慢性阻塞性肺疾病合并2型糖尿病大鼠模型的建立

目的探讨制作慢性阻塞性肺疾病（COPD）合并2型糖尿病大鼠模型的方法。方法将80只Sprague-Dawley（SD）雄性大鼠随机分成COPD组、糖尿病组、COPD＋糖尿病组和正常组,每组20只。采用单纯熏香烟法制备COPD大鼠动物模型,利用链脲佐菌素诱导SD大鼠产生糖尿病,两种方法协同产生COPD＋糖尿病的大鼠模型,正常组常规饲养。3个月后作常规病理检查,血糖测定。结果 COPD＋糖尿病组大鼠肺组织病理学改变：支气管黏膜上皮脱落严重,肺间质及气道管壁有大量的炎性细胞浸润,肺泡结构破坏,部分融合成肺大疱。造模成功后COPD＋糖尿病组的血糖水平为（27.1±1.1）mmol/L,与其他3组比较差异有统计学意义（P〈0.05）。结论被动吸烟方式能够建立COPD大鼠模型,利用链脲佐菌素诱导SD大鼠产生糖尿病,两种方法协同产生COPD合并糖尿病的大鼠模型,为进一步医学研究提供动物模型。     

补肺通络方对慢性阻塞性肺疾病模型大鼠的保护作用

目的观察补肺通络方对慢性阻塞性肺疾病(COPD)模型大鼠的保护作用,为进一步探讨其对COPD气道重塑的影响作基础。方法采用烟熏加气管内注入脂多糖法复制COPD大鼠模型,分组观察补肺通络方对COPD模型大鼠的体质量、温水游泳时间、呼吸频率及肺功能FEV0.3/FVC%、MMF、CL、Ri、Re、PEF的影响。结果补肺通络方可提高COPD模型大鼠体质量增幅,减慢其呼吸频率,延长其温水游泳时间,使其FEV0.3/FVC%、MMF、CL升高,使Ri、Re降低。结论补肺通络方可有效改善COPD模型大鼠多项肺功能指标,改善其营养状态,提高其活动能力,对COPD模型大鼠起一定保护作用。     

烟熏联合不同细菌建立大鼠慢性阻塞性肺疾病急性加重期动物模型

目的应用烟熏联合2种不同细菌混悬液建立SD大鼠慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的模型。方法 60只SPF级雄性SD大鼠,随机选取10只作为正常组,其余50只放入烟熏箱建立慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)模型,分别于烟熏30、60、90d时观察大鼠肺组织大小、颜色及改变;90d后,随机选30只大鼠并分为COPD稳定组、肺炎链球菌组、铜绿假单胞菌组,每组各10只。将2.4×109cfu/mL肺炎链球菌混悬液0.2mL、6×108cfu/mL铜绿假单胞菌混悬液0.2mL分别接种于肺炎链球菌组、铜绿假单胞菌组大鼠气道建立AECOPD模型,COPD稳定组及正常组大鼠以相同方法注入0.2mL灭菌生理盐水。观察各组大鼠一般情况、存亡状况及体温变化,并于接种24h后取大鼠右肺组织行组织病理检查,取左肺组织做肺组织匀浆培养细菌。结果 COPD模型建立中,大鼠肺体积不断增大,其表面凹凸不平,有苍白色斑形成;组织病理显示大鼠肺组织炎症细胞增多,炎症加重,肺泡融合;与正常组、COPD稳定组比较,铜绿假单胞菌组、肺炎链球菌组大鼠一般状况差,肺组织病理改变明显加重,大鼠死亡3只;正常组和COPD稳定组细菌培养未见细菌菌落,肺炎链球菌组和铜绿假单胞菌组匀浆培养为阳性;接种6、12h,COPD稳定组大鼠体温[(38.5±0.5)、(37.8±0.3)℃]高于正常组[(36.5±0.4)、(37.4±0.3)℃]、铜绿假单胞菌组[(35.0±0.7)、(35.4±0.6)℃]及肺炎链球菌组[(34.6±0.7)、(35.6±0.5)℃](P<0.05),正常组高于肺炎链球菌组和铜绿假单胞菌组(P<0.05);接种24h,铜绿假单胞菌组、肺炎链球菌组体温[(36.4±0.3)、(36.1±0.3)℃]低于COPD稳定组[(37.4±0.6)℃]和正常组[(37.2±0.9)℃](P<0.05),COPD稳定组与正常组比较差异无统计学意义(P>0.05);各时间点,肺炎链球菌组与铜绿假单胞菌组大鼠体温比较差异均无统计学意义(P>0.05)。结论采用单纯烟熏联合气管内注入细菌混悬液的方法可成功建立SD大鼠AECOPD模型。     

