圣乔治呼吸问卷与慢性阻塞性肺疾病稳定期患者客观指标的相关性研究

目的:研究圣乔治呼吸问卷(St George's respiratory questionnaire,SGRQ)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者客观指标的相关性。方法:对44例COPD稳定期患者进行SGRQ评分,并测定体质量指数(BMI)、一秒用力呼气容积/预计值(FEV1/pre%)、功能性呼吸困难分级(MMRC)、6分钟步行距离(6MWD)、BODE指数。结果:SGRQ总分及其3个组成部分(即呼吸症状、活动受限、疾病影响评分)均与FEV1%pre、MMRC、6MWD、BODE指数等客观指标显著相关,而与BMI无相关性。结论:SGRQ与COPD稳定期患者的FEV1%pre、MMRC、6MWD、BODE指数等客观指标显著相关。     

肺康复护理对慢性阻塞性肺疾病稳定期病人BODE指数的影响

[目的]探讨肺康复护理对慢性阻塞性肺疾病(COPD)稳定期病人BODE指数的影响.[方法]对64例COPD稳定期病人实施肺康复护理,比较康复护理前后病人BODE指数变化.[结果]64例病人经肺康复护理后,BODE指数的第1秒用力呼吸容积占预测值百分比(FEV1%)、6 min步行距离(6MWD)及呼吸困难量表(MMRC)的评分以及BODE指数总积分较康复护理前均明显降低(P＜0.05),而体重指数(BMI)康复护理前后均无明显变化(P＞0.05).[结论]BODE指数是反映肺康复效果的有效指标,肺康复护理可有效地改善COPD稳定期病人的BODE指数.     

肺康复护理对慢性阻塞性肺疾病稳定期病人BODE指数的影响

[目的]探讨肺康复护理对慢性阻塞性肺疾病（COPD）稳定期病人BODE指数的影响。[方法]对64例COPD稳定期病人实施肺康复护理,比较康复护理前后病人BODE指数变化。[结果364例病人经肺康复护理后,BODE指数的第1秒用力呼吸容积占预测值百分比（FEV1％）、6min步行距离（6MWD）及呼吸困难量表（MMRC）的评分以及BODE指数总积分较康复护理前均明显降低（P〈0．05）,而体重指数（BMI）康复护理前后均无明显变化（P〉0．05）。[结论]BODE指数是反映肺康复效果的有效指标,肺康复护理可有效地改善COPD稳定期病人的BODE指数。     

综合性肺康复对中重度稳定期慢性阻塞性肺疾病患者的影响

目的探讨综合性肺康复对中重度稳定期慢性阻塞性肺疾病患者的影响。方法选取2015年6月—2017年6月在本院治疗的58例中重度稳定期慢性阻塞性肺疾病患者为研究对象,采用随机数字表法将其分为对照组和观察组,每组各29例。对照组患者给予常规药物治疗;观察组患者在常规药物治疗的基础上联合综合性肺康复治疗。随访6个月,测定综合性肺康复治疗前后患者的BODE指数、自我效能、自我管理能力及血气分析结果。结果两组患者治疗前BODE指数比较,差异无统计学意义(P0.05);治疗后,观察组患者BMI、FEV1%Pred、MMRC、6MWT及BODE总分均优于对照组,差异有统计学意义(P0.05);两组患者治疗后症状管理、疾病共性管理、总分均比治疗前有所提高,且观察组高于对照组(P0.05);两组患者治疗后自我管理5个维度的得分较治疗前都有所提高,且观察组高于对照组(P0.05);两组患者治疗后的PaO_2均高于治疗前,且观察组高于对照组(P0.05),PaCO_2均低于治疗前,且观察组低于对照组(P0.05)。结论综合性肺康复可以提高中重度稳定期慢性阻塞性肺疾病患者的自我管理能力、自我效能水平,改善肺功能,减轻呼吸困难症状,增强活动耐力。     

