慢性阻塞性肺疾病伴肺动脉高压对运动中气体交换的影响

目的:通过比较中重度慢性阻塞性肺疾病相关肺动脉高压(COPD-PH),与慢性阻塞性肺疾病无肺动脉高压(COPD-non PH),在运动中气体交换及运动耐量的差异,旨在为COPD-PH临床诊断、鉴别诊断、评估提供一定参考价值。方法:对54例处于稳定期的中重度慢性阻塞性肺疾病(COPD)患者依据肺动脉收缩压(PASP)分为两组,比较两组间血气分析、常规肺功能(PFT)、心肺运动试验(CPET)。结果:血气分析:COPD-PH的动脉氧分压(Pa O2)明显低于COPD-non PH(P0.01)。PFT:COPD-PH的第一秒用力呼气量(FEV1)、第一秒用力呼气量占预计值的百分比(FEV1%pred)及一氧化碳弥散量(DLco)均低于COPD-non PH(P0.05)。CPET:COPD-PH的峰值功率(Peak Load)、峰值摄氧量(Peak VO2)、峰值公斤摄氧量(Peak VO2/kg)、峰值分钟通气量(Peak VE)、Peak VE%pred及峰值氧脉搏(Peak O2pulse)均明显低于COPD-non PH(P0.01)。COPD-PH的峰值摄氧量占预计值的百分比(Peak VO2%pred)低于COPD-non PH(P0.05)。Pearson相关分析:PASP与DLco、Pa O2、Peak Load、Peak VO2及Peak O2pulse均呈负相关(P0.01)。结论:COPD-PH会导致患者肺换气功能明显受损、运动耐力明显下降,其降低程度与PASP存在相关性。对COPD行CPET,有助于早期发现COPD-PH。     

固本养肺活血方对老年慢阻肺稳定期患者的临床疗效

目的探讨固本养肺活血方对老年慢阻肺(COPD)稳定期患者的治疗效果。方法选取该院2011年11月至2013年11月诊治的老年COPD稳定期患者114例,根据治疗方案分为两组,常规治疗患者57例为对照组,常规治疗加用固本养肺活血方治疗患者57例为观察组,比较两组患者治疗前后相关指标的改变情况和综合临床疗效。结果治疗后,两组患者临床症状评分、肺动脉压均显著降低,6 min步行距离显著增加。观察组患者临床症状评分、肺动脉压均明显低于对照组,观察组患者6 min步行距离明显大于对照组,观察组患者总有效率明显高于对照组(均P<0.05)。结论固本养肺活血方可明显改善老年COPD稳定期患者的临床病症和心肺功能,治疗效果显著,值得临床推广使用。     

慢性阻塞性肺疾病合并肺动脉高压发病机制研究进展

慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)是可以预防和治疗的常见呼吸系统疾病,其主要特征是持续呼吸道症状和气流受限。肺动脉高压(pulmonary hypertension,PH)指各种原因引起的肺动脉压力升高,是COPD的最常见的并发症之一。近年来,随着研究的进展,专家学者们对慢阻肺合并肺动脉高压(COPD-PH)发病机制研究进展有了新的认识,COPD-PH发病机制较为复杂,本文将从内皮细胞功能障碍及交感神经过度兴奋两个方面进行阐述。     

血清生长分化因子-15水平与慢性阻塞性肺疾病患者肺动脉压力的关系

目的:探讨慢性阻塞性肺疾病(COPD)患者血清生长分化因子-15(GDF-15)水平与肺动脉压力的关系。方法:选择本院收治COPD急性加重期患者44例(急性加重期组)和COPD稳定期患者51例(稳定期组)。另选取同期在本院健康部经体检健康者50例(对照组)。采取酶联免疫吸附试验(Elisa)检测三组血清中生长分化因子-15(GDF-15)和脑钠肽(BNP)水平。使用心脏彩超间接估测两组患者肺动脉收缩压。Pearson相关性分析COPD患者血清中GDF-15与肺动脉压和BNP水平的相关性。结果:与对照组比较,稳定期组和急性加重期组患者血清中GDF-15和BNP水平显著增加(P0.01)。与稳定期组比较,急性加重期组患者血清中GDF-15和BNP水平提高更明显(P0.01)。与无肺动脉高压组比较,肺动脉压组患者血清中GDF-15和BNP水平明显升高(P0.01);肺动脉中度患者血清中GDF-15和BNP水平明显高于轻度组(P0.01);肺动脉重度患者血清中GDF-15和BNP水平明显高于轻度和中度患者(P0.01)。Pearson相关性分析显示:COPD患者血清GDF-15水平与肺动脉压和BNP水平均呈正相关(P0.01)。结论:COPD肺动脉压患者血清中GDF-15水平明显升高,且肺动脉压和BNP呈正相关。     

