支气管哮喘的治疗

发炎已被证实为哮喘的一个重要机理。哮喘患者由于气道反应性高,受过敏因素激发和作用,无论哮喘发作与否,支气管炎症始终存在。根据这一认识,以炎症为重点的哮喘治疗显得更加合理。 哮喘的治疗可分三类:(1)缓解症状治疗;(2)预防性治疗;(3)急性发作的治疗。 第一类治疗的药物有β-受体兴奋剂,抗胆碱能作用剂及茶硷三类支气管舒张剂。常用的β-受体兴奋剂有舒喘灵、叔丁喘宁、酚丙喘宁,这些药物     

哮喘患儿的福音———哮喘之家

哮喘患儿的福音———哮喘之家ＧｏｓｐｅｌｆｏｒＣｈｉｌｄｗｉｔｈＡｓｔｈｍａ———ＨｏｍｅｆｏｒｔｈｅＡｓｔｈｍａｔｉｃｓ６１００７２四川省人民医院万庆福徐翠霞ＷａｎＱｉｎｇｆｕ，ＸｕＣｕｉｘｉａ（ＳｉｃｈｕａｎＰｒｏｖｉｎｃｉａｌＰｅｏｐｌｅ’ｓＨ...     

儿童哮喘门诊规范化管理的实践

目的 开展儿童哮喘门诊规范化管理实践并探讨其效果。方法 采用方便抽样法,选取2016年12月-2017年2月在上海市某三级曱等儿童医院哮喘门诊就诊的哮喘患儿173例为研究对象,成立哮喘门诊规范化管理团队,干预措施包括流程优化、患儿档案建立、专业评估、规范诊疗、个性化的健康教育和干预措施的实施、示教药物吸入治疗、实时疾病监控、运用信息技术为哮喘患儿提供专业哮喘管理服务。结果 干预6个月后,173例患儿的儿童哮喘测试问卷评分由（19.24±3.49)分提升至（24.25±2.47)分;完全控制哮喘的患儿由61.8%上升到78.6%,未控制哮喘的患儿由11%下降至6.4% ;生存质量评分由（69.92±13.56)分上升至（76.37±9.44)分;医疗支出由[2519.04 (750.00,3750.00)]元/半年降低到[1338.00(643.75,1 718.75)]元/半年,差异均具有统计学意义（p<0.05)。结论 哮喘门诊规范化管理能有效提高哮喘患儿及家长的哮喘管理意识、知识和技术,在提高哮喘控制水平和生存质量的 同时,降低医疗支出,缓解家庭的经济压力。     

哮喘固本丸在哮喘治疗中免疫作用的观察

支气管哮喘(以下称哮喘)是全球健康问题，近10年病例逐渐增加。为探索中医中药在哮喘治疗中的作用．本文用中药哮喘固本丸治部哮喘患者，治疗前后进行血液SIL2R、IL4R检测，以观察其免疫调节作用。     

支气管哮喘的治疗新进展

支气管哮喘(简称支哮)是一种常见的呼吸系统变态反应性疾病.可由多种因素诱发.临床上以呼吸困难、咳嗽、哮喘三联症为主要表现.以往常用治疗药物有四类:(1)交感神经兴奋剂;(2)甲基黄嘌呤类;(3)糖皮质激素;(4)副交感神经对抗剂.近年来,支哮的治疗有了较大的进展.现综述如下:一、免疫疗法(一)减敏注射 此疗法是根据过敏原皮试阳性确定引起哮喘发作的过敏原,然后以一定浓度的抗原     

重症哮喘的治疗和护理

1临床资料我科2000～2004年共收治经临床诊断为重症哮喘48例,其诊断标准均符合中华医学会呼吸病学分会哮喘学组的诊断标准[1]。其中男28例,女20例,年龄31～89岁,病程8个月～60a。入科后观察患者精神差,均有呼吸困难,R>30次/min,HR>102次/min。部分患者不能平卧、讲话不连贯及烦躁不安、出汗;部分患者出现嗜睡或意识模糊,胸腹呈反向运动,哮鸣音从明显变为消失,伴紫绀。2治疗方法2.1药物治疗本组均在有效的抗感染、充足补液及稳定酸、碱、电解质平衡的基础上使用氨茶碱0.25g加入5%葡萄糖250ml静点(滴速为25～30滴/min),每日氨茶碱量≤1.0g,…     