连续护理对慢性阻塞性肺疾病病人BODE指数的影响

[目的]探讨连续护理干预对慢性阻塞性肺疾病(COPD)病人多因素分级系统(BODE)指数的影响。[方法]采用便利取样法,将2011年10月1日—2012年10月30日住院的COPD急性发作期病人100例分为对照组和研究组各50例,对照组给予COPD常规护理,研究组采取连续护理干预,比较两组病人护理后BODE指数变化。[结果]干预后两组第1秒用力呼吸容积占预测值百分比(FEV1%)、6 min步行距离(6MWD)、呼吸困难量表(MMRC)评分、体重指数(BMI)和BODE指数评分比较差异均有统计学意义(P0.05)。研究组BODE指数总积分均优于对照组,研究组出院前与出院后8周FEV1%比较差异无统计学意义。[结论]连续护理干预可有效降低COPD病人BODE指数,提高生活质量。     

慢性阻塞性肺疾病评估测试问卷对慢性阻塞性肺疾病稳定期患者生活质量的评估价值

目的：探究慢性阻塞性肺疾病评估测试问卷（chronic obstructive pulmonary disease assessment test,CAT）对慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）稳定期患者生活质量的评估价值.方法：对40例COPD稳定期患者进行CAT评分以及圣乔治呼吸问卷（St George＇s respiratory questionnaire,SGRQ）评分,并测定体质量指数（BMI）、第1秒用力呼气容积/预计值（percentage of forced expiratory volume in 1 second in predicated value,FEV1％ pred）、改良的英国医学研究委员会呼吸困难量表（modified Medical Research Council dyspnea scale,MMRC）评分、6 min步行距离（six-minute walk distance,6MWD）、BODE（B为体质量指数,O为气道阻塞程度,D为呼吸困难分数,E为运动耐力）指数,并对结果进行相关性分析.结果：CAT评分与FEV1％pred、6MWD呈显著负相关（r分别为-0.71和-0.85,P＜0.01）,与MMRC评分、BODE指数呈显著正相关（r分别为0.78和0.83,P＜0.01）,与SGRQ总分及3个组成部分即呼吸症状、活动受限、疾病影响评分均呈显著正相关（r为0.92～0.97,P＜0.01）,与BMI无相关性.结论：CAT问卷可作为评估COPD稳定期患者生活质量的有效手段.     

培脾理肺方对慢性阻塞性肺疾病稳定期患者BODE指数及焦虑、抑郁情绪的影响

目的:观察慢性阻塞性肺疾病(COPD)稳定期患者应用培脾理肺方前后BODE指数及焦虑、抑郁情绪的改变情况。方法:采用随机数字表将102例COPD稳定期患者分为2组,对照组51例给予福莫特罗吸入剂、噻托溴铵吸入剂联合吸入,观察组在对照组基础上加用培脾理肺方治疗,对比观察周期(6个月)前后2组患者BODE指数及焦虑、抑郁情绪的改变情况。结果:观察结束时,观察组BODE指数及其BMI、MMRC、FEV1%pred、6MWD各因子数值与对照组差异均有统计学意义(P0.01);观察结束后,观察组HADS分值(9.12±2.96)分及10分者比例33.33%均明显低于对照组的(13.87±3.18)分及80.39%,差异有统计学意义(P0.01)。结论:培脾理肺方可降低COPD稳定期患者BODE指数,改善焦虑、抑郁情绪,值得临床进一步研究推广。     

慢性阻塞性肺疾病患者BODE指数与疲乏症状的相关性分析

目的 探索稳定期COPD患者BODE指数与疲乏症状的相关性,为临床评估、预测、控制疲乏症状,制定有效的管理方案提供新途径.方法 对2011年12月至2013年1月120例稳定期COPD患者进行调查.采用英国医学研究委员会呼吸困难量表(mMRC)、6 min步行距离(6MWD)、体重指数(BMI)、肺功能及疲乏量表-14(FS-14)等方法,分析BODE指数与疲乏症状的相关性.结果 患者疲乏症状与BODE指数、mMRC成高度线性正相关;与6MWD成高度线性负相关;与FEV1％预计值、BMI成显著性负相关.结论 稳定期COPD患者疲乏发病率高,BODE指数及各因子与疲乏症状相关度高,是预测和评估COPD患者疲乏症状的一项客观指标.     

