老年高血压患者肺功能的研究

目的 研究老年高血压患者肺功能的变化。方法 本研究设高血压病组68人，对照组46人，高血压病组根据WHO／ISH分类分为3组，其中1级22人，2级28人，3级18人。检测检测肺活量（VC）、用力肺活量（FVC）、一秒钟用力呼气容积（FEV1）、FEV1／FVC、肺一氧化碳弥散量（DLCO）、单位肺泡容积的一氧化碳弥散量（DLCO／VA）、最大通气昔（MVV）、呼出25％啼活量时最大呼气流量（FEF25）、呼出50％肺活量时最大呼气流量（FEF50）、呼出75％肺活量时最大呼气流苗（FEF75）等肺功能指标，采用SPSS11．5软件进行统计学处理，比较各组间肺功能各指标间的差异，结果高血压病组患者VC、FEV1／FVC、MVV、FEF25、FEF50、FEF75，低于对照组，差异有统计学意义（P〉0．05）．两组间FEV1、DLCO、DLCO／VA差异无统计学意义（P〉0．05）。高血压病3级患者VC、FEV1／FVC、MVV、FEFn、FEF50、FEF75低于1级，高血压病2级患者FEF25，低于1级，差异有统计学意义（P〈0．05）。三组间FEV1、DLCO、DLCO／VA差异无统计学意义（P〉0．05）。结论高血压病患者存在以通气功能为主的肺功能损伤，且通气功能的损伤稃度与高血压的进展及严重程度相关。     

呼吸锻炼对结核性胸膜炎患者肺功能的影响

目的探讨呼吸锻炼对结核性胸膜炎患者肺功能的影响。方法采用随机对照研究,纳入35例结核性胸膜炎患者,随机分为试验组（n=18）和对照组（n=17）,两组均予常规治疗,试验组每日在医生指导下进行2次呼吸锻炼,所有患者治疗前后均检查肺功能。结果两组病例基线资料可比,治疗后试验组较对照组的肺活量（VC）平均增加525ml（P〈0．05）,最大通气量（MVV）平均增加5．3L（P〈0．05）,第1秒用力呼气容积（FEV1）和用力肺活量（FVC）无差异（P〉0．05）,1秒率（FEV1／FVC％）下降（P〈0．05）。结论结核性胸膜炎患者在常规治疗基础上加强呼吸锻炼有助于改善肺通气功能。     

老年肺癌术后呼吸衰竭28例临床分析

目的：探讨老年肺癌术后呼吸衰竭的原因,预防和治疗。方法：对我院1995年1月至2001年1月60岁以上的肺癌术后发生呼吸衰竭者28例,并以同期手术未发生呼衰的211例老年肺癌患者作对照,用X^2检验分析可能导致呼吸衰竭的高危因素。结果：术后呼吸衰竭的发生率为11．7％（28／239）,病死率21．4％（6／28）。呼衰组肺活量占预计值的百分比（VC%),最大通气量占预防的百分比（MVV％）、一秒钟呼气容积（FEV1）、一秒钟呼气量占用力肺活量的百分比（FEV1／FVC％）都明显低于无呼衰组（P＜0．01）。全肺切除组术后呼衰发生可能性明显高于肺叶和段／楔形切除组（P＜0．01）。结论：术前心肺功能异常,呼吸道感染,手术创伤和伤口疼痛刺激是引起术后呼吸衰竭的主要原因,及早诊断、及时行气管切开术并给予机构通气是抢救成功的最有效手段,加强围手术期呼吸道管理,避免手术后并发症是预防是预防术后呼吸衰竭的关键。     

不同通气麻醉对肺癌患者术后肺功能的影响

目的 探讨不同通气麻醉对肺癌患者术后肺功能的影响.方法 选择20例行单侧肺叶切除手术患者,随机分为两组各10例,单肺通气(OLV)组用双腔支气管导管行开胸术,双肺通气(TLV)组用加强型气管导管行开胸术.两组术前(T0)与术后第1天(T1)、第2天(T2)、第3天(T3)、第4天(T4)、第5天(T5)、第6天(T6)、第7天(T7)行肺功能指标检测,包括肺活量占预计值百分比(VC％)、用力肺活量占预计值百分比(FVC％)、最大自主通气量占预计值百分比(MVV％)、第1秒用力呼气量占预计值百分比(FEV1％)、FEV1/FVC.结果 两组VC％、FVC％、FEV1％、MVV％术后T1～T7均明显低于T0(P均＜0.05),FEV1/FVC术后T1 ～T7高于T0(P均＜0.05);组间比较P均＞0.05.结论 OLV不是影响肺科手术后肺功能变化的主要因素.     

