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目的：探讨羧甲司坦联合沙美特罗替卡松气雾剂治疗稳定期D组慢性阻塞性肺疾病（COPD）患者的临床疗效。方法选取2011年8月—2013年6月就诊于天津市第四中心医院处于稳定期D组COPD患者96例,随机分为治疗组（50例）和对照组（46例）。对照组在常规治疗基础上吸入沙美特罗替卡松气雾剂,1揿/次,2次/d。治疗组在对照组治疗的基础上口服羧甲司坦口服溶液10 mL/次,3次/d。两组均连续治疗48周。观察两组患者治疗前,治疗8、24、48周运动耐量、呼吸困难指数（mMRC）及肺功能的变化,同时观察两组患者治疗过程中急性加重次数。结果两组患者6 min 步行距离（6MWD）在治疗8、24、48周后均较治疗前显著增加,mMRC均较治疗前有所降低,治疗前后差异有统计学意义（P＜0.05）;治疗24、48周治疗组6MWD显著长于对照组,mMRC显著低于对照组,两组比较差异有统计学意义（P＜0.05）。两组患者在治疗24、48周第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEV1/pred%）均较治疗前有所增加,治疗前后差异有统计学意义（P＜0.05）;治疗24、48周治疗组患者FEV1、FEV1/pred%显著高于对照组,两组比较差异有统计学意义（P＜0.05）。结论羧甲司坦联合沙美特罗替卡松气雾剂治疗稳定期D组COPD患者具有较好的临床疗效,可增加患者的运动耐力,改善呼吸困难症状和肺功能,值得临床推广应用。 相似文献
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Atsushi Miyamoto Atsuko Kurosaki Shuhei Moriguchi Yui Takahashi Kazumasa Ogawa Kyoko Murase Shigeo Hanada Hironori Uruga Hisashi Takaya Nasa Morokawa Takeshi Fujii Junichi Hoshino Kazuma Kishi 《Respiratory investigation》2019,57(2):140-149
Background
This study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer.Methods
We retrospectively reviewed the medical chart data and high-resolution computed tomography (HRCT) findings for 81 consecutive patients with CPFE and 92 primary lung cancers (70 men, 11 women; mean age, 70.9 years). We selected 8 axial HRCT images per patient, and visually determined the normal lung, modified Goddard, and fibrosis scores. Multivariate analysis was performed using the Cox proportional hazards regression model.Results
The major clinical features were a high smoking index of 54.8 pack-years and idiopathic pulmonary fibrosis (n = 44). The major lung cancer profile was a peripherally located squamous cell carcinoma (n = 40) or adenocarcinoma (n = 31) adjacent to emphysema in the upper/middle lobe (n = 27) or fibrosis in the lower lobe (n = 26). The median total normal lung, modified Goddard, and fibrosis scores were 10, 8, and 8, respectively. TNM Classification of malignant tumors (TNM) stage I, II, III, and IV was noted in 37, 7, 26, and 22 patients, respectively. Acute exacerbation occurred in 20 patients. Multivariate analysis showed that a higher normal lung score and TNM stage were independent radiologic and clinical predictors of poor survival at the time of diagnosis of lung cancer.Conclusions
A markedly reduced area of normal lung on HRCT was a relevant radiologic predictor of survival. 相似文献4.
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目的研究慢性阻塞性肺疾病(慢阻肺)稳定期患者运动后心率恢复(heart rate recovery,HRR)与其CAT评分、mMRC评分及急性加重风险的关系,进而探讨HRR对慢阻肺稳定期评估的价值。方法选取2018年9月~2020年3月安徽医科大学第一附属医院门诊及住院的60例慢阻肺稳定期患者。所有患者均完成CAT评分、mMRC评分、记录过去1年的急性加重次数,并行6min步行试验(6MWT),运动结束后,记录即时心率与休息1min后心率差值即为运动后1分钟心率恢复(heart rate recovery after 1 minute,HRR1)。分析HRR1与CAT评分、mMRC评分相关性及其与急性加重风险的关系,并比较慢阻肺稳定期ABCD各组间HRR1差异。结果慢阻肺稳定期患者HRR1与CAT评分、mMRC评分呈明显负相关,Pearson相关系数分别为0.611、0.549,且均有统计学意义(P<0.01);急性加重频繁组患者、急性加重非频繁组患者HRR1分别为14.38±7.02次/分、24.68±7.67次/分,两者平均差值为10.30次/分,差异具有统计学意义(P<0.05);慢阻肺稳定期ABCD各组HRR1有显著差异,且总体呈逐渐下降趋势。结论慢阻肺患者运动后心率恢复对慢阻肺病情的评估具有一定价值,有助于评估患者病情。 相似文献
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目的 探讨3种呼吸问卷评分之间的相关性及其与肺通气功能严重程度的相关性,了解现有的呼吸问卷用于评估慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)病情和肺通气功能受损程度的优劣。方法 纳入复旦大学附属中山医院2019年4月7日—2020年4月11日的109例稳定期COPD患者。记录患者一般情况、临床症状、并发症、受教育程度、呼吸问卷(CAT、mMRC、SGRQ)评分、肺功能参数、治疗用药等,分析各指标与3种呼吸问卷评分的相关性。结果 109例患者中,轻-中度COPD患者(FEV1%pred≥50%) 62例(56.88%),重-极重度COPD患者(FEV1%pred<50%) 47例(43.12%)。相关性分析显示,SGRQ、mMRC、CAT评分之间均具有良好的相关性(P<0.05);分层分析发现,对重-极重度患者,SGRQ(总分和症状部分)、mMRC、CAT评分能较好反映其肺功能(FEV1%pred)水平(r：0.4~0.5),而对轻-中度COPD患者,上述评分与患者的肺通气功能之间无明显相关性。结论 3种呼吸问卷两两之间相关性好,均可用于COPD评价。SGRQ评分全面系统,在呼吸疾病科学研究中具有重要价值;CAT评分侧重临床使用,方便快捷;SGRQ评分及CAT评分与重-极重度肺通气功能受损程度具有良好的相关性。 相似文献
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Norichika Iga Hideyuki Nishi Nobukazu Fujimoto Takumi Kishimoto 《Respiratory investigation》2018,56(2):144-149
Background