比索洛尔对冠心病合并慢性阻塞性肺疾病患者BODE指数的影响

目的评价比索洛尔对冠心病合并慢性阻塞性肺疾病（COPD）患者BODE指数的影响。方法42例冠心病合并稳定期轻、中度COPD患者，给予比索洛尔口服，起始剂量1．25mg／d，逐步增加至5mg／d。治疗开始前及治疗60d后，分别检测BODE指数（BODEindex）的四个相关参数，即第1秒用力呼气容积占预计值百分比（（FEVI％pred）、功能性呼吸困难量表评分（MMRC）、6min步行距离（6MWD）、体重指数（BMI），并计算BODE指数。结果治疗前后BODE指数及其四个相关参数分别为：FEV1％pred（68．05±7．32VS．67．38±7.13）；6MWD（322．834-65．72Vs．320．43±62．34）；MMRC（2．13±0．57VS．2．18±0．65）；BMI（20．58±3．52VS．20．26±3．07）；BODEindex（3．51±1．97vs．3．54±2．01）。（均为P〉0．05）。结论比索洛尔对冠心病合并稳定期轻、中度COPD患者的BODE指数无明显影响。     

慢性阻塞性肺疾病患者自我管理与生活质量相关性分析

目的:探讨慢性阻塞性肺疾病(COPD)患者自我管理和生活质量之间的关系.方法:采用描述性相关性研究,用COPD自我管理量表、COPD生活质量量表对 169例 COPD患者进行问卷调查.结果:COPD患者自我管理总分和生活质量总分分别为(154.75±16.15)分、(90.69±19.44)分,二者存在中度负相关(r=-0.663,P＜0.01);自我效能可以解释生活质量总变异的48.00%.结论:护理人员应积极开展COPD患者的自我管理健康教育,从而提高其自我效能、自我管理水平及生活质量.     

Endovascular treatment for chronic pulmonary hypertension: a focus on angioplasty for chronic thromboembolic pulmonary hypertension

Introduction: Percutaneous transluminal pulmonary angioplasty (PTPA) was introduced for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in the late 20^th century, and first attempts in collective patients were made in 2001 with beneficial effects but a moderate amount of complications. It was refined around 2010, and has been recently established as an effective and safe treatment.

Areas covered: The indication was originally inoperable CTEPH with peripheral lesions, but has now widened to symptomatic or hypoxic patients. The lesion is typically a meshwork-like structure of organized thrombi and is sometimes not seen as a stenosis angiographically, necessitating other means of investigation such as measurement of distal pressure. The technique to treat lesions is the same as for coronary angioplasty except in several ways.

Expert commentary: The effects of PTPA are comparable to those of surgical endarterectomy, and the complications of reperfusion pulmonary edema and vascular injury are now controlled by several strategies and based on experience.     

肺转移瘤的外科治疗

目的 :探讨肺转移性肿瘤外科治疗的手术指征、手术方式、手术疗效。方法 :对 36例肺转移性肿瘤的相关临床资料进行回顾性分析。结果 :对 36例肺转移性肿瘤行肺切除术 39次 ,随访 1年～ 15年 ,术后 1年、3年、5年、10年生存率分别为 77.8%、48.2 %、2 1.7%、7.7%。无手术死亡。结论 :对原发肿瘤已控制、肺转移瘤可以切除、无他处转移及肺功能可承受手术者作为手术指征     

Transthoracic Echocardiographic Evaluation of Pulmonary Valve Anomalies in Pediatric Patients

The pulmonary valve normally consists of 3 leaflets supported in a semilunar fashion within the sinuses of the pulmonary trunk. Pulmonary leaflet malformations, such as congenital single pulmonary cusp absence, bicuspid pulmonary valve, and quadricuspid pulmonary valve anomalies, as well as pulmonary valve commissural fusion, are seldom identified preoperatively on echocardiography. In this study, we report on 5 children with different types of pulmonary valve malformations diagnosed by transthoracic echocardiography.     

成人经皮球囊肺动脉瓣成形术的临床应用

目的：评价成人经皮球囊肺动脉瓣成形术（ＰＢＰＶ）临床应用的疗效。方法：采用 ＰＢＰＶ对 ３７例成人先天性肺动脉瓣狭窄患者进行治疗。结果：ＰＢＰＶ后即刻肺动脉瓣跨瓣压差（△Ｐ）由术前８１±２６ｍｍＨｇ降至３６±１７ｍｍＨｇ（Ｐ＜０．０１）,３２例随访１～９年,平均４．３±２．１年,△Ｐ进一步降为２５±７ｍｍＨｇ。术中及术后无严重并发症。结论：ＰＢＰＶ治疗成人肺动脉瓣狭窄安全、有效,即刻与中远期效果均良好。     