恢复期SARS患者肺功能的改变

目的 观察SARS患者恢复期肺功能状况，评价SARS对患者肺功能的影响。方法 SARS组10例，对照组13例，分别测定肺活量(VC)、用力肺活量(FVC)、一秒钟用力呼气容量与用力肺活量比值(FEVl．0％)、25％～50％肺活量位最大呼气流量(V25％～50％)、残气量(RV)和肺一氧化碳弥散量(DLCO)。结果 SARS组VC、FVC和DLCO均显著低于对照组。结论 SARS患者肺功能受到损害，主要以限制性通气功能障碍和弥散功能损害为特征。对SARS患者作肺功能检查能及时了解和评估患者的肺功能状况。     

吸入复方异丙托溴铵与异丙托溴铵对COPD肺功能的影响

目的 观察单剂量吸入复方异丙托溴铵与异丙托溴铵对慢性阻塞性肺疾病(COPD)患者静态肺功能的不同影响.方法 26例稳定期COPD患者随机分为两组,分别吸入复方异丙托溴铵和异丙托溴铵后,进行静态肺功能测定.结果 14例吸入复方异丙托溴铵的患者,第一秒用力呼气量(FEV1)和用力肺活量(FVC)、呼气流速指标均有显著改善,第一秒用力呼气量占肺活量比值(FEV1/FVC)无明显的改变;深吸气量(IC)增加;12例吸入异丙托溴铵的患者,FEV1,FVC,FEV1/FVC无显著改变,呼气流速指标亦无显著改变但IC增加.结论 单剂量吸入复方异丙托溴铵能够显著改善COPD患者肺通气功能.     

老年慢性阻塞性肺疾病患者营养状况与肺通气量的关系

目的研究慢陛阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者营养状况与肺通气功能的关系。方法对217例患者进行以身体组成评价法（BCA）营养状况调查。根据其营养评价结果分为营养良好组和营养不良组,两组进行肺通气功能测定,观察指标包括：最大通气量（MVV）,用力肺活量（FVC）,第1秒用力呼气容积（FEV1）,最大呼气流量（PEF）。结果在调查的217例患者中,有67例患者营养状况良好,占30．87％,有150例COPD患者被评为营养不良,营养不良发生率为69．13％。营养不良组的肺通气量指标MVV％（36．21±17．36）、FVC％（75．42±19．65）、FEV1％（41．92±16．29）、PEF％（36．06±17．25）均低于营养良好组MVV％（59．25±22．61）、FVC％（93．19±15．32）、FEV1％（52．3±14．43）、PEF％（68．19±24．23）,差异有统计学意义（P〈0．05）。结论COPD患者的营养状况评价结果均不理想,而营养不良会使呼吸肌储备力量下降及呼吸肌容易疲劳,导致肺通气功能降低,所以改善COPD患者营养不良的发生,对肺通气功能恢复有重要意义。     

大容量全肺灌洗对尘肺病患者远期疗效的影响及改进方法

目的通过对大容量肺灌洗（WLL）治疗尘肺病患者远期疗效的分析,探讨影响WLL远期疗效的因素及改进方法。方法2007～2008年对陕西韩城桑树坪矿、山东招远玲珑金矿和安徽淮北刘桥一矿78例男性尘肺病患者的远期疗效进行回顾性调查,比较肺灌洗组和非灌洗组的肺功能及生存状况。结果WLL治疗10a后,大部分肺功能指标[肺活量（VC）、用力肺活量（FVC）、第1秒用力呼气量（FEV1）、第1秒用力呼气率（FEV1％）、25％FVC时的用力呼流量（FEF75）、最大通气量（MVV）]无明显改善,仅50％FVC时的用力呼气流量（FEF50）、75％时的用力呼气流量（FEF25）有好转,差异有统计学意义（t=2．749、3．216,P=0．008、0．002）;肺灌洗组及非灌洗组治疗后10年生存率分别为69．8％、54．3％,差异无统计学意义（χ^2=1．980,P=0．159）。结论经过10a时间观察,肺灌洗组在肺功能指标及生存情况方面较非灌洗组略有优势,但WLL远期疗效尚不十分明显。     

