患慢性阻塞性肺疾病吸烟者外周气道中的CD8~ T细胞

吸烟是慢性阻塞性肺疾病（ＣＯＰＤ）的一个高危诱因，外周气道炎症可致气道狭窄、气流受限，对此，本文研究了具有吸烟史的ＣＯＰＤ患者外周气道的炎症特征。作者收集了因患周围性肺癌而行肺部分切除术的１６例吸烟患者的外周气道标本，其中９例有慢性支气管炎和慢性气道受限的明显症状，另外７例为肺功能正常的无症状吸烟者。应用免疫组化的方法观察了外周气道炎性细胞浸润情况，并对石蜡切片测量了管道内径、气道壁面积和平滑肌面积。结果有症状ｉｌｌＦＥＶＩ值和ＦＥＶＩ／ＦＥＶ比对照组明显降低。两组之间气道壁面积、中性粒细胞，巨…     

肺功能改变COPD临床观察

目的 观察中重度慢性阻塞性肺疾病(以下简称COPD)气道阻力增加是否与弥散功能降低相关.方法 对于新入院COPD患者首次作肺功能.观察中重度COPD患者气道阻力增加是否与弥散功能改变相关.结果 治疗10天前后肺功能气道阻力变化无明显差异,弥散功能治疗前后亦无明显差异.但中、重度COPD患者随着气道阻力的增加,弥散功能亦进行性降低,比较中及重度弥散功能变化差异有显著性.结论 COPD气道阻力增加,弥散功能进行性降低,应早诊断及早治疗.     

严重烧伤建立人工气道后气道梗阻识别与急救对策研究

目的总结严重烧伤建立人工气道后气道梗阻识别与急救对策,以期提高疗效。方法回顾性分析2011年2月至2015年2月郑州市第一人民医院烧伤科严重烧伤建立人工气道34例患者的临床资料,按照不同的治疗方法将患者分成观察组和对照组,各17例。对照组患者伤后立即给予吸氧、雾化等常规治疗;观察组患者伤后则先总结气道梗阻的原因,对气道内压力过高,呼吸机不能有效通气则考虑给予支气管镜检查等综合改善通气治疗。比较两组患者住院时间,气道再次梗阻发生率,吸痰、痰痂形成、刺激性咳嗽、气道黏膜损伤发生率,血氧饱和度、动脉氧分压、呼吸、脉搏,用力肺活量(FVC)、第一秒量(FEV1)、最高呼气流速(PEF)。应用SPSS15.0统计软件,相关指标比较采用t检验与χ~2检验。结果观察组的住院时间为(30.1±9.0)d显著短于对照组的(41.4±11.7)d,差异有统计学意义(t=8.677,P=0.032);对照组气道再次梗阻发生率为41.18%,观察组为11.76%,两组比较差异有统计学意义(χ~2=8.946,P=0.011);对照组吸痰、痰痂形成、刺激性咳嗽、气道黏膜损伤发生率分别为47.06%、41.18%、64.71%、58.82%,观察组分别为11.76%、11.76%、17.65%、17.65%,比较差异均有统计学意义(P值均小于0.05)。对照组治疗后血氧饱和度、动脉氧分压、呼吸、脉搏分别为(89.68±8.45)%、(92.34±6.82)mmHg、(95.46±5.62)次/min、(95.46±5.62)次/min;观察组相对应分别为(95.34±7.23)%、(98.94±5.23)mmHg、(78.34±7.23)次/min、(16.46±1.67)次/min,治疗后观察组显著优于对照组,差异均有统计学意义(P值均小于0.05);对照组治疗后FVC、FEV1、PEF分别为(3.01±0.61)、(2.24±0.81)、(7.11±1.41)L;观察治疗后相对应分别为(4.11±0.32)、(4.11±0.32)、(8.21±1.52)L,差异均有统计学意义(P值均小于0.05)。结论早期气道梗阻识别并及时有效地通畅呼吸道能降低严重烧伤建立人工气道后气道梗阻的发生率,缩短住院时间,改善患者的肺功能。     

纤维支气管镜引导下气管支气管支架置入术治疗肺癌并气道梗阻临床分析

目的观察纤维支气管镜引导下气管支气管置入术治疗肺癌并气道梗阻的近期疗效。方法肺癌并呼吸道梗阻患者,在病房床边纤维支气管镜引导下行气管支气管支架置入术,观察气管支气管支架置入前后患者气促症状、PO2、PCO2变化。结果18例患者均成功放置,气管支气管支架放置后呼吸困难症状立即缓解,PO2、PCO2明显改善。结论纤维支气管镜引导下气管支气管置入术对肺癌并气道梗阻患者安全有效,可明显改善患者近期生存质量。     

Th17细胞与气道变应性疾病

气道变应性疾病传统上认为是以Th2型免疫应答占优势的Th1/Th2细胞功能失衡所致.近年来,大量研究证实Th17细胞在气道变应性炎症中发挥重要作用,使人们对气道变应性疾病有了崭新的认识.IL-17A能促进中性粒细胞的募集、活化,促进炎症反应;IL-23-Th1轴不仅能诱导中性粒细胞性气道炎症,还能正调节嗜酸性粒细胞性气...     