血清超敏C反应蛋白和前白蛋白在老年COPD患者中的变化

目的探讨血清超敏C反应蛋白(hs-CRP)、前清蛋白(PA)水平在老年慢性阻塞性肺疾病(COPD)患者、老年慢性阻塞性肺疾病急性发作期(AECOPD)患者中的变化及与预后的关系。方法分别检测健康老年组(年龄≥60岁)、老年COPD稳定期组、老年AECOPD死亡组、老年AECOPD存活组患者血清hs-CRP、PA水平的变化,将检测结果进行组间对照研究。结果老年AECOPD组、老年COPD稳定期组hs-CRP均明显高于老年健康组(P0.05);老年AECOPD组hs-CRP明显高于老年COPD稳定期组(P0.05);老年AECOPD死亡组hs-CRP明显高于老年AECOPD存活组(P0.05)。而PA水平与hs-CRP呈负相关,在各组间比较也均具有统计学差异。结论 hs-CRP及PA可能参与老年COPD的发病过程,并在AECOPD发生、发展中起重要作用,hs-CRP、PA可作为评估AECOPD病情及预后的指标。     

贝前列素钠治疗老年稳定期COPD合并肺动脉高压的疗效观察

目的探讨贝前列素钠治疗老年稳定期慢性阻塞性肺疾病（COPD）合并肺动脉高压的疗效。方法选择稳定期COPD合并肺动脉高压患者38例,随机分成治疗组和对照组,两组患者均按COPD常规治疗,治疗组加用贝前列素钠20μg,每日3次,口服8周。治疗前后行心脏彩超检测肺动脉收缩压,并取当日空腹静脉血采用电化学发光法检测血浆N-端脑钠肽前体（NT-pro BNP）的含量。结果治疗组治疗后肺动脉压及血清NT-pro BNP含量较治疗前均明显减低（P〈0.05）。对照组治疗前后两指标差异无统计学意义（P＞0.05）。治疗组治疗后肺动脉压及血清NT-pro BNP含量亦较对照组明显减低（P〈0.05）。结论贝前列素钠治疗老年稳定期COPD合并肺动脉高压,可降低患者血浆NT-pro BNP的水平,降低肺动脉收缩压。     

稳定期慢性阻塞性肺疾病合并重度肺动脉高压的临床研究

目的探讨稳定期慢性阻塞性肺疾病(COPD)合并重度肺动脉高压的临床特征及意义。方法985例COPD患者,排除其它影响肺血流动力学的因素,脉冲多普勒肺动脉血流频谱分析法测定肺动脉平均压,依据肺动脉压水平将患者分为肺动脉压正常组、轻中度升高组和重度升高组,比较3组患者Borg呼吸困难评分、肺功能检查及动脉血气分析参数。结果稳定期COPD患者重度肺动脉高压的发生率为6.39%(63/985),多为中重度患者;与肺动脉压正常及轻中度升高组患者相比,重度肺动脉高压组患者Borg呼吸困难评分较高,肺泡动脉氧分压差{A-aDO2}增大,第一秒用力呼气容积占预计值的百分比(FEV1%)、一氧化碳弥散量(DLCO)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)较低(P<0.05)。结论少数稳定期COPD患者合并重度肺动脉高压,这些患者血管疾病表现突出,需要运用血管扩张剂进行治疗。     

慢性阻塞性肺病患者左心室心肌做功指数

目的 组织多普勒成像测量心肌做功指数(MPI)评价慢性阻塞性肺病(COPD)患者左心室功能.方法 入选46例稳定期COPD及22例年龄性别匹配的健康者,根据肺动脉收缩压将COPD患者分为肺动脉高压组,肺动脉压力正常组,均完成经胸超声心动图检查,并用组织多普勒成像技术测量左室MPI.结果 COPD肺动脉高压组的左室MPI明显高于COPD肺动脉压力正常组和正常对照组(P<0.01),COPD肺动脉压力正常组左室MPI轻度高于正常对照组(P<0.05),左室MPI与肺动脉收缩压呈正相关(r=0.59,P<0.01).结论 左室射血分数正常的COPD患者存在左心室收缩和舒张功能障碍,尤其是伴有肺动脉高压的患者,MPI是一种较好反映COPD患者左心室功能障碍的指标.     