测定慢性阻塞性肺疾病患者6s用力呼气容积的意义

目前判断气流受限的常用肺功能指标是时间肺活量,包括:第1秒用力呼气容积(FEV1)和1 s率(FEV1与用力呼气容积比值)的降低来确定的。气道阻塞患者呼气时间可明显延长,最长可达20 s或以上,但呼气时间过长会使患者出现过度通气,导致头晕、呼吸困难、肢体麻木,甚至危及性命,尤其慢性阻塞性肺疾病(COPD)患者多见于老年人,体质较差,容易出现并发症。6 s呼气容积(FEV6)是指最大吸气至肺总量位后6 s之内快速呼出气量。由于呼气时间相对较短,患者比较容易接受,不良反应少。本文就COPD患者肺功能指标用力肺活量(FVC)与FEV6及FEV1/FVC与FEV1/FEV6进行相关性分析。     

高血压病患者肺通气功能和弥散功能的变化

目的　探讨不同分级、危险度分层的原发性高血压病 (essential hypertension,EH )患者的肺功能改变及其临床意义。方法　对 6 7例未经正规治疗的 EH患者和 6 3例血压正常者的肺通气功能 (用力肺活量 FVC、第一秒用力呼气量FEV1 、最大呼气中段流量 MMEF、最大通气量 MVV)和弥散功能 (肺一氧化碳弥散量 DLCOSB)进行前瞻性单盲对照研究。结果　 (1) EH组 FVC、FEV1 、MMEF、MVV、DLCOSB与正常对照组比较差异有显著性 (P<0 .0 0 1)。(2 ) 2、3级 EH患者肺功能较 1级 EH患者肺功能降低 ,两者在 FVC、FEV1 的差异有非常的显著性 (P<0 .0 0 1) ,而在 MMEF、MVV、DLCOSB的差异无显著性 (P>0 .0 5 )。(3)与低危组相比 ,中危组 EH患者的各项肺功能指标都有所降低 ,但其中仅 FEV1的差异具有显著性 (P<0 .0 5 ) ;高危 /极高危组 EH患者的肺功能皆降低 ,其中 FVC、FEV1 、MMEF的差异具有显著性(P<0 .0 2～ 0 .0 0 1) ,而 MVV、DLCOSB的差异无显著性 (P>0 .0 5 )。 (4)与中危组相比 ,高危极高危组 EH患者肺功能降低 ,其中 FVC、FEV1 的差异具有显著性 (P<0 .0 0 1) ,而 MMEF、MVV、DLCOSB的差异不具有显著性 (P>0 .0 5 )。结论　 EH患者肺通气功能和弥散功能减低 ,并有随血压分级和危险度分层的加重而减低趋势     

健康中老年人肺功能下降与呼吸中枢驱动变化的关系

目的 探讨健康中老年人肺功能下降与呼吸中枢驱动变化的关系. 方法 随机选择8例健康中老年人及8例性别匹配的健康青年人,平均年龄分别为(57.3±5.0)岁和(28.3±3.4)岁,检测其肺功能.同时,通过多导食道电极记录膈肌肌电反映呼吸中枢驱动,观察静息状态下及最大用力吸气时的膈肌肌电. 结果 中老年组平均肺活量(VC)(3.2±0.5)L,显著低于青年组(4.0±0.8) L(t=-2.27,P＜0.05)；中老年人最大用力吸气动作时的膈肌肌电与青年人相似,分别为(172.2±54.6)μV与(175.0±55.7)μV(t=- 0.10,P=0.921)；中老年人安静状态下的潮气量及每分通气量与青年人相似,但其呼吸中枢驱动占最大值的百分数显著高于青年人,分别为( 27.8+12.9)％与(16.4±7.2)％(t=2.18,P＜0.05):中老年人呼吸中枢驱动有效性比青年人小1倍,分别为(62.7±23.2)％与(128.6±96.2)％. 结论 中老年人的呼吸中枢驱动储备低于青年人,肺功能随增龄减退并不是因为呼吸中枢驱动下降,而可能是因为肺结构本身改变所致.     

The impact of COVID-19 and masking practices on pertussis cases at a large academic medical center (2019-2021)

We reviewed cases of Bordatella pertussis (B. pertussis) cases in ambulatory clinics at a large academic health care institution in Los Angeles from 2019-2021. Public health prevention measures during the Coronavirus disease 19 (COVID-19) pandemic impacted the number of pertussis cases identified.     