孟鲁司特联合复方甲氧那明治疗咳嗽变异性哮喘观察

目的 探讨孟鲁司特联合复方甲氧那明对咳嗽变异性哮喘(cough variantasthma, CVA)患者肺功能和临床疗效的影响.方法 64例CVA患者随机分为两组,治疗组(32例)口服孟鲁司特每晚10 mg及复方甲氧那明胶囊每日3次,每次2粒;对照组(32例)吸入布地奈德200～400μg每日早晚各1次.两组均治疗4周.观察临床症状及肺功能的变化.结果 治疗组治疗后临床症状、晨间最大呼气峰流速值(PEFam)、晚间最大呼气峰流速值(PEFpm)及FEV1%等指标明显改善,同治疗前相比差异均有显著性(P<0.05);对照组治疗前后上述指标比较亦有显著性差异(P<0.05);治疗组和对照组比较无显著性差异(P>0.05).结论 口服孟鲁司特联合复方甲氧那明胶囊对CVA患者有改善肺功能和降低非特异性气道高反应性的作用.     

雾化吸入布地奈德在慢性阻塞性肺病急性发作中的临床应用

慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是一种具有气流受限特征的疾病，病情呈进行性发展，病理特征为气道慢性炎症，严重影响着患者的劳动能力和生活质量。糖皮质激素治疗AECOPD可以减轻症状，加快肺功能恢复，缩短住院时间并降低治疗失败率等。吸入糖皮质激素具有较强的局部抗炎作用和较小的全身副作用。短期较大剂量雾化吸入较小剂量更能改善患者临床症状、血气分析、肺功能。     

基于逆向工程的人体气道重建及其流场分析

目的 针对老年人气管萎缩导致整体气道尺寸变小的情况，研究狭窄气道重建及不同呼吸状态下空气流场对气道的影响。方法 运用Mimics建立人体气道的三维模型，利用计算流体动力学方法对气道内的流场进行仿真，分析并比较不同呼吸状态下气管内壁压强及其气流的分布状态。结果 在不同呼吸状态下，气管内壁压强数值在主气管内壁相对均匀，但在支气管狭窄段的气流入口处出现明显下降，在最狭窄的区域附近达到负压。气流速度从气管管道中心向边界层递减，流速在狭窄处达到最大值。气流穿过狭窄区域后产生涡流，且入口流速越大，正压和负压压强越大，狭窄处压降越明显，涡流现象越明显。结论 气道狭窄区域因负压造成继续收缩，会导致病人呼吸困难，而涡流会使气管壁受到气动剪切应力的影响可能损伤气道壁黏膜。因此，了解萎缩狭窄气道内的压强分布及流速分布情况，可为此类病变气道的临床诊治提供参考依据。     

气道炎症介质检测对评价咳嗽变异性哮喘患者肺功能的价值

咳嗽变异性哮喘(CVA)是以咳嗽为惟一症状或主要症状的一种特殊类型支气管哮喘。CVA的发病机制目前仍不甚清楚,有文献显示,哮喘患者的血循环中炎症性细胞因子分泌紊乱,认为炎症性细胞因子可能在其病程中发挥了重要作用,检索国内外文献关于患者气道炎症介质水平与患者肺功能状态的临床研究目前仍不多见。本文以CVA患者为对象,通过观察CVA患者治疗前后气道炎症介质及肺功能     

细胞外基质参与调控慢性阻塞性肺疾病气道重塑的研究进展

<正>慢性阻塞性肺疾病（chronic obstructive pulmo-nary disease,COPD）是一种以气流受限、气道重塑和肺实质破坏为特征的慢性气道炎症性疾病，气道重塑是其发病的关键因素之一。COPD的气道重塑过程主要发生在小气道，随着疾病进展，     

Effect of body posture on dynamic lung functions in young non-obese Indian subjects

Flow volume loop and its various indices can be used to diagnose UAO. Change in posture from sitting to horizontal position per se causes a decrease in effort dependent inspiratory and expiratory flow rates but no significant change in upper airway obstruction indices. Thus, measurement of FVL in supine posture may be used to detect UAO as it may be missed if spirometry is performed in sitting posture.     