血浆巨噬细胞刺激蛋白表达在AECOPD的临床研究

目的研究患者血浆巨噬细胞刺激蛋白(macrophage stimulating protein,MSP)表达在AECOPD的临床研究。方法随机选择我院收治的60例急性加重期COPD(AECOPD)患者,60例稳定期COPD患者,并选择年龄、性别配对的60例正常体检人员设为对照组。检测三组受试者血浆MSP水平以及白介素6(in-terleukin-6,IL-6)、IL-8等炎性因子水平,并进行MSP水平与血清炎性因子水平及肺动脉压的相关性分析。结果 AECOPD组血浆MSP水平显著高于稳定期COPD组与对照组,稳定期COPD组显著高于对照组,(P 0. 05); AECOPD组血清IL-6、IL-8、肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)水平显著高于稳定期COPD组与对照组,稳定期COPD组显著高于对照组,(P 0. 05);血浆MSP表达水平与血清IL-6、IL-8、TNF-α水平、平均肺动脉压(mm Hg)呈显著正相关(P 0. 05)。结论 MSP与COPD有关,与急性加重有关,可能与MPS通过调控巨噬细胞参与COPD气道炎症反应有关,其表达水平变化有助于COPD诊断与治疗指导。     

老年慢性阻塞性肺疾病血清白细胞介素-13的变化

目的　探讨白细胞介素 13 (IL 13 )与慢性阻塞性肺疾病 (COPD )的关系。方法　用双抗夹心ABC ELISA法测定 3 5例老年COPD患者 (急性加重期 2 0例 ,稳定期 15例 )血清IL 13水平 ,并与 2 2名健康者 (对照组 )进行比较。结果　老年COPD急性加重期组 ,COPD稳定期组和对照组血清IL 13水平分别为 (4 7.2 6± 3 .47) pg/ml、(3 6.11± 5 .3 4)pg/ml和 (3 0 .99± 2 .19) pg/ml。COPD急性加重期组和COPD稳定期组血清IL 13水平均显著高于对照组 (P <0 .0 5 ) ,且COPD急性加重期组血清IL 13水平显著高于COPD稳定期组 (P <0 .0 5 )。结论　老年COPD患者血清中IL 13水平显著升高 ,IL 13与COPD的发生发展有关     

Nonneoplastic diseases of aorta and pulmonary trunk—Part V

This five-part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the pulmonary trunk and the right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part V of this five-part series on diseases of the aorta and the pulmonary trunk focuses on nonneoplastic diseases of the pulmonary trunk and the right and left main pulmonary arteries.     

肺癌患者肺叶切除术后肺功能的变化

目的观察肺癌患者行单侧肺叶切除术的术前、术后肺功能及血气指标变化。方法测定63例行单侧肺叶切除术的肺癌患者术前、术后3个月的肺功能及血气指标。结果术后早期肺功能各项指标均有下降（P〈0．05）。术后3个月FEV1及DLCO较术前有所改善,与术前相比,P〈0．05。结论单侧肺叶切除术对肺癌患者肺功能无显著影响,其气道阻塞程度及弥散功能术后有所改善。     

Chronic solitary pulmonary nodule due to unsuspected pulmonary infarction from silent pulmonary embolism

Abstract A case of pulmonary embolism showing a longstanding solitary pulmonary nodule is presented. An asymptomatic 57 year-old man with a solitary nodule in the right lower lobe was referred to our hospital. A pulmonary perfusion-ventilation scan following a sudden onset of dyspnoea established the diagnosis of recurrent pulmonary embolism. The nodule gradually disappeared after anticoagulant treatment, indicating that the nodule was pulmonary infarction from silent pulmonary embolism. Although the incidence of pulmonary infarction is low in Japan, this case suggests that pulmonary infarction from silent pulmonary embolism should be considered as one important cause of a solitary pulmonary nodule.     

The pulmonary circulation and its systemic arterial supply in pulmonary atresia

The pulmonary circulation and its systemic arterial supply in cases of pulmonary atresia were studied angiocardiographically. In 69% of the cases the pulmonary arteries were hypoplastic and supplied by a patent ductus arteriosus or a few large systemic arteries. A classification into four groups is suggested, and a developmental paradox represented by this classification is discussed.     

Treatment options and strategies for acute severe pulmonary embolism

Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk-stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.     

Floating pulmonary embolus: unusual cause of recurrent syncope

A 69-year old woman was admitted because of recurrent syncopalepisodes. In hospital, she had repeated attacks of near faintingor syncope when she was turned into the left decubitus position.Continuous arterial pressure monitoring revealed that severehypotension initiated these events. Secondarily, the heart ratedropped markedly. The symptoms quickly reversed when the patientwas turned back into the supine or right decubitus position.Angiography revealed a large, riding and partly floating pulmonaryembolus that obstructed the pulmonary circulation to a variabledegree, apparently influenced by the patient's body position.During subsequent emergency surgery the angiographic findingswere confirmed. It appears that the severe hypotensive episodeswere caused by intermittent high degree obstruction of the pulmonarycirculation by the floating pulmonary embolus, a mechanism that,to our knowledge, has not previously been described as a causeof recurrent syncope.