成人呼吸系统疾病中呼吸道合胞病毒的监测

目的:了解呼吸道合胞病毒(RSV)在成人呼吸系统疾病中的发病情况。方法:对呼吸科住院患者253例及同期健康体检者200例静脉血清用酶联免疫法(ELISA)测定RSV抗体IgM。结果:对照组阳性12例,阳性率6%;患者组阳性37例,阳性率14.6%,其中慢性阻塞性肺病(COPD)、肺炎与对照组比较差异有显著性(P<0.05);急性支气管炎、肺间质纤维化、结核性胸膜炎与对照组比较差异有显著性(P<0.01)。本组患者秋冬季发病较多,阳性率19.5%,春夏季阳性率9.6%,二者相比差异有显著性(P<0.05)。结论:RSV是成人呼吸道感染的重要病原,可引起下呼吸道炎症(如COPD、肺炎、急性支气管炎、肺间质疾病等)的发生和反复发作,应引起重视。     

新型冠状病毒肺炎呼吸支持手段介入的时机与策略

呼吸支持技术作为救治重症新型冠状病毒肺炎的有效手段,正确应用会有效改善氧合、降低病死率.但不同呼吸支持技术介入的时机、如何合理应用在一定程度上直接关系到治疗的成败.本文就作者团队临床救治重症新型冠状病毒的经验结合国内外相关研究成果进行阐述,希望对当前救治重症新型冠状病毒有所帮助.     

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society

BackgroundThe impact of the outbreak of COVID-19 on the work of respiratory physicians in Japan has not yet been evaluated. The study investigates the impact of the outbreak on respiratory physicians’ work over time and identifies problems to be addressed in the future.MethodsWe conducted a web-based survey of respiratory physicians in 848 institutions. The survey comprised 32 questions and four sections: Survey 1 (April 20, 2020), Survey 2 (May 27, 2020), Survey 3 (August 31, 2020), and Survey 4 (December 4, 2020).ResultsThe mean survey response rate was 24.9%, and 502 facilities (59.2%) participated in at least one survey. The proportion of facilities that could perform PCR tests for diagnosis and more than 20 tests per day gradually increased. The percentage capable of managing extracorporeal membrane oxygenation (ECMO) or more than five ventilators did not increase over time. The proportion that reported work overload of 150% or more, stress associated with lack of personal protective equipment (PPE), and harassment or stigma in the surrounding community did not sufficiently improve.ConclusionWhile there was an improvement in expanding the examination system and medical cooperation in the community, there was no indication of enhancement of the critical care management system. The overwork of respiratory physicians, lack of PPE, and harassment and stigma related to COVID-19 did not sufficiently improve and need to be addressed urgently.     

A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD

Respiratory viruses are associated with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) in hospitalized patients. However, exacerbations are increasingly managed in the community, where the role of viruses is unclear. In community exacerbations, the causal association between viruses and exacerbation maybe confounded by random fluctuations in the prevalence of circulating respiratory viruses. Therefore, to determine whether viral respiratory tract infections are causally associated with community exacerbations, a time-matched case-control study was performed. Ninety-two subjects (mean age 72 yrs), with moderate to severe COPD, (mean FEV(1) 40% predicted), were enrolled. Nasopharyngeal swabs for viral multiplex polymerase chain reaction and atypical pneumonia serology were obtained at exacerbation onset. Control samples were collected in synchrony, from a randomly selected stable patient drawn from the same cohort. In 99 weeks of surveillance, there were 148 exacerbations. Odds of viral isolation were 11 times higher in cases, than their time-matched controls (34 discordant case-control pairs; in 31 pairs only the case had virus and in three pairs only control). Picornavirus (26), influenza A (3), parainfluenza 1,2,3 (2), respiratory syncytial virus (1), and adenovirus (1) were detected in cases while adenovirus (1) and picornavirus (2) were detected in controls. In patients with moderate or severe COPD the presence of a virus in upper airway secretions is strongly associated with the development of COPD exacerbations. These data support the causative role of viruses in triggering COPD exacerbations in the community.     