About mechanisms of prostaglandin E1 induced deterioration of pulmonary gas exchange in COPD patients

Summary. Prostaglandin E₁ (PGE₁) has been reported to attenuate COPD-related pulmonary hypertension and to slightly lower the arterial oxygen tension (PaO₂). In order to infer the involved mechanisms, the effects of intravenous infusion of PGE₁ on pulmonary haemodynamics, diffusing lung capacity for CO (DLCO), membrane diffusing capacity (Dm), pulmonary capillary blood volume (Vc), physiological shunt (Q_ps/Q_t), arterial blood gases and other lung functional indices were evaluated in 20 COPD patients with pulmonary hypertension and, excluding right catheterization, in 14 control subjects. The examines were studied at baseline and during infusion of 20–30 ng kg^-1min PGE₁ or placebo. In control subjects PGE₁ only caused systemic arterial pressure decrease (-17.8%). In COPD patients, as expected, PGE₁ increased cardiac index (16-2%), but decreased systemic arterial pressure (-21.2%), pulmonary arterial pressure (-27.9%), pulmonary vascular resistance (-45.4%) and PaO₂ (-10.4%), worsening their hypoxaemia. However, the effect of PGE₁ on DLCO was an increase (11.9%), due to an increase in Vc (15.2%) and less markedly in Dm (4.9%). Physiological and anatomical shunts were increased with PGE₁ (20.2% and 14.8%) and the overall ventilation/perfusion ratio decreased from 0.89 to 0.79. Decrements in PaO₂ correlated with increments in Q_ps/Q_t (r= 0.86). In conclusion, in COPD patients studied, PGE₁ increased DLCO, which compensated for the deleterious effect of increased cardiac output on alveolar-capillary gas equilibration. Therefore, worsening of hypoxaemia during PGE₁ infusion was related with increased right-to-left shunt and deterioration of ventilation-perfusion relationship.,     

Flash Pulmonary Edema in Multiple Sclerosis

Background

Neurogenic pulmonary edema (NPE) occurs in the setting of an acute neurological insult and in the absence of a primary cardiopulmonary cause. No unifying theory on NPE pathogenesis exists. NPE triggered by a discrete neurological lesion is rare, but such cases offer valuable insight into NPE pathogenesis.

Objective

To describe an unusual and instructive case of NPE in multiple sclerosis.

Case Report

A young woman with multiple sclerosis presented to the Emergency Department in acute respiratory failure. She was cyanotic centrally, hypertensive, and tachycardic. The chest X-ray study suggested pulmonary edema. She required non-invasive mechanical ventilation for 12 h. Echocardiography revealed left ventricular hypokinesis. The asymmetrical pulmonary infiltrate raised the suspicion of pneumonia; she was given intravenous antibiotics. By 36 h, she had persistent dyspnea, paroxysmal tachycardia, nausea, and facial flushing; carcinoid syndrome was excluded. By 48 h, she had facial numbness and ataxia. Magnetic resonance imaging (MRI) revealed a demyelinating lesion at the rostromedial medulla. Her symptoms promptly resolved with intravenous steroids, as did the perilesional edema on follow-up MRI.

Conclusion

Life-threatening pulmonary edema can complicate medullary demyelination. Lack of awareness of this diagnostic possibility and an asymmetrical pulmonary infiltrate culminated in diagnostic delay in this case. The case provides clinico-radiological evidence of the pathogenic link between medullary lesions and NPE. The pathogenesis is likely to rely on lesion involvement of the nucleus tractus solitarius or its immediate pathways. Non-uniform vasoconstriction of the pulmonary arterial bed might account for the other peculiarity of this case: the asymmetrical pulmonary infiltrate. Timely diagnosis of NPE is essential because the condition is best managed by nullifying the “neurogenic” trigger.     

