百分比(FEV_(1)/FVC)均高于对照组(P<0.05)。治疗后,观察组的调节性T细胞(Treg)高于对照组,辅助性T细胞17(Th17)、Th17/Treg低于对照组(P<0.05)。治疗后,观察组的嗜酸性粒细胞趋化因子-2(eotaxin-2)、白细胞介素-33(IL-33)水平低于对照组(P<0.05)。结论布地奈德福莫特罗粉吸入联合孟鲁司特钠可提高支气管哮喘急性发作患者的治疗效果,促进肺功能及免疫功能改善,也能下调eotaxin-2、IL-33表达。

儿童哮喘急性发作的特征基因挖掘及其对哮喘发作的预测前景

目的:应用生物信息学方法对哮喘急性发作患者的基因表达谱芯片进行分析,以探索哮喘急性发作的机制,寻找精准提前识别哮喘急性发作的检测指标。方法:从GEO平台库获取GSE103166芯片数据集,在对数据集进行清洗和整理后,对急性哮喘发作的儿童和非哮喘儿童的表达谱进行差异分析。利用R语言进行富集分析,对差异表达基因(DEGs)进行功能注释。利用基因互作信息,构建DEGs互作网络,并对网络进行结构拆解,筛选出关键基因和调控子网络。结果:GSE103166数据集包含87例儿童(56例急性哮喘发作的儿童和31例非哮喘儿童)鼻拭子样本。筛选出63个显著DEGs,其中上调基因39个,下调基因24个。DEGs主要富集在内吞小泡与内吞小泡膜中,其中CD163是这两个细胞组件唯一显著上调基因。对互作网络进行结构拆解,得出4个主要互作子网络。其中CD163涉及子网络Ⅰ,此网络由CD163、ARG2、CAT、GSTA2、SCNN1G、MT2A组成,其中ARG2、CAT处于调控网络中心。结论:CD163及CD163、ARG2、CAT、GSTA2、SCNN1G、MT2A组成的基因调控网络可能是哮喘急性发作的关键基因与主要调控网络,为精准提前识别哮喘急性发作的检测指标和治疗靶点提供了研究思路。

苏葶止喘汤联合西医治疗小儿支气管哮喘急性发作期(痰热阻肺证)38例

目的探讨苏葶止喘汤联合西医治疗小儿支气管哮喘急性发作期(痰热阻肺证)临床疗效。方法收集2020年2月至2022年3月河北省沧州中西医结合医院就诊的急性发作期的支气管哮喘病儿78例,根据随机数字表法分为对照组与治疗组各39例,对照组病儿给予硫酸沙丁胺醇、异丙托溴铵、布地奈德雾化吸入等西医治疗,治疗组在对照组基础上给予苏葶止喘汤治疗,观察两组治疗前后的临床疗效,症状缓解时间(咳痰消失时间、哮鸣音消失时间、咳嗽消失时间、喘息消失时间),肺功能指标[用力肺活量(FVC)、第1秒用力呼吸容积(FEV_(1))、第1秒用力呼气量占所有呼气量的比例(FEV_(1)/FVC)、最大呼气流量(PEF)、呼气中断流速(PEF25%)、呼吸中期瞬间流速(PEF50%)、呼吸后期瞬间流速(PEF75%)],血清炎症因子指标[C反应蛋白(CRP)、白细胞介素-22(IL-22)、白细胞介素-4(IL-4)],Toll样受体2(TLR2)、Toll样受体4(TLR4)表达水平。结果治疗后治疗组总有效率94.74%显著高于对照组71.05%(P<0.05);治疗组症状缓解时间快于对照组(P<0.05);治疗后两组FVC、FEV_(1)、FEV_(1)/FVC、PEF、PEF25%、PEF50%、PEF75%值均较治疗前升高且治疗组高于对照组(P<0.05);治疗后两组血清CRP、IL-22、IL-4、TLR2、TLR4水平均较治疗前降低,且治疗组CRP[(10.23±3.26)mg/L比(15.25±5.37)mg/L]、IL-22[(37.13±9.84)ng/L比(45.46±11.08)ng/L]、IL-4[(48.15±12.28)ng/L比(56.07±14.36)ng/L]、TLR2[(16.78±1.91)ng/L比(21.15±2.08)ng/L]、TLR4[(18.05±2.53)ng/L比(22.44±3.27)ng/L]低于对照组(P<0.05)。结论苏葶止喘汤联合西医治疗小儿支气管哮喘急性发作期临床疗效显著。

