激素治疗对运动诱发性哮喘患者痰嗜酸性粒细胞计数的影响

目的探讨气道嗜酸性粒细胞性炎症和运动诱发的支气管痉挛（EIB）之间的关系,及其对吸入糖皮质激素（ICS）治疗的反应。方法本研究为随机、双盲、二阶段交叉试验,将26例有运动诱发性支气管痉挛发作史且从未接受过激素治疗的哮喘患者随机分为两组,每组分别给予两个剂量水平的布地奈德吸入：①100μg/d与400μg/d对比;②200μg/d与800μg/d对比。每一阶段为3周,洗脱期3～8周。治疗前及开始治疗后每隔1周进行1次运动激发试验并留取痰液标本行嗜酸性粒细胞计数。结果高剂量ICS治疗（400μg/d和800μg/d）可显著减少痰嗜酸性粒细胞比例。痰嗜酸性粒细胞百分比与运动诱发性支气管痉挛严重程度相关,且对EIB的严重程度有预测作用;高剂量ICS治疗时,尚可预测EIB对激素治疗有效,而对低剂量ICS组（100μg/d和200μg/d）则无预测作用。低剂量ICS治疗,不管基线痰嗜酸性粒细胞计数是否增多,EIB在第1周末发作显著减轻,尔后几无改善。而高剂量ICS治疗对EIB的改善作用在痰嗜酸性粒细胞增多的患者中显著优于嗜酸性粒细胞计数小于5%者,这种明显的差异在开始治疗1周后即显现,且随时间的推移而继续加大。结论气道嗜酸性粒细胞性炎症可能在EIB的发生及其对ICS治疗有效的调节机制中起重要的作用。测定痰嗜酸性粒细胞计数在预测EIB的严重程度及其对不同剂量ICS治疗的反应具有一定的临床应用价值。     

帕瑞昔布钠预防瑞芬太尼复合麻醉术后早期疼痛的临床应用

 目的探讨静注帕瑞昔布钠对瑞芬太尼复合麻醉术后早期疼痛和阿片类药物不良反应发生率的影响。方法选择年龄18~60 岁、ASAⅠ~Ⅱ级、拟在全身麻醉下行胃大部切除手术的患者100 例。随机分为静脉麻醉实验组（VA 组）、静脉麻醉对照组（VB 组）、吸入麻醉实验组（IA 组）和吸入麻醉对照组（IB 组）4 组。所有患者麻醉诱导均给予长托宁0.5 mg、咪达唑仑0.05mg·kg^-1、丙泊酚2 mg·kg^-1、罗库溴铵0.6 mg·kg^-1及瑞芬太尼2 ng·mL^-1靶控,术后均使用静脉患者自控止疼泵（PCA）。术中以丙泊酚4~8 mg·kg-1·min-1或七氟醚1鄄3MAC 维持麻醉。手术开始及结束前实验组分别给予帕瑞昔布钠40 mg 静注。术毕送麻醉后恢复室。记录患者苏醒拔管时间、术后1 h、2 h、4 h、6 h、12 h及24 h切口疼痛VAS 评分、PCA使用量及相关不良反应。结果IA 组与IB 组患者术后24 h各观察点VAS 评分均高于VA 组与VB 组,且术后1 h、2 h、4 h、6 h时差异有统计学意义（P <0.05）,12 h仅IB组差异有统计学意义（P < 0.05）;IA组与IB组患者术后24 h各观察点阿片类药物累积用量均高于VA组与VB 组,仅24 h时,IB组药物用量差异有统计学意义（P < 0.05）。VA 组与VB 组术后24 h内各观察点的VAS 评分和阿片类累积
用量差异无统计学意义。4 组患者清醒拔管时间和术后不良反应的发生率差异无统计学意义。结论手术结束前静注帕瑞昔布钠40 mg 可降低瑞芬太尼复合麻醉手术后早期手术切口痛觉过敏,且全凭静脉麻醉较吸入麻醉能够更好的预防瑞芬太尼诱发的痛觉过敏。     

麻醉药对[Ca2＋]i的多途径改变及相关生物学效应

Ca2＋是细胞内的第二信使．它参与细胞内很多生理活动过程．包括神经递质释放．肌肉收缩,腺体分泌．学习记忆及细胞凋亡等。麻醉药可以通过多种方式直接或间接改变[Ca2＋]i从而对生物体产生错综复杂的影响．这些影响有些与麻醉作用有关有些与麻醉作用无关。     

高频超声引导下硬膜外分娩镇痛的研究

目的评估高频超声引导下硬膜外穿刺分娩镇痛的可行性。方法选择80例拟行硬膜外穿刺的患者,为分娩的初产妇,妊娠足月,年龄20~35岁。随机分为对照组和观察组,每组各40例。对照组采用常规方法进行定位穿刺,观察组采用超声引导穿刺硬膜外麻醉。穿刺成功后,观察两组穿刺麻醉后镇痛效果、麻醉药物使用量等指标,并进行比较。结果 80例硬膜外穿刺患者均穿刺成功。观察组较对照组减少麻醉药用量;观察组麻醉有效率为97.5%,对照组为92.5%;观察组优于对照组,差异有统计学意义(P0.05)。结论经高频超声引导下硬膜外麻醉穿刺成功率高,减少麻醉药用量,安全性好,是有一定的临床应用价值的方法。     

Phenotype classification using the combination of lung sound analysis and fractional exhaled nitric oxide for evaluating asthma treatment

Background

We report the utility of combining lung sound analysis and fractional exhaled nitric oxide (FeNO) for phenotype classification of airway inflammation in patients with bronchial asthma.We investigated the usefulness of the combination of the expiration-to-inspiration sound power ratio in the mid-frequency range (E/I MF) of 200–400 Hz and FeNO for comprehensively classifying disease type and evaluating asthma treatment.

Prevalence,disease burden,and treatment reality of patients with severe,uncontrolled asthma in Japan

BackgroundThe severe asthma and severe, uncontrolled asthma (SUA) populations in Japan are not well-studied. We investigated the prevalence of continuously treated severe asthma and SUA patients, their disease burden, and the treatment reality via a Japanese health insurance claims database.MethodsContinuously treated asthma patients (patients prescribed inhaled corticosteroids for asthma ≥4 times in the past year) aged ≥17 years at the index date (latest visit between April 2014 and March 2015 for asthma treatment) were included in this analysis (KEIFU study, UMIN000027695). Asthma severity and control status at the index date were defined using modified criteria of ERS/ATS guidelines. Asthma hospitalization, oral corticosteroid (OCS) use, and total medical expenses were calculated using data up to 12 months post–index date.ResultsWe identified 10,579 patients as continuously treated asthma patients. Of these, 823 (7.8%) had severe asthma; 267 (2.5%) and 556 (5.3%) patients had SUA and severe, controlled asthma (SCA), respectively. Compared with SCA and mild to moderate asthma patients, a greater percentage of SUA patients required hospitalization (13.7%, 6.2%, and 3.0%, respectively) and were prescribed OCSs (67.4%, 45.9%, and 16.2%, respectively). Yearly total medical expenses were also greater for SUA patients (mean [standard deviation]: 8346 [12,280], vs 5989 [10,483] and 3422 [8800] USD, respectively).ConclusionsThe percentages of severe asthma and SUA patients continuously treated in Japan were obtained through this large-scale analysis using a health insurance claims database. SUA patients had greater medical and economic burdens, suggesting more appropriate treatment is required according to the treatment guidelines.