Interpretation of changes in spirographic and flow-volume variables after operative treatment in bilateral vocal cord paralysis

In 13 patients, who underwent a superolateralization of a vocal cord after bilateral vocal cord paralysis, we studied pre- and postoperatively spirometric dynamic and static lung volumes and variables from maximal expiratory and maximal inspiratory flow-volume (MEFV and MIFV) curves. The effects of surgical treatment on these variables have been established by comparing the statistical significance of the changes post- versus preoperative. A significant increase was found in the vital capacity and a significant decrease in the indices associated with the dynamic variability of the obstruction. The most significant changes were found in peak inspiratory flow and peak expiratory flow, and in the inspiratory defined dynamic estimates, as forced inspiratory volume in 1 second and maximal voluntary ventilation at a frequency of 30 c X min-1. Significant correlations, however, were found to exist only for the changes within the group of flow-volume indices and for those within the group of spirographic variables. This led us to the conclusion that for the diagnosis of this type of upper airway obstruction these measurements are additive, reflecting different aspects of airway mechanics.     

Rhinomanometry and nasal peak expiratory and inspiratory flow rate

Variation in nasal patency can be studied by rhinomanometry as well as by nasal expiratory and inspiratory peak flow rate. The accuracy of 12 sets of peak flow meters was tested in a standardized way using a pump. Differences between flow meters were found. Consequently it is recommended for a patient to use the same flow meter throughout a study. Comparison between nasal expiratory and inspiratory peak flow was performed before and after provocation of 12 grass pollen-allergic patients. Inspiratory peak flow showed certain advantages compared with expiratory peak flow measurements. The results can best be expressed as the means rather than the top values of three consecutive registrations. Twelve healthy subjects were also tested with rhinomanometry, nasal expiratory and inspiratory peak flow before and after decongestion with nose spray. Comparisons among the three methods showed significant correlations.     

Disturbances in airflow dynamics and tracheal sounds during forced and quiet breathing in subjects with unilateral vocal fold paralysis.

Variable extra thoracic obstruction has been found in spirometric studies in subjects with unilateral vocal fold paralysis. The aim of the study was to further evaluate airflow dynamics in these subjects with body plethysmography and tracheal sound analysis. Ten patients with unilateral vocal fold paralysis without a history of chronic pulmonary diseases and 10 healthy control subjects were studied. Flow-volume spirometry, body plethysmography and tracheal sound analysis were performed within 1 day. The study shows that peak inspiratory flow (PIF) and specific airway conductance (SG(aw)) expressed as percentage of Finnish reference values were significantly lower and airway resistance (R(aw)) was higher among the patients than among the controls (P=0.004, P=0.026 and P=0.004, respectively). The patients had higher sound amplitude of both inspiratory and expiratory tracheal sounds than the controls [root mean square (RMS) values of the power spectra were 31.5 and 25 dB, P=0.006 in inspiration and 31.5 and 26 dB, P=0.013 in expiration, respectively]. Quartile frequencies (F25 and F50) and RMS of expiratory tracheal sounds had significant negative correlation with PIF (P=0.02, P<0.001, P=0.02, respectively) and forced inspiratory volume in 1 s (FIV(1)) (P=0.01, P<0.001, P=0.01, respectively). There was also an association between F50 and peak expiratory flow (PEF) (P=0.02). According to the present study, both quiet breathing and forced inspiration are disturbed in subjects with unilateral vocal fold paralysis. A close relationship between tracheal sounds and respiratory function tests exists.     

Flow oscillations on the flow-volume loop: a nonspecific indicator of upper airway dysfunction

Flow oscillations on flow-volume loops (a "saw-tooth" pattern) have been reported as a manifestation of obstructive sleep apnea (OSA), but the specificity of this flow-volume loop pattern has not been determined. In a review of 2800 flow-volume loops performed in our pulmonary function laboratory, we identified flow oscillations in 40 patients, an incidence of 1.43%. Thirty-one of these 40 patients (77%) did not have OSA. In 16 of these 31 patients (52%), a structural disorder of the upper airway or neurologic disease involving the upper airway muscles was found. Flow oscillations were associated with physiological upper airway obstruction (UAO) in 14 of these 40 patients (35%), but were the only physiological evidence of upper airway dysfunction in the other 26 patients. Flow oscillations on flow-volume loops thus represent nonspecifically instability of the upper airway, caused by a variety of disorders, including OSA. Detection of this peculiar flow-volume loop configuration should lead to investigation of the upper airway and the surrounding musculature as it might be an early indicator of ongoing disorders eventually leading to UAO.     

Airway obstruction in rheumatoid arthritis: CT manifestations, correlated with pulmonary function testing

In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF(25-75%)) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF(25-75% ) (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only.     