慢性阻塞性肺疾病急性加重期大鼠模型的建立

目的 建立一种慢性阻塞性肺疾病(COPD)急性加重期动物模型.方法 采用多次经鼻腔注入肺炎克雷伯杆菌菌液致呼吸道感染的方法复制的COPD大鼠稳定期模型,在此基础上以反复、高剂量经鼻腔注入肺炎克雷伯杆菌菌液的方法建立COPD急性加重期模型,观察其肺组织病理学变化,测定外周血和支气管肺泡灌洗液(BALF)中的细胞计数,并进行血气分析和肺功能测定.结果 两种模型动物外周血和BALF中白细胞、中性粒细胞、巨噬细胞、淋巴细胞均较对照组增加,以急性加重期增高更明显(P<0.05或P<0.01).两个模型组潮气量(VT)、呼气峰流速(PEF)、动脉血氧分压(PaO_2)均低于对照组,动脉血二氧化碳分压(PaCO_2)及右心肥大指数高于对照组(P均<0.01),肺病理变化明显,以急性加重期模型组为甚,且其气道内压上升坡度(IP)明显高于稳定期模型组(P<0.01).结论 以适量肺炎克雷伯杆菌反复经鼻腔注入大鼠肺内可引起COPD急性加重;应结合血气分析、肺功能等变化评价所建模型是否具有COPD急性加重期的主要特征.     

血小板与慢性阻塞性肺疾病

慢性阻塞性肺疾病(慢阻肺,COPD)是多种病因引起的慢性气道阻塞,其主要病理生理改变为:阻塞性通气功能障碍,后期发展为肺动脉高压、肺心病.慢阻肺肺动脉血栓形成率达20～50%,合并严重肺动脉高压者血栓形成率更高.血小板具有粘附、促凝和收缩血块的功能,因此在血栓形成和血管损伤中起重要作用.     

黏蛋白在慢性阻塞性肺疾病大鼠肺组织中的研究

慢性阻塞性肺疾病的病理特点是呼吸道黏液高分泌,黏蛋白是气道黏液的主要成分,二者关系密切,本文就二者关系做一综述.     

黄芪对慢性阻塞性肺疾病模型大鼠气道重塑的影响

目的：探讨黄芪对慢性阻塞性肺疾病（COPD）模型大鼠气道重塑的影响。方法：采用熏吸香烟加气管内注射脂多糖的方法建立大鼠COPD模型，测定黏膜下炎症细胞、肺小动脉、支气管壁的变化。结果：治疗组支气管黏膜下炎症细胞数较模型组明显减少（P〈0.01）；治疗组肺小动脉管壁厚度明显较模型组薄，差异有显著性（P〈0.05）；治疗组细支气管平滑肌厚度亦明显较模型组薄，差异有显著性（P〈0.05）。结论：黄芪能够减缓COPD患者的气道重构，延缓或阻止COPD疾病的发展。     

慢性阻塞性肺疾病的康复护理

慢性阻塞性肺疾病的康复护理孟祥荣１牛卫东２慢性阻塞性肺疾病（ｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅｐｕｌｍｏｎａｒｙｄｉｓｅａｓｅ，ＣＯＰＤ）是严重危害人类健康的常见病、多发病。目前在治疗上还没有特效方法，我们在临床中采用综合医疗措施对３０例ＣＯＰＤ患...     

慢性阻塞性肺疾病稳定期的管理策略

慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Diseases,COPD)是一种以气流受限为特征的疾病,其患者数目多,病死率高,社会经济负担重,是一个世界性公共卫生问题。对COPD稳定期患者的有效管理,例如督导患者戒烟、氧疗、肺康     

慢性阻塞性肺疾病的康复治疗

慢性阻塞性肺疾病(COPD)是人类死亡及致残的主要原因之一,其康复治疗已日益受到重视.早在1974年美国胸科医师学会肺康复委员会曾对肺疾病康复下一定义:“肺疾病康复可视为临床医学中的专门学科.通过精确诊断、治疗、心理支持和宣教等,制订出针对个人的康复程序以逆转或稳定肺疾病的病理生理或精神病理学的变化,使患者恢复到病损后的最佳功能状态,并经受各种生活场合的考验.此定义要求康复医师在制订康复程序时,要遵从①个体化原则;②综合康复治疗原则;③重视病理生理及精神病理学变化的原则.一个成功的肺康复程序一定要适应每个患者的具体情况,由有经验的医师协调运用多种康复措施,同时调动心理和社会的有利因素,以强化各种治疗效果.     