Few studies have focused on the management of secondary spontaneous pneumothorax (SSP) as a complication of pneumoconiosis. The aim of this study was to investigate the clinical features and therapeutic course of SSP associated with silicosis.Methods
Between April 2005 and March 2015, 17 patients with silicosis underwent chest tube drainage for SSP in our institution. We retrospectively analyzed patient characteristics, type of treatment, clinical course, rate of recurrence, and survival time, and compared them with those of 30 patients diagnosed with chronic obstructive pulmonary disease (COPD) during the same period.Results
Fourteen patients with silicosis had performance status score ≥ 2 and modified Medical Research Council Grade ≥ 2; these were significantly different from those in patients with COPD (P = 0.047, P = 0.026). Patients with silicosis had a significantly longer duration of chest tube placement and hospital stay. Recurrent pneumothorax occurred in 47.1% of patients with silicosis, which was not significantly different from the proportion of patients with COPD (40.9%, P = 0.843). However, in the silicosis group, patients treated with chest tube drainage alone tended to have a higher rate of ipsilateral recurrence than those who had pleurodesis, although this was not statistically significant. The median overall survival time of patients with silicosis was 82.6 months, while that of patients with COPD was 104.1 months.Conclusions
Patients with silicosis had worse physical status and respiratory functions at the time of occurrence of pneumothorax than those with COPD. Pleurodesis could be an effective treatment for SSP complicating silicosis. 相似文献8.
《Respiratory investigation》2020,58(4):246-254
BackgroundLung hyperinflation in chronic obstructive pulmonary disease (COPD) is closely associated with emphysema and non-emphysematous gas trapping, termed functional small airway disease (fSAD), on inspiratory and expiratory computed tomography (CT). Because the cranial-caudal emphysema distribution affects pulmonary function and fSAD may precede emphysema on CT, we tested the hypothesis that lobar fSAD distribution would affect lung hyperinflation differently in COPD with minimal and established emphysema.MethodsThe volume percentages of fSAD and emphysema (fSAD% and Emph%) over the upper and lower lobes were measured using inspiratory and expiratory CT in 70 subjects with COPD. Subjects were divided into those with minimal and established emphysema (n = 36 and 34) using a threshold of 10% Emph% in the whole lung.ResultsIn the minimal emphysema group, fSAD% in the upper and lower lobes was positively correlated with functional residual capacity (FRC) and residual volume to total lung capacity ratio (RV/TLC), and the correlation of fSAD% with RV/TLC was greater in the lower lobes. Conversely, in the established emphysema group, fSAD% in the upper and lower lobes was correlated with RV/TLC, but not with FRC. In multivariate analysis, fSAD% in the lower lobes, but not in the upper lobes, was associated with RV/TLC in subjects with minimal emphysema after adjusting for age, smoking status, and bronchodilator use.ConclusionNon-emphysematous gas trapping in the upper and lower lobes has a distinct physiological effect, especially in COPD with minimal emphysema. This local evaluation might allow sensitive detection of changes in lung hyperinflation in COPD. 相似文献
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目的 探讨伴有外周血嗜酸性粒细胞增多的慢性阻塞性肺疾病急性加重（AECOPD）患者临床特征及治疗后的症状缓解情况。方法 选取2016年10月—2018年7月南京医科大学附属苏州科技城医院AECOPD加重患者140例。根据入组时外周血嗜酸性粒细胞百分比（B-Eos）分为两组。A组为B-Eos≥2%的患者,B组为B-Eos<2%的患者。入组时收集相关资料,对AECOPD患者予以相应治疗,随访治疗后的1周、
1、3及6个月的英国医学研究委员会呼吸困难量表（mMRC）评分及1年内急性加重次数,比较两组治疗后mMRC评分和急性发作变化。结果 140例患者经1年随访共98例患者完成本项研究。这些患者中基线B-Eos≥2%的患者占45.1%。两组患者治疗后6个月的mMRC评分整体分析差异无统计学意义（P?>0.05）,但在时间点、分组与时点间交互作用上差异有统计学意义（P?<0.05）。组间比较示在1周、1个月这2个时间点mMRC评分差异有统计学意义（P?<0.05）。随访1年后两组患者再住院率分别为41.6%和64.0%,差异有统计学意义（P?<0.05）。结论 B-Eos≥2%的AECOPD患者经治疗后mMRC评分下降较快。表明外周血嗜酸性粒细胞水平能预测AECOPD患者短期内的疗效。 相似文献
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