咳喘涂膜剂治疗急慢性支气管炎50例临床观察

目的:临床观察咳喘涂膜剂对治疗急慢性支气管炎的疗效。方法:将诊断符合《临床疾病诊断依据治愈好转标准》的急慢性支气管炎患者以不透光信封方式随机分为治疗组、中成药组和西药组进行对照观察。结果:治疗组总有效率98.00％,中成药组总有效率85.11％,西药组总有效率98.04％。治疗组与西药组比较痊愈率、显效率、总有效率差异无显著性(P>0.05)。治疗组与中成药组比较痊愈率、显效率、总有效率差异有显著性(P<0.01)。结论:该涂膜剂治疗急、慢性支气管炎均有较好的疗效,与常用中成药相比,疗效明显,尤其对痰量多者效果更佳;与常用西医治疗经统计学处理具有相同的效果,副作用少明显优于西药组,且使用方便。     

Paired inspiratory–expiratory thin-section CT findings in patients with small airway disease

The objective of this study was to evaluate minimal small airway disease (SAD) as reflected on paired inspiratory–expiratory CT findings. Seventy-two subjects, 34 with SAD, 11 with normal lung function, and 27 with chronic obstructive pulmonary diseases (COPD), underwent thin-section CT during deep inspiration and expiration at upper, middle, and lower lung levels. Evaluation of CT measurement was performed between inspiratory and expiratory CT attenuation of lung parenchyma, in non-dependent and dependent lung at each of the three levels. Visual assessment of mosaic patterns and attenuation differences was also performed using the inspiratory and expiratory images. Patients with SAD were differentiated from those with COPD, by visual assessment and from the CT measurements. Visual assessment failed to differentiate between the SAD and normal groups. However, one measurement, an inspiratory–expiratory attenuation difference in the dependent lower lung, was different between SAD and normal group. Early small airway disease may be indicated by an inspiratory–expiratory attenuation difference in the dependent lower lung using the simple method of a paired inspiratory–expiratory CT. Received: 10 April 2000 Revised: 7 June 2000 Accepted: 8 June 2000     

麻杏射干汤治疗哮喘性支气管炎疗效观察

目的:探讨中药治疗哮喘性支气管炎的有效性。方法:我院儿科住院患儿40例,随机分为治疗组与对照组各20例。治疗组用自拟麻杏射干汤治疗哮喘性支气管炎,对照组使用常规方法,比较两组结果。结果:治疗组显效3例(15%),有效15例(75%),无效2例(10%),总有效率为90%;对照组显效8例(40%);有效6例(30%),无效6例(30%),总有效率为70%。平均用药时间治疗组2~7 d,平均3.2 d;对照组2~9 d,平均4.1 d,治疗组有2例患者出院后再次哮喘复发(1月内),对照组6例。结论:麻杏射干汤治疗哮喘性支气管炎与单纯西药比较具有治疗费用低、毒副反应少、用药时间短、给药方法简便、复发率低。值得推广。     

澳特斯治疗急性支气管炎咳嗽的效果评价

目的探讨澳特斯治疗急性支气管炎咳嗽的效果。方法选择确诊的400例急性支气管炎，随机分成治疗组和对照组。两组均在控制感染的基础上，治疗组口服澳特斯，对照组口服急支糖浆，均不用其它镇咳化痰药物及糖皮质激素，疗程5d。观察两组治疗前、治疗后3d及5d咳嗽频度、咳嗽强度、咳痰量、咳痰难易程度评分及综合评分变化。结果两组治疗后咳嗽频度、咳嗽强度、咳痰量、咳痰难易程度均较治疗前明显减轻（P〈0．01）；治疗后3d两组咳嗽频度、咳嗽强度、咳嗽量、咳痰难易程度的有效率比较差异有非常显著性意义（P〈0．01）；疗后5d，两组咳嗽强度有效率比较差异有非常显著性意义（P〈0．01），咳嗽频度、咳痰难易程度有效率比较差异有显著性意义（P〈0．05），咳痰量有效率比较差异无显著性意义（P〉0．05）；两组咳嗽、咳痰持续时间比较差异有非常显著性意义（P〈0．01）；两组综合疗效中临床控制率、总有效率比较差异有显著性意义（P〈0．05）。结论澳特斯治疗急性支气管炎咳嗽疗效显著、依从性好、安全度高。     

Modell-Vorsorgeuntersuchung in zwei Betrieben

Zusammenfassung Ziel der Untersuchung war die Fahndung nach Koronarerkrankungen, chronischer Bronchitis, Diabetes mellitus, Hypertonie, peripheren Durchblutungsstörungen und Übergewicht in zwei Betrieben bei über 40jährigen arbeitsfähigen Personen. Typische Labortests, standardisierte kurze ärztliche Untersuchung und ein Fragebogen wurden eingesetzt. In einer 10%-Stichprobe wurde der Fragebogen durch ein Kontrollinterview wiederholt und die Hälfte des Serums per Post an das Labor gesandt neben dem Transport in gekühltem Behälter im Auto. Nach der Beschreibung der Durchführung der Untersuchungen und der klinisch-chemischen Verfahren wird eine Ergebnisübersicht gegeben.Insgesamt 2429 Probanden wurden untersucht, der Untersuchungsablauf in den Betrieben war gut organisiert, es entstanden keine Warteschlangen. Die Laborergebnisse werden nach Geschlecht, Alter und Ort mitgeteilt und ihre Zusammenhänge dargestellt. In knapp 70% der Männer und in etwas über 60% der Frauen wurde der Hausarzt benachrichtigt wegen mindestens einem verdächtigen Befund. Im einzelnen fand sich eine pathologische Glycoseausscheidung im Urin bei 14,7% der Untersuchten, eine Konzentrationserhöhung der Glucose (über 113 mg-%) bei 5,7% der Triglyceride (über 181 mg-%) bei 12,6%, des Cholesterins (über 264 mg-%) bei 15,4%, der Harnsäure ( über 7,7 mg-%, über 7,1 mg-%) bei 6,8%, des Kreatinins (über 1,3 mg-%) bei 6,4% und eine positive Sulfosalizylsäureprobe im Urin bei 2,2% der Untersuchten.     