MSCT诊断慢性阻塞性肺疾病合并慢性肺源性心脏病

目的 比较不同严重程度慢性阻塞性肺疾病（COPD）及COPD合并慢性肺源性心脏病患者右心室功能,评价MSCT诊断COPD合并慢性肺源性心脏病的价值。方法 对53例COPD患者（轻中度组13例、重度组22例及合并慢性肺源性心脏病组18例）和36名健康志愿者（对照组）行肺功能和MSCT检查。记录肺功能和右心室功能参数。比较各组右心室功能差异,分析COPD患者肺功能与右心室功能的相关性。分别绘制右心室每搏输出量（SV）、射血分数（EF）的ROC曲线,评价MSCT在COPD合并慢性肺源性心脏病中的诊断价值。以预试验确定的右心室SV<48 ml或EF<40%作为诊断慢性肺源性心脏病的标准,计算诊断敏感度和特异度。结果 4组间右心室舒张末容积（EDV）、EDV/体质量指数（BMI）、SV、SV/BMI及EF差异有统计学意义（P均<0.05）,而收缩末容积（ESV）及ESV/BMI差异无统计学意义（P均>0.05）。COPD患者右心室SV/BMI、EF与第1秒用力呼气容积（FEV1）（r=0.321、0.296,P=0.019、0.031）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）（r=0.305、0.280,P=0.026、0.043）及FEV1占预计值百分比（FEV1%_pred;r=0.457、0.351,P=0.001、0.001）均呈正相关。分别绘制右心室EF、SV ROC曲线,AUC分别为0.973、0.930（P均<0.001）,MSCT诊断慢性肺源性心脏病的敏感度分别为77.77%、77.77%,特异度分别为98.59%、88.63%。结论 COPD患者在未达到慢性肺源性心脏病诊断标准前右心室功能已出现减退,且其肺功能与右心室功能呈正相关。MSCT能早期发现COPD患者右心室功能不全,且对于诊断慢性肺源性心脏病具有重要价值。     

A comparison of twice- versus once-weekly supervision during pulmonary rehabilitation in chronic obstructive pulmonary disease

OBJECTIVE: To compare the effects of twice- versus once-weekly supervised pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Prospective, randomized, parallel-group study. SETTING: Hospital outpatient physiotherapy department. PARTICIPANTS: Patients with COPD. INTERVENTION: Group 1 (n=46) received 1 supervised exercise session a week and 2 unsupervised sessions; group 2 (n= 45) received 2 supervised exercise sessions a week and 1 unsupervised session for 6 weeks. Patients were assessed at baseline and at 6 weeks, 2 months, and 6 months. MAIN OUTCOME MEASURES: Incremental (ISWT) and endurance (ESWT) shuttle walk tests and Chronic Respiratory Disease Questionnaire (CRDQ). RESULTS: Sixty-six of 91 patients (group 1, n=34; group 2, n=32) completed the 6-week program. There was no significant difference in key outcome measures between the 2 groups (ISWT, 13.50m; 95% confidence interval [CI], -10.06 to 37.15m; ESWT, 72.64s; 95% CI, -96.01 to 241.29s; CRDQ total score, 2.54; 95% CI, -3.16 to 8.24). The results of the ESWTs suggest there may be an interaction between baseline exercise capacity and benefit of pulmonary rehabilitation, with more disabled patients achieving greater benefit if they are supervised twice weekly. Irrespective of group, allocation benefits after pulmonary rehabilitation had almost dissipated by 6 months. CONCLUSIONS: There was no difference in the effectiveness of twice- versus once-weekly supervised pulmonary rehabilitation. This study highlights the need for development of strategies that will maintain the improvement achieved by the initial pulmonary rehabilitation program.     

慢性阻塞性肺疾病中针对性护理模式的临床价值分析

[目的]分析针对性护理模式在慢性阻塞性肺疾病中的临床价值。[方法]选取在我院呼吸科接受治疗的178例慢性阻塞性肺疾病病人作为临床研究对象,采用单盲、随机的分配方式将178例研究对象分为观察组和对照组,每组89例。观察组采用针对性护理,对照组采用常规护理。两组病人护理结束后,观察两组病人稳定期的血气分析(动脉血氧分压和动脉血二氧化碳分压)、肺功能变化情况,并将两组数据比较分析。[结果]观察组病人的血气分析和肺功能较护理前有明显改善,与对照组相比具有统计学意义(P<0.05)。[结论]针对性护理模式在临床上疗效显著,能较大程度改善慢性阻塞性肺疾病病人的病症和生活质量。     

A community model of group therapy for the older patients with chronic obstructive pulmonary disease: a pilot study