The Effects of Inhaled Albuterol and Salmeterol in 2- to 5-Year-Old Asthmatic Children as Measured by Impulse Oscillometry*

The functional assessment of the response to bronchodilators in 2- to 5-year-old asthmatic children is technically difficult. For this reason, there have been no reports on the effects of long-acting bronchodilators, such as salmeterol, in this age group. Of the several techniques available for measuring resistance to airflow, forced oscillation remains the most adaptable to young children and the most practical for research and clinical use. In this study we used the Jaeger MasterScreen Impulse Oscillometry System to assess the response of 2 to 5 year-old asthmatic children to an inhaled long-acting bronchodilator, salmeterol, by comparing it to the effect of a standard dose of the short-acting bronchodilator, albuterol. We performed a placebo-controlled, randomized, crossover study in 10 children aged 2 to 5 years who had a history of physician-diagnosed asthma and who were not on regular controller therapy. At weekly intervals after baseline measurements of reversibility, each child received two inhalations from an albuterol metered-dose inhaler (MDI) with a spacer (200 µg), or placebo MDI with spacer, or two inhalations from a salmeterol MDI (50 µg), or 50 µg from a salmeterol Diskus®. Measurements were obtained at 5, 30, 60, 360, and 540 min, the last time interval only on the salmeterol days. Based on previous studies, total respiratory system reactance at 5 Hz (X₅), calculated by the MasterScreen computer from mouth pressure and flow data, was used as the primary efficacy variable. The mean intra-individual variability in X₅ was 10.5% (range 3.6% to 17.9%). The mean (SE) changes from baseline X₅ at each time point were as follows: for placebo, 9.6 (3.0), 10.1 (2.6), 5.1 (2.9), 6.1 (3.5), p=0.36 vs. baseline; after treatment with albuterol, 32.7 (3.8), 53.9 (1.2), 47.3 (5.4), 18.1 (5.8), p<0.01 vs. baseline at all time points; after salmeterol MDI, 16 (6.4), 28.9 (5.2), 32.7 (3.9), 34.6 (4.4), 31.2 (4.8), p<0.05 at 60, 360, and 540 min; and after salmeterol Diskus®, 16.4 (4.0), 16.9 (6.6), 27.8 (5.9), 28.6 (5.6), 33.8 (4.0), p<0.05 at 540 min. No significant adverse events or electrocardiographic changes were noted at any time. Impulse oscillometry is an acceptable method of assessing airway responses to bronchoactive drugs in this age group. Compared to albuterol and to its effect in older children and adults, the response to salmeterol Diskus® appears to be somewhat blunted in this age group. The MasterScreen system is well suited for pharmacodynamic studies and clinical investigations in pre-school-aged children.     

Respiratory infections: Community-acquired pneumonia and newer microbes

Respiratory infections, especially community-acquired forms of pneumonia (CAP), are challenging for clinicians because (1) a causative microorganism can only be found in about 50% of cases; (2) initial therapy, therefore, must be based on a probable or most likely etiology in the context of the patient's overall medical condition; and (3) new microbes or those considered previously as normal flora or less virulent forms seem responsible for some cases. It is important to be acquainted with new causes of infection which include Legionella species, Chlamydia pneumoniae, diphtheroids in certain instances (Corynebacterium pseudodiphtheriticum), and viruses such as the Hanta strains. Infections with Bordetella pertussis are increasing. However, the ever present and most common cause of CAP, Streptococcus pneumoniae, continues to present problems because of increasing antibiotic resistance, the high case fatality rate when bacteremia accompanies pneumonia, and the inability to give prophylactic immunization to all people with risk factors for this infection. Offprint requests to: H. Y. Reynolds     

Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age

BACKGROUND: To evaluate rates of rehospitalisation due to respiratory illness in preterm infants of 29-36 weeks gestation without chronic lung disease. PATIENTS AND METHODS: Retrospective single centre cohort study including infants from 1998 to 1999 with follow-up over two respiratory syncytial virus (RSV) seasons. RESULTS: Of 435 infants included 61 infants (14%) experienced 78 rehospitalisations. The overall RSV attack rate was 4.4% over two consecutive RSV seasons for infants below 6 months of age at onset of RSV season (7.7 and 1.1%, respectively, p=0.015), with significant differences between infants of 29-32 and 33-36 weeks gestational age (10.5% vs. 2.3%, p=0.008). None of the infants needed mechanical ventilation or admission to the intensive care unit. Infants with RSV infection were younger of age (mean 4.2 vs. 8.2 months; p=0.015), had longer stays at the hospital (11.5 vs. 7.0 days; p=0.006), and more severe courses of disease (score 3.0 vs. 1.8; p<0.001). Additional risk factors for RSV infection were multiple gestation (OR 5.5; CI 95% 1.439-21.028) and congenital heart disease (OR 4.2; CI 95% 1.005-17.669). CONCLUSION: The total burden of respiratory disease and RSV infection in this population was low. A lower gestational age, multiple gestation, and congenital heart disease were associated with increased risk of RSV infection.