哮喘控制测试结合峰流速在评估哮喘患者控制状况的研究

目的：评价哮喘控制测试（ACT）结合呼气峰流速（PEF）在评估哮喘患者控制状况的应用效果。方法选取收治的非急性发作期哮喘患者200例，采用前瞻性自身对照研究方式，通过Spearson相关性分析，对ACT、PEF以及ACT结合PEF三者评估哮喘控制状况与专家评价结果进行相关性分析。结果 ACT、PEF以及ACT结合PEF评估结果与专家评估结果间差异无统计学意义。 Spearson相关性分析显示，ACT、PEF以及ACT结合PEF三者评估哮喘控制状况与专家评价结果具有显著相关性（ r＝0.718、0.744、0.775，P＜0.05）。结论 ACT与PEF与专家评估结果均具较好的相关性，但二者结合相关性更高，可以较全面准确地反映哮喘患者的病情，更加有利于哮喘病情控制。     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

The comparison of effects of rapid opiate detoxification with ketamine complex and with tramadol and naltrexone under general anesthesia with propofol

Objective To release the heroin addicts‘ sufferings,we made rapid opiate detoxification by injecting naloxine under the general anesthesia.Method 160 volunteers were divided at randon into two groups:Group A were performed under the combined anesthesia with propofol,midazolam and kelamine.Group B were performed under the combined anesthesia with propofol with midazolam and tramadol.The vital signs were recorded and the withdrawal syndrome of the volunteers were assessed during the whole process.Result All of the withdrawal symptoms scores 24 hours after ROD in group B were lower than its pre-treatment;The symptoms of the thirs,tsleeping disturbance,nausea and vomiting,skeletal muscular pains and anorexia scores in group A were also lower than its pre-treatment;and no too much differeence belween group A and group B.But tearing,anxiety and diarrhea scores in group A were almost the same as the pre-treatment and higher than group B.Both groups received of the naloxone treatment smoothly,and remained in the hospital for about 3 days.Conclusion The effect of rapid opiate detoxification of naltrexone with the ketamine or tramadol under anesthesia is obvious.The tramadol is better than others.     

替吉奥联合亚叶酸钙及奥沙利铂治疗晚期结直肠癌病人的观察与护理

[目的]总结替吉奥联合亚叶酸钙及奥沙利铂治疗晚期结直肠癌病人的观察与护理。[方法]对25例无法手术切除的晚期结直肠癌病人采用替吉奥胶囊联合亚叶酸钙、奥沙利铂方案进行治疗,同时加强心理护理、毒副反应的观察与护理等。[结果]治疗过程中出现Ⅰ级和Ⅱ级神经毒性8例,恶心、呕吐、食欲下降12例,骨髓抑制5例,变态反应1例,经处理后均好转;1例病人死亡,其余病人均顺利进行治疗。[结论]加强替吉奥联合亚叶酸钙及奥沙利铂治疗晚期结直肠癌病人的护理,可保证治疗的顺利进行。     

艾滋病合并结核病及马尔尼菲青霉病患者的护理

目的通过分析艾滋病合并结核病及马尔尼菲青霉病患者的临床资料,提高对三病并存的护理认识。方法分析并总结26例艾滋病合并结核病及马尔尼菲青霉病住院患者的临床特点、治疗及护理方法。结果本组患者治愈5例,好转13例,死亡8例。存活患者随访6～30个月均未复发。结论三病并存时临床表现复杂,无特异性,护理难度大,应仔细观察病情,及早诊治,精心护理,对改善预后有重要意义。     

异病酚静脉全麻下复合氯胺酮或曲马多行纳屈酮快速阿片脱毒的效果比较

Toreleasetheseverewithdrawalsymptomsoftheheroinad-dicts,weinjecttheNaloxineinthegeneralanesthesia.160volun-teersreceivedRODwereperformedunderthecombinedanesthesiawithpropofol,midazolamandketamine.1Subjectsandmethods1.1Subjects160volunteerswhoaccordingwiththediagnosticstandardoftheICD-10abouttheopiate-addiction,male:145,fe-male15.Age:(30±6),theeldestwas45yearsold.Themeanbodyweightwasabout(58±8)kg.Educationalbackground:pri-maryschool118cases,juniorhighschool:24casesandseniorhighschool/seco…     

Association of optimism-pessimism with quality of life in patients with head and neck and thyroid cancers

OBJECTIVE: To examine the relationship between optimism-pessimism and quality of life (QOL) in survivors of head and neck and thyroid cancers. PATIENTS AND METHODS: Between 1963 and 2000, 190 patients completed both the Minnesota Multiphasic Personality Inventory (MMPI), used to assess explanatory style (optimism-pessimism), and either the 12-Item or 36-Item Short-Form Health Survey (SF-12 or SF-36), used to assess QOL. The MMPIs were completed an average of 13.4 years before the QOL assessment. The QOL measures were completed an average of 12.5 years after cancer diagnosis. Patients were divided into quartiles based on their MMPI Optimism-Pessimism scale score. Analysis was performed for all patients, those with head and neck cancer, and those with thyroid cancer. Adjustments were made for age, sex, and disease stage. RESULTS: For all 190 patients, optimism was associated with a higher QOL on both the mental and the physical component scales and 6 of 8 subscales of the SF-12 and SF-36. For patients with head and neck cancer, optimism was associated with higher QOL on 3 subscales but neither component scale. For patients with thyroid cancer, optimism was associated with higher QOL on both component scales and 6 subscales. After adjusting for age, sex, and disease stage, optimism was not associated with QOL in the head and neck cancer group. CONCLUSIONS: Optimism was associated with a higher QOL in survivors of thyroid cancer compared with survivors of head and neck cancer. After adjusting for age, sex, and disease stage, optimism was not associated with QOL for survivors of head and neck cancer. Optimism was more associated with the mental rather than physical QOL subscales.     