OBJECTIVE: A community-based programme for chronic obstructive pulmonary disease (COPD) patients in group sessions is designed, and the feasibility, acceptability and physical and psychosocial outcomes evaluated. METHODS: Patients with COPD discharged from hospital, or those attending specialist outpatient clinic, with a history of hospital admission owing to COPD in the preceding 12 months were recruited. Those who had malignancy or were housebound were excluded. Group sessions were arranged once a week in a Community Centre, and consisted of two hourly sessions. The components of each session consist of education regarding the disease, breathing techniques, use of oxygen and other medication, smoking cessation, nutrition, dyspnoea management skills, relaxation and energy conservation techniques, introduction of social and community support, and strengthening as well as aerobic exercises. Assessments before and after intervention include lung function, 6 minutes walk test (6MWT), general Health Questionnaire (GHQ), the St. George's Respiratory Questionnaire (SGRQ), and a COPD knowledge Questionnaire. A programme evaluation was carried out using questionnaire and group discussions. RESULTS: Forty-four subjects were recruited, with 75% completing the programme, and 20% with drawing for unavoidable reasons. Statistically significant improvement was noted in all domains of the GHQ, SGRQ, and knowledge test, while the mean 6MWT improved, although statistical significance was not reached. Subjects were enthusiastic about the provision of this service in helping them cope with the disease through empowerment and mutual support. CONCLUSION: A group community intervention programme for COPD patients is feasible and acceptable, with positive psychosocial outcomes. Such a model could be further developed and cost-effectiveness evaluated as a model of chronic disease management in the community.     

慢性阻塞性肺疾病合并肌少症研究进展

慢性阻塞性肺疾病(COPD)是一种复杂的、具有高度异质性的全身性疾病.肌少症作为COPD多种合并症中之一,能够加速疾病进程,增加致残率和全因死亡率.近年来研究发现,COPD合并肌少症的危险因素为活动受限、营养不良、脂肪沉积等.结合肺功能相关指标与肌肉测量技术能够较精确的预测住院患者生存率和死亡率,在此基础上进行个性化干...     

慢性阻塞性肺病社区综合防治状况研究

目的提高慢性阻塞性肺病(COPD)社区综合防治水平,研究COPD社区的患病情况,探讨调查发病的危险因素,及COPD防治现状。方法选取上海市虹口区乍浦街道两个社区40岁以上居民进行肺功能筛查和呼吸情况问卷调查,并评估其发病危险因素。结果社区COPD总患病率为11.02%(102/926),男性患病率显著高于女性(分别为14.51%、7.84%,P<0.01),患病率随年龄增大而增大。性别、年龄、吸烟史、教育程度、儿童期呼吸疾病史与COPD的发生有密切的关系。高危人群患病率显著高于非高危人群(P<0.01)。患者中仅19.60%曾被诊断为慢性支气管炎或支气管哮喘,35.29%患者无呼吸系统症状,仅3.92%患者做过肺功能检查。结论社区40岁以上人群COPD发病率较高,COPD社区防治水平较低下,需努力提高COPD社区综合防治水平。     

Fatigue in patients with chronic obstructive pulmonary disease

BACKGROUND: Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives. OBJECTIVE: The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls. METHOD: The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire. RESULTS: Almost half of the patients (47.2%), reported fatigue every day during the preceding month compared with 13.5% of the control group (P < 0.001). The duration of fatigue was more than 6 hours in 52.7% of the patients and 44.4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18.9% (P < 0.001) and 10.8% (P < 0.01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0.001). CONCLUSION: These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.     

慢性阻塞性肺疾病病人姑息照护模式的应用进展

介绍了姑息照护的概念和应用范畴,综述了慢性阻塞性肺疾病(COPD)病人对姑息照护的需求及国内外研究现状。     

慢性阻塞性肺病社区综合防治状况研究

目的提高慢性阻塞性肺病（COPD）社区综合防治水平,研究COPD社区的患病情况,探讨调查发病的危险因素,及03PD防治现状。方法选取上海市虹口区乍浦街道两个社区40岁以上居民进行肺功能筛查和呼吸情况问卷调查,并评估其发病危险因素。结果社区COPD总患病率为11．02％（102／926）,男性患病率显著高于女性（分别为14．51％、7．84％,P〈0．01）,患病率随年龄增大而增大。性别、年龄、吸烟史、教育程度、儿童期呼吸疾病史与00PD的发生有密切的关系。高危人群患病率显著高于非高危人群（P〈0．01）。患者中仅19．60％曾被诊断为慢性支气管炎或支气管哮喘,35．29％患者无呼吸系统症状,仅3．92％患者做过肺功能检查。结论社区40岁以上人群COPD发病率较高,COPD社区防治水平较低下,需努力提高COPD社区综合防治水平。