造血干细胞移植后侵袭性肺曲霉病患者12例的肺功能改变

目的观察12例造血干细胞移植(HSCT)后并发侵袭性肺曲霉病(IPA)对患者肺功能参数及动脉血气的影响。方法 2007年2月~2009年10月本院接受HSCT后并发IPA患者12例,男8例,女4例,中位年龄34岁(26~67岁)。移植前后均行肺功能测试、动脉血气分析以及影像学检查。结果中位随访时间为132 d(97~432 d),无1例发生Ⅲ、Ⅳ度急性移植物抗宿主病(GVHD)。2例在移植1年后发生慢性GVHD。12例均为病理确诊或临床诊断IPA者,移植前肺功能测定仅有弥散功能轻度减退。抗真菌治疗8周后肺功能测试发现所有患者均存在不同程度的阻塞性通气障碍,其中8例患者呈小气道病变[FEF50和FEF75分别为(55.9±3.4)%和(41.9±4.1)%],4例患者则出现混合性通气障碍,总弥散量(DLCO)也显著降低[(47.4±2.9)%预计值],动脉血氧分压(PaO2)仅为(68.7±4.1)mmHg,但弥散常数(DLCO/VA)尚正常,与移植前无显著差异(P0.05)。结论 HSCT后并发IPA可对患者的肺功能造成不同程度的损害,肺内多部位感染或反复发生IPA的患者可出现较严重的混合性通气障碍,弥散也显著减退。     

Pathogenesis and clinical features of chronic pulmonary aspergillosis – Is it possible to distinguish CNPA and CCPA clinically?

BackgroundThe pathogenesis of chronic pulmonary aspergillosis (CPA) including chronic necrotizing pulmonary aspergillosis (CNPA), chronic cavitary pulmonary aspergillosis (CCPA), and simple aspergilloma (SA) has been poorly investigated. We examined all types of CPA cases with histopathological evidence to clarify the differences in pathogenesis and clinical features.MethodWe searched for cases diagnosed as pulmonary aspergillosis by histopathological examination in Nagasaki University Hospital between 1964 and September 2010. All available clinical information including radiological findings were collected and analyzed.ResultWe found 7, 5, 8, and 7 cases of proven CNPA, probable CNPA, CCPA, and SA, respectively. The radiograph of proven and probable CNPA was initially infiltrates or nodules that progress to form cavities with or without aspergilloma, whereas the radiograph of CCPA showed pre-existed cavities and peri-cavitary infiltrates with or without aspergilloma. The patients with proven and probable CNPA exhibited not only respiratory symptoms but also systemic symptoms and malnutrition. Aspergillus fumigatus was the most frequently isolated Aspergillus species (n = 14), however, Aspergillus niger was the predominant isolated species in proven CNPA cases (n = 4).ConclusionOur data indicate that the cases with chronic infiltration, progressive cavitation, and subsequent aspergilloma formation should be diagnosed as CNPA, and the cases with pre-existed cavities showing peri-cavitary infiltrates with or without aspergilloma would mean CCPA. However, it may be difficult to distinguish the two subtypes if a series of adequate radiography films are not available. We propose the term “chronic progressive pulmonary aspergillosis (CPPA)” for the clinical syndrome including both CNPA and CCPA.     

Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography

Summary.  Objective: To investigate whether fast grading of reflux of contrast to the inferior vena cava (IVC) on computerized tomographic pulmonary angiography (CTPA) is a potential biomarker for real-time risk stratification. Methods: We retrospectively identified 343 patients investigated for possible pulmonary embolism (PE) by CTPA at our medical center between September 2004 and March 2006. A total of 145 consecutive patients with PE (age 67 ± 19 years) and 168 consecutive ones with negative CTPAs (age 64 ± 20 years) fulfilled entry criteria. CTPAs were evaluated for retrograde reflux of contrast to the IVC by fast visual grading from 1 to 6 using the original axial images. Pulmonary obstruction index, the diameters of right and left ventricles and pulmonary artery, and patient survival data were recorded as well. Results: Twenty-nine (20.0%) patients with positive CTs and 23 (13.7%) patients with negative CTs had substantial degrees (≥4) of reflux of contrast to the IVC ( P  = 0.14). The Kaplan–Meier 30-day survival curves demonstrated significant reduction in survival in individuals with PE and grade ≥4 reflux of contrast to the IVC compared with lower grades ( P  = 0.008), but not in patients with grade ≥4 and no PE on CTPA ( P  = 0.26). The other cardiovascular parameters showed no significant correlation with survival in patients with and without PE. Conclusion: Substantial grades of reflux of contrast to the IVC during CTPA could predict early mortality in patients with acute PE. Rapid grading of reflux of contrast from the original axial CTPA images can be used for real-time risk stratification in patients with acute PE.