肿瘤血液透析患者的心理分析及护理

目的评价为肿瘤血液透析患者实施心理护理的效果。方法肿瘤血液透析患者38例实施自身对照,观察心理护理前后其心理状态的变化。结果经过心理护理,患者心态变得平稳,依从性增强,能更好地配合治疗。结论有针对性的心理护理能帮助患者以积极的心态面对困难,增强战胜疾病的信心,更好地配合治疗,并有助于血液透析治疗的顺利进行。     

Comparison of platelet immunity in patients with SLE and with ITP

Idiopathic thrombocytopenic purpura (ITP) is characterized by the development of a specific anti-platelet autoantibody immune response mediating the development of thrombocytopenia. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of a wide variety of autoantibodies. In 15-20% of SLE cases, patients develop thrombocytopenia which appears to be autoimmune in nature (SLE-TP). To better understand the pathogenesis of the thrombocytopenia associated with SLE, we investigated the overlapping platelet and cellular immune features between SLE and ITP. Thirty-one patients with SLE, eight with SLE-TP, and 17 with ITP, were studied and compared to 60 healthy controls. We evaluated platelet-associated IgG, platelet microparticles, reticulated platelets, platelet HLA-DR expression, in vivo cytokine levels, lymphocyte proliferation, and the T lymphocyte anti-platelet immune response in these patients. Patients with SLE-TP and those with ITP had increased platelet-associated IgG, an increased percentage of platelet microparticles, a higher percentage of reticulated platelets and larger platelets, suggesting antibody-mediated platelet destruction and increased platelet production. More than 50% of patients with ITP had increased HLA-DR on their platelet surface whereas subjects with SLE-TP did not. Analysis of serum cytokines demonstrated increased levels of IL-10, IL-15 and TNF-alpha in patients with SLE, but in those with ITP, only increased levels of IL-15 were seen, no increases in any of these cytokines were observed in patients with in SLE-TP. The ability of lymphocytes to proliferate in response to phorbol myristate acetate (PMA) stimulation was increased in SLE-TP, but was normal in both SLE and ITP. Lymphocytes from subjects with ITP displayed an increased ability to proliferate on exposure to platelets, in contrast, those with SLE-TP did not. While the number of subjects evaluated with SLE-TP was small, these data reveal a number of differences in the immunopathogenesis between SLE-TP and ITP.     

An electroencephalographic comparison of alfentanil with other narcotics and with thiopental

Using aperiodic analysis, we compared the EEC produced by alfentanil with the EEGs produced by two other opiates—fentanyl and sufentanil—on the one hand and with the EEG produced by a barbiturate—thiopental—on the other hand. Alfentanil and thiopental were injected over 1 minute: fentanyl and sufentanil were injected over 10 to 15 minutes. From the aperiodic analysis we derived up to seven single-number variables computed over 30- or 60-second epochs. All the opiates induced EEGs that were qualitatively similar to each other, although the maximum or minimum values tended to be greater and the time course more rapid with alfentanil than with the other two opiates. This finding may have been related to the fact that we injected relatively more alfentanil and administered it more rapidly. The EEGs produced by alfentanil and thiopental differed markedly, both qualitatively and quantitatively. The total power at 1 Hz and cumulative power at 3 Hz went to higher peak values with alfentanil, the latter tending to decrease with thiopental. The total number ot waves per epoch went to lower peak values with alfentanil; there was little change with thiopental. The frequency below which 90% ot the power resides went to considerably lower peak values with alfentanil than with thiopental. Finally, total power at 10 to 12 Hz (alpha waves; and average power at 17 to 19 Hz (beta waves) went to very high peak values with thiopental, but decreased with alfentanil. In spite ot differences in the opiate studies in the timing ot injection and the relative amount ot drug injected, the variables that proved useful in their response to fentanyl and sutentanil also proved useful with altentanil. In contrast, almost all variables showed a difference in response between alfentanil and thiopental. Supported in part by Janssen Pharmaceutics, Inc. Pisacataway, NJ, and by Diatek Corporation, and the Veterans Administration Medical Center, San Diego, CA.