小儿肺咳颗粒联合硫酸沙丁胺醇治疗支气管哮喘患儿急性发作期的临床研究

目的探讨小儿肺咳颗粒联合硫酸沙丁胺醇治疗支气管哮喘患儿急性发作期的效果。方法选取2021年10月至2022年11月在江西省儿童医院接受治疗的支气管哮喘患儿84例,按随机数字表法将患儿分为对照组和观察组,各42例。对照组在常规治疗基础上采用硫酸沙丁胺醇雾化吸入溶液治疗;观察组在对照组基础上联合小儿肺咳颗粒口服治疗;2组均治疗7 d。比较2组的临床疗效以及治疗前后呼气峰值流速占预计值百分比(PEF%)、第1秒用力呼气容积占预计值百分比(FEV_(1)%)、白细胞介素1β(IL-1β)、白三烯B4、C反应蛋白(CRP)、CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)水平和不良反应发生情况。结果观察组总有效率高于对照组[90.5%(38/42)比73.8%(31/42)](P=0.046)。治疗后,2组PEF%、FEV_(1)%均高于治疗前,且观察组均高于对照组[(90±10)%比(85±10)%、(92±8)%比(88±8)%](均P<0.05);2组血清IL-1β、白三烯B4、CRP水平均低于治疗前,且观察组均低于对照组(均P<0.05);2组CD_(3)^(+)、CD_(4)^(+)水平均高于治疗前,且观察组均高于对照组,2组CD_(8)^(+)水平均低于治疗前,且观察组低于对照组(均P<0.05)。治疗期间,2组不良反应发生率比较差异无统计学意义(P>0.05)。结论小儿肺咳颗粒联合硫酸沙丁胺醇治疗支气管哮喘患儿急性发作期的效果较好,可有效改善患儿的肺功能及细胞免疫功能,降低炎症反应。

线粒体功能障碍及其影响因素在不同脏腑虚损哮喘患者中的变化趋势分析

【目的】通过对不同脏腑虚损哮喘患者线粒体功能及其相关受损因素的分析,探寻不同脏腑虚损哮喘患者的病例特征,并通过对不同脏腑虚损组哮喘患者的线粒体功能变化及影响因素的差异性分析,试图发现不同脏腑虚损哮喘患者DDAH1/L-Arg/ADMA通路以及线粒体功能、氧代谢的变化趋势及规律。【方法】选取符合纳入标准的支气管哮喘急性发作期患者共122例,对入组患者进行临床资料采集,按脏腑虚损辨证分型标准分为肺气虚组47例、肺脾气虚组39例、肺脾肾虚组36例;并于同期选取正常对照组44例。观察不同脏腑虚损哮喘患者的第1秒用力呼气量(FEV1)、第1秒用力呼气量与用力肺活量的比值(FEV1/FVC)、呼气峰值流速(PEF)等肺功能指标和病情严重程度情况;同时,抽取患者静脉血,采用高效液相联合质谱法(HPLC-MS/MS)检测左旋精氨酸(L-Arg)及不对称二甲基精氨酸(ADMA)水平,采用酶联免疫吸附法(ELASA)检测蛋白精氨酸甲基转移酶1(PRMT1)、二甲基精氨酸二甲氨基水解酶1(DDAH1)等精氨酸代谢相关指标及活性氧自由基(ROS)、硫代巴比妥酸反应产物(TBARS)、8-异前列腺素(8-Iso)、过氧化脂质(LPO)、丙二醛(MDA)等氧化损伤标记物水平;提取哮喘患者及正常对照组的血小板及线粒体,JC-1流式细胞法测定血小板线粒体膜电位(MMP)、三磷酸腺苷(ATP)和细胞色素C氧化酶(COX)的活性,以此评估线粒体功能;分析不同脏腑虚损组哮喘患者的线粒体功能变化及影响因素的差异性,并与正常对照组比较。【结果】(1)不同脏腑虚损哮喘患者的年龄和肺功能(FEV1、FEV1/FVC、PEF)比较,差异均有统计学意义(P<0.01)。表现为肺脾肾虚组的年龄明显高于肺气虚组和肺脾气虚组(P<0.05),以及随脏腑虚损情况的加重,肺功能(FEV1、FEV1/FVC、PEF)呈显著下降趋势(P<0.05)。(2)不同脏腑虚损患者的病情严重程度分布比较,差异有统计学意义(P<0.01)。其中,肺气虚组以间歇状态(1级)为主(65.96%),其次为轻度哮喘(2级)(25.53%);肺脾气虚组以中度哮喘(3级)为主(41.03%),其次为间歇状态(1级)(30.77%);肺脾肾虚组以重度哮喘(4级)为主(52.78%),其次为中度哮喘(3级)(33.33%)。即随着脏腑虚损情况的加重,哮喘的病情严重程度也表现出随之加重的趋势。(3)不同脏腑虚损组哮喘患者与正常对照组的血浆8-Iso、ROS、LPO、MDA水平比较,差异均有统计学意义(P<0.05)。其中,不同脏腑虚损组哮喘患者的血浆8-Iso、LPO水平和肺脾气虚组、肺脾肾虚组患者的血浆MDA、ROS水平均明显高于正常对照组(P<0.05),且肺脾气虚组、肺脾肾虚组患者的血浆ROS水平均明显高于肺气虚组(P<0.05);而不同脏腑虚损组哮喘患者的血浆TBARS水平有高于正常对照组趋势,但差异无统计学意义(P>0.05)。表明不同脏腑虚损哮喘患者机体内均有活性氧及过氧化脂质类物质的蓄积,且随脏腑虚损情况的加重其水平均呈增高趋势。(4)不同脏腑虚损哮喘患者与正常对照组的MMP、ATP、COX比较,差异均有统计学意义(P<0.05或P<0.01),表现为不同脏腑虚损哮喘患者的MMP、ATP、COX水平均较正常对照组明显降低(P<0.05),且随着脏腑虚损的加重,COX活性有下降趋势。(5)不同脏腑虚损哮喘患者与正常对照组的血浆L-Arg、L-Arg/ADMA、DDAH1水平比较,差异均有统计学意义(P<0.05)。表现为不同脏腑虚损哮喘患者的血浆L-Arg、L-Arg/ADMA、DDAH1水平均较正常对照组明显降低(P<0.05),且随脏腑虚损的加重,上述指标均有逐渐降低的趋势;而不同脏腑虚损哮喘患者与正常对照组的血浆ADMA、PRMT1比较,差异均无统计学意义(P>0.05)。【结论】该研究从机体代谢角度论证了中医脏腑虚损理论对病情变化趋势判断的正确性,证实了哮喘患者的脏腑虚损状况与临床病情进展、氧代谢及其影响因素和机体氧化损伤程度均表现出一致的变化趋势。