慢性支气管炎患者慢性阻塞性肺疾病发病影响因素的研究

目的 研究慢性支气管炎患者慢性阻塞性肺疾病（COPD）发病的影响。方法 1992年对≥15岁的67251名农民普查发现1999例未发生COPD的慢性支气管炎患者,收集吸烟、COPD家族史、炉灶情况、粉尘接触、肺功能等基线资料。整群随机分为干预区和对照组,对干预区实施戒烟宣传等干预措施。2000年采用分层随机抽样方法抽取1114例进行复查。结果 应答且资料完整者869例（占1114例的78．0％）。吸烟、基线COPD家族史阳性使第1秒用力呼气量（FEV1）和／或第1秒用力呼气量百分比（FEV1／FVC）随年龄下降速度加快,戒烟者与不吸烟者下降速度无显著差异。COPD8年累积发病与基线年龄、吸烟、COPD家族史阳性呈独立的正相关,而与基线FEV1和FEV1／FVC呈独立的负相关,戒烟与不吸烟者发病危险差异无显著意义。结论 衰老、吸烟、COPD家族史、肺功能低下且慢性支气管炎患者COPD发病独立的危险因素,特别不是独立的危险因素,戒烟可使吸烟者发病危险降低至近似于不吸烟者的水平。     

阿奇霉素与左氧氟沙星门诊治疗慢性支气管炎急性发作的对照研究

目的比较口服阿奇霉素与左氧氟沙星门诊治疗慢性支气管炎轻-中度急性发作的疗效和安全性。方法采用随机、开放、对照方法分为两组,共入选慢性支气管炎轻-中度急性发作门诊就诊者65例,阿奇霉素组32例(实际完成治疗30例),口服阿奇霉素500mg,1次/d,连续5d;左氧氟沙星组33例(实际完成治疗32例),口服左氧氟沙星500mg,1次/d,连续7d。结果治疗后第10天、第24天两组疗效比较差异无统计学意义(P>0.05)。两组临床症状改善所需时间、平均症状严重程度评分比较差异均无统计学意义(P>0.05)。两组细菌清除率、非典型病原体感染率间差异均无统计学意义(P>0.05)。两组不良反应发生率均较低,且差异无统计学意义(P>0.05)。结论口服阿奇霉素5d与口服左氧氟沙星7d门诊治疗慢性支气管炎轻-中度急性加重均有效且安全。     

The nature and causes of chronic obstructive pulmonary disease: A historical perspective: The Christie Lecture 2007, Chicago, USA

Chronic obstructive pulmonary disease (COPD) is the currently favoured name for the diseases formerly known as emphysema and bronchitis. COPD has been recognized for more than 200 years. Its cardinal symptoms are cough, phlegm and dyspnea, and its pathology is characterized by enlarged airspaces and obstructed airways. In the 19th century, the diagnosis of COPD depended on its symptoms and signs of a hyperinflated chest, and reduced expiratory breath sounds. The airflow obstruction evident on spirometry was identified in that century, but did not enter into clinical practice. Bronchitis, and the mechanical forces required to overcome its obstruction, was believed to be responsible for emphysema, although the inflammation present was recognized. The causes of bronchitis, and hence emphysema, included atmospheric and domestic air pollution, as well as dusty occupations. Cigarette smoking only became recognized as the dominant cause in the 20th century. The lessons learned of the risks for COPD in 19th-century Britain are very pertinent to the world today.     

Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing

ObjectivesThis study aimed to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts the benefit of antibiotics.MethodsChildren between 6 months and 12 years presenting to UK general practices with an acute LRTI were randomized to receive amoxicillin 50 mg/kg/d for 7 days or placebo. Children not randomized (ineligible or clinician/parental choice) could participate in a parallel observational study. The primary outcome was the duration of symptoms rated moderately bad or worse. Throat swabs were taken and analyzed for the presence of bacteria and viruses by multiplex PCR.ResultsSwab results were available for most participants in the trial (306 of 432; 71%) and in the observational (182 of 326; 59%) studies. Bacterial pathogens potentially sensitive to amoxicillin (Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae) were detected among 51% of the trial placebo group and 49% of the trial antibiotic group. The median difference in the duration of symptoms rated moderately bad or worse between antibiotic and placebo was similar when potentially antibiotic-susceptible bacteria were present (median: –1 day; 99% CI, –12.3 to 10.3) or not present (median: –1 day; 99% CI, –4.5 to 2.5). Furthermore, bacterial genome copy number did not predict benefit. There were similar findings for all secondary outcomes and when including the data from the observational study.DiscussionThere was no clear evidence that antibiotics improved clinical outcomes conditional on the presence or concentration of bacteria or viruses in the upper airway. Before deploying microbiologic point-of-care tests for children with uncomplicated LRTI in primary care, rigorous validating trials are needed.