Technique to Determine Inspiratory Impedance during Mechanical Ventilation: Implications for Flow Limited Patients

We present the design of an enhanced ventilator waveform (EVW) for routine measurement of inspiratory resistance (R) and elastance (E) spectra in ventilator-dependent and/or severely obstructed flow-limited patients. The EVW delivers an inspiratory tidal volume of fresh gas with a flow pattern consisting of multiple sinusoids from 0.156 to 8.1 Hz and permits a patient-driven exhalation to the atmosphere or positive end-expiratory pressure. Weighted least-squares estimates of the coefficients in a sinusoidal series approximation of the EVW inspirations yielded inspiratory R and E spectra. We first validated the EVW approach using simulated pressure and flow data under different physiological conditions, noise levels, and harmonic distortions. We then applied the EVW in four intubated patients during anesthesia and paralysis: two with mild airway obstruction and two with severe emphysema and flow limitation. While the level of inspiratory R was similar in both groups of patients, the inspiratory E of the emphysematous patients demonstrated a pronounced frequency-dependent increase consistent with severe peripheral airway obstruction. We conclude that the EVW offers a potentially practical and efficient approach to monitor lung function in ventilator-dependent patients, especially those with expiratory flow limitation. © 1999 Biomedical Engineering Society. PAC99: 8719Uv, 8780-y     

Day-to-day variability of oscillatory impedance and spirometry in asthma and COPD

Variability in airway function may be a marker of disease activity in COPD and asthma. The aim was to determine the effects of repeatability and airway obstruction on day-to-day variability in respiratory system resistance (Rrs) and reactance (Xrs) measured by forced oscillation technique (FOT). Three groups of 10 subjects; normals, stable asthmatic and stable COPD subjects underwent daily FOT recordings for 7 days. Mean total and inspiratory Rrs and Xrs, and expiratory flow limitation (EFL) Index (inspiratory – expiratory Xrs), were calculated. The ICC's were high for all parameters in all groups. Repeatability, in terms of absolute units, correlated with airway obstruction and was therefore lowest in COPD. Day-to-day variability was due mostly to repeatability, with a small contribution from the mean value for some parameters. FOT measures are highly repeatable in health, stable asthma and COPD in relation to the wide range of measures between subjects. For home monitoring in asthma and COPD, either the coefficient of variation or individualized SDs could be used to define day-to-day variability.     

Effect of compliant intermediate airways on total respiratory resistance and elastance in mechanical ventilation.

Total respiratory resistance and elastance were estimated off-line in a sample of 60 patients undergoing mechanical ventilation by means of two regression models in order to analyse and understand a possible physiological mechanism determining differences in inspiration and expiration. The first model considered a single value for resistance and elastance over a whole breathing cycle, whereas the second model considered separate values for inspiratory and expiratory resistance and a single value for elastance. Inspiratory resistance was found to be lower than expiratory resistance, and intermediate values were obtained for resistance estimated over the whole breathing cycle. Student's t-test showed a highly significant difference between these resistance estimates, and principal components analysis demonstrated a significant increase in information when both inspiratory and expiratory resistances were used. Minor differences were found between values of elastance calculated with the two approaches. In an attempt to interpret these experimental results, a lung model incorporating the non-linear viscoelastic properties of the intermediate airways was considered. This model suggested that changes in intermediate airway volume play a significant role in breathing mechanics during artificial ventilation and indicated that inspiratory and expiratory resistance could be useful parameters for locating airway obstruction.     

Rare tracheal chondroid hamartoma masquerading as asthma in a 14-year-old girl.

BACKGROUND: Tracheal hamartomas are rare in all age groups and have not been previously described in adolescence. OBJECTIVE: To report the first case of a tracheal chondroid hamartoma presenting as exercise intolerance and wheezing and previously misdiagnosed and treated as asthma. METHODS: Symptoms, pulmonary function tests, chest x-ray examination, chest computed tomography, and histologic examination of the specimen were performed. RESULTS: The pulmonary function tests obtained throughout several years revealed progressive decreases (approximately 30% of predicted) in peak expiratory flow and forced expiratory volume in 1 second (approximately 50% of predicted). The inspiratory and expiratory flow-volume curve suggested a fixed central airway obstruction. Both the chest x-ray examination and computed tomography revealed an intraluminal tracheal tumor that was surgically excised. Histologic examination revealed a chondroid hamartoma. CONCLUSIONS: Rare benign primary tracheal tumors, including chondroid hamartoma, can present in adolescence with asthma-like symptoms for years and should be considered in the differential diagnosis, especially in the setting of appropriately abnormal spirometry or when asthma is very difficult to control.