多索茶碱对支气管哮喘急性发作患者肺功能与免疫功能的影响

目的 分析多索茶碱对支气管哮喘(bronchial asthma,BA)急性发作患者肺功能、免疫功能的影响。方法 选择就诊的96例BA急性发作患者,随机分为对照组和观察组,每组48例。对照组给予氨茶碱,观察组给予多索茶碱。比较2组的症状改善时间、肺功能[用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积占预计值百分比(first second forced expiratory volume accounts for the percentage of FVC,FEV_(1))、峰值呼气流速(peak expiratory flow rate,PEF)]、免疫功能(CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)值)、血清炎性因子[白细胞介素-18(interleukin-18,IL-18)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)和血管内皮生长因子(vascular endothelial growth factor,VEGF)]及不良反应的发生情况。结果 与对照组比较,治疗后观察组的喘息、胸闷和咳嗽改善时间均明显缩短(P<0.05);FVC、FEV_(1)和PEF均明显升高(P<0.05);CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)值均明显升高(P<0.05),CD8^(+)明显降低(P<0.05);IL-18、MMP-9和VEGF水平均明显降低(P<0.05);2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论 与氨茶碱比较,多索茶碱可缩短BA急性发作患者的症状改善时间,改善其肺功能和免疫功能,下调血清炎性因子水平,且安全性较好。

高仿真情景模拟教学在支气管哮喘急性加重期治疗中的教学价值

目的 探究高仿真情景模拟教学在支气管哮喘急性加重期治疗中的教学价值。方法 选取2022年1月—2022年12月江阴市中医院肺病科,2021级与2022级床边教学班学生86名,将其客观随机分为对照组、观察组,各43名。对照组采用传统式教学法,观察组采用高仿真情景模拟教学方法。比较两种教学方法后理论考核成绩、教学满意度。结果 教学后,观察组理论考核成绩[(90.15±7.29)分]高于对照组[(85.33±8.22)分],差异有统计学意义(P <0.05)。观察组教学满意度(90.70%)高于对照组(65.12%),差异有统计学意义(P <0.05)。结论 在支气管哮喘急性加重期治疗中引用高仿真情景模拟教学方法能够提升学生的考核成绩,增加教学满意度,使得学生更加积极地投入学习当中,具有较高的临床教学前景。

孟鲁司特钠结合普米克令舒对支气管哮喘急性发作患儿疗效及免疫功能指标的影响

目的分析孟鲁司特钠结合普米克令舒对支气管哮喘急性发作患儿的治疗效果。方法选取我院2022年1月至2023年4月期间收治的80例支气管哮喘急性发作患儿,按数字随机表法分为两组,即对照组40例,采用普米克令舒治疗;观察组40例,基于对照组用药方案上采用孟鲁司特钠;对比两组治疗效果、免疫功能、炎症表达等。结果观察组治疗效果总有效率97.50%高于对照组的80.00%,差异有统计学意义(P<0.05)。观察组治疗后免疫球蛋白IgA、IgG、IgM水平高于对照组,血清白细胞介素(IL)-6、IL-17、嗜酸性粒细胞(EOS)水平低于对照组(P<0.05)。两组不良反应发生率比较无差异(P>0.05)。结论孟鲁司特钠结合普米克令舒治疗支气管哮喘急性发作患儿取得理想效果,且能改善机体免疫功能,降低血清炎症表达,值得临床应用。

异丙托溴铵联合布地奈德、特布他林雾化吸入治疗小儿支气管哮喘急性发作的有效性及安全性

目的分析异丙托溴铵联合布地奈德、特布他林雾化吸入治疗小儿支气管哮喘急性发作的有效性及安全性。方法纳入2022年9月至2023年8月收治的80例支气管哮喘急性发作患儿为研究对象,以治疗方案差异将其分为对照组(n=40,布地奈德、特布他林雾化吸入治疗)和研究组(n=40,异丙托溴铵联合布地奈德、特布他林雾化吸入治疗)。比较两组的治疗效果。结果研究组的治疗总有效率显著高于对照组(P<0.05)。治疗后,研究组的白细胞介素-17(IL-17)、白细胞介素-33(IL-33)、骨桥蛋白(OPN)水平低于对照组,蛋白磷酸酶1A(PPM1A)、对氧磷酶1(PON1)水平高于对照组(P<0.05)。治疗后,研究组的用力肺活量(FVC)、肺顺应性、呼气峰流速(PEF)、达峰容积比高于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论异丙托溴铵联合布地奈德、特布他林雾化吸入治疗小儿支气管哮喘急性发作的效果显著,有利于促进患儿肺功能恢复,且安全性较高,值得推广。

四子温肺汤治疗哮喘-慢阻肺重叠综合征急性期寒痰郁肺夹瘀证患者临床观察

目的:探讨四子温肺汤对哮喘-慢阻肺重叠综合征(Asthma-COPD overlap syndrome,ACOS)急性期寒痰郁肺夹瘀证患者肺功能、炎症因子水平及临床疗效的影响。方法:将88例ACOS患者按照治疗方案不同分为对照组和观察组,每组44例。对照组采用布地奈德福莫特罗吸入粉雾剂(Ⅱ)联合噻托溴铵吸入粉雾剂进行治疗,而观察组则在对照组治疗方案的基础上,联合给予四子温肺汤治疗。两组均连续治疗10天。比较两组治疗前后肺功能指标,血清炎性因子[超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素17(interleukin,IL-17)、白细胞介素4(interleukin,IL-4)]水平、哮喘控制测试(asthma control test,ACT)评分、慢性阻塞性肺疾病评估测试(COPD assessment test,CAT)评分和临床疗效、不良反应发生情况。结果:治疗后两组用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、FEV1/FVC与呼气流量峰值(peak expiratory flow,PEF)均较治疗前升高(P<0.05),血清炎症因子水平、CAT评分均较治疗前降低(P<0.05),ACT评分增加(P<0.05);且上述指标观察组与对照组比较,差异均有统计学意义(P<0.05)。观察组总有效率[97.72%(43/44)]高于对照组[90.91%(40/44)](P<0.05);两组不良反应发生率无明显差异(P>0.05)。结论:四子温肺汤治疗ACOS寒痰郁肺夹瘀证患者,能改善患者肺功能,控制哮喘症状,降低血清炎性反应,提高临床疗效。

氢气在呼吸系统疾病中的作用及研究进展

氢气是一种无色无味、具有生物活性的还原性小分子气体,具有抗炎、抗氧化、抗凋亡等生物学功能,可用于多种疾病的辅助治疗。人们使用氢的方式已不局限于氢气吸入,还出现了氢水饮用、含氢溶液注射、含氢透析液透析等新方法,氢的生物学作用得到广泛关注。本文围绕氢气在慢性阻塞性肺疾病、哮喘、肺癌、新型冠状病毒感染、急性肺损伤、肺纤维化等呼吸系统疾病中的作用及研究进展进行讨论。