慢性阻塞性肺疾病急性加重期痰细菌培养与肺功能关系探讨

目的　探讨慢性阻塞性肺疾病 (COPD)急性加重期患者的痰细菌学特征以及细菌感染与肺功能损伤的关系。　方法　对在我院就诊痰培养阳性的 77例急性期COPD患者进行肺功能测试 ,并根据肺功能测试结果将患者分为三个期。　结果　 77例痰菌培养阳性患者根据细菌培养结果分为 5组 ,A组为G+ 球菌 ,B组为除C组以外的G 杆菌 ,C组为肠杆菌和假单孢菌 ,D组为霉菌 ,E组为D组合并前A或C组中任何一类。Ⅰ期 (FEV1 ≥ 5 0 %预计值 ) 2 0例中 10例为A组 ,4例为B组 ,6例为C组 ;Ⅱ期 (30 % 相似文献   

COPD稳定期肺功能与急性加重期痰细菌学关系探讨

目的探讨COPD稳定期肺功能分级与急性加重期痰培养细菌学状况以及细菌感染之间关系。方法对我院142例有发病前稳定期肺功能检查结果的AECOPD住院病例进行回顾性分析。结果痰培养阳性者73例,阳性率为51.41%。FEV1占预计值百分比(FEV1%)50%时假单胞菌、肠杆菌及不动杆菌出现的机会比FEV1%≥50%时多,FEV1%50%与假单胞菌、肠杆菌和不动杆菌有高度相关性(P0.05)。结论随着COPD患者基础肺功能的降低,特别在FEV1%50%时,发生急性加重时痰菌以假单胞菌和肠杆菌最常见。FEV1%≥50%时痰培养诊断率较低,大多数无菌生长。     

肺切除术前肺功能与术后并发症的关系探讨

目的　探讨术前肺功能与肺切除术后并发症的相关关系。方法　对 318例肺切除患者于术前行肺功能检查 ,观察其术后并发症的发生。结果　 76例患者肺切除术后发生并发症 ,1秒钟用力呼气量 (FEV1 )占预计值 %、最大通气量 (MVV)占预计值 %、术后预计 FEV1 (FEV1 - ppo)降低与术后并发症有显著相关性。术前心肺基础疾患亦是术后并发症的高危因素。结论　 FEV1 占预计值 % <70 % ,MVV占预计值 % <5 0 % ,FEV1 - ppo<1.0 L 时 ,全肺切除的危险性增大 ;FEV1 占预计值 % <6 0 % ,MVV占预计值 % <4 0 % ,FEV1 - ppo<1.0 L 时 ,肺叶切除危险性升高。     

慢性阻塞性肺疾病不同分期全身炎症与气道炎症的变化及相互关系

目的　探讨COPD患者急性发作期及缓解期全身炎症和气道炎症的变化及二者的相关性。方法　对 45例COPD急性发作期患者治疗前及治疗 1 0～ 1 4d后分别行肺功能检查 ,测定FEV1 0占预计值百分数 (FEV1 0pre)、用ELISA法检测外周血浆和诱导痰液中白介素 8(IL 8)和肿瘤坏死因子α(TNF α)的水平。结果　COPD急性发作时外周血浆及诱导痰液中IL 8和TNF α均明显高于缓解期水平 (P <0 0 5 ,P <0 0 1 ) ,痰液IL 8和TNF α与血浆IL 8和TNF α水平无明显相关 (分别为r =0 491 5 ,P >0 0 5 ;r=0 41 2 7,P >0 0 5) ,外周血及痰液TNF α与FEV1 0pre无明显相关 (分别为r=0 351 2 ,P >0 0 5 ;r =0 4739,P >0 0 5) ,外周血IL 8与FEV1 0 pre有关 (r=- 0 62 71 ,P <0 0 5) ,痰液IL 8与FEV1 0 pre呈显著负相关 (r=- 0 852 7,P <0 0 1 )。结论　痰液IL 8与COPD气道阻塞密切相关 ,气道炎症与全身炎症无关。     

稳定期慢性阻塞性肺疾病气道炎症的研究

目的 研究稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)气道炎症和肺功能、下气道细菌定植(lower airway bacterial colonization,LABC)的关系.方法 随机入选45例稳定期COPD门诊患者和28名健康志愿者,行肺功能、血常规和胸片检查.采用痰诱导方法 留取深部合格痰液,COPD患者的痰液行细菌定量培养,两组研究对象的痰液均行细胞因子检测.结果 稳定期COPD组痰液中白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、IL-10、IL-19明显高于对照组(P＜0.05).第1秒用力呼气容积占预计值百分比(FEV1%pred)＜50%组痰液中IL-8、TNF-α、IL-19明显高于FEV1%pred≥50%组(P＜0.05),而IL-10在两组间比较差异无统计学意义.在本实验中LABC量≥107CFU/ml者占总人数的33.33%,主要的下气道定植菌为卡他莫拉菌、副流感嗜血杆菌、肺炎链球菌、流感嗜血杆菌等.LABC量≥107 CFU/ml组痰液中IL-8、TNF-α、IL-19明显高于LABC＜107 CFU/ml组(P＜0.05),而IL-10在两组间比较差异无统计学意义.相关性分析显示,IL-19与IL-10呈负相关,相关系数r=-0.548(P＜0.05),IL-19与IL-8、TNF-α呈正相关,相关系数分别为r=0.702(P＜0.05)、r=0.708(P＜0.05).FEV1%pred＜50%组细菌定植量明显高于FEV1%pred≥50%组(P＜0.05).FEV1%pred＜50%预计值组的吸烟指数明显高于FEV1%pred≥50%组(P＜0.05).结论 稳定期COPD患者存在气道炎症,既与LABC有关,又与吸烟有关,这种与LABC和吸烟相关的气道炎症可能是导致COPD患者肺功能进行性下降的原因.     

稳定期慢性阻塞性肺疾病下呼吸道细菌定植与气道炎症关系的研究

目的:研究稳定期慢性阻塞性肺疾病(COPD)患者下呼吸道细菌定植与气道炎症、吸烟、肺功能的关系。方法:入选34例稳定期COPD门诊患者,测定其肺功能,留取深部痰液进行细菌定量培养。抽取静脉血,检测血清和痰液白细胞介素-8(IL-8)浓度,对他们的相关性进行统计学分析。结果:下呼吸道细菌定植≥107菌落形成单位(CFU)/mL组,其血清及痰液IL-8浓度与下呼吸道细菌定植量<107CFU/mL组相比,2组差异有显著性(P<0.05)。下呼吸道细菌定植≥107CFU/mL组吸烟指数与下呼吸道细菌定植量<107CFU/mL组相比,2组差异有显著性(P<0.05)。第一秒用力呼气量(FEV1)<50%预计值组细菌定植量与FEV1≥50%预计值组比较,2组差异有显著性(P<0.05)。结论:稳定期COPD患者的气道炎症与吸烟和下呼吸道细菌定植有关,吸烟和下呼吸道细菌定植可导致气道炎症加重。     

慢性阻塞性肺病患者幽门螺杆菌感染状况及其致病危险性分析

目的 探讨幽门螺杆菌感染(Hp)及其产生的毒力因子与慢性阻塞性肺病(COPD)的关系,并分析Hp对肺功能的影响.方法 选取80例COPD稳定期患者为COPD组,同时选取性别、年龄相匹配的健康人80例为对照组.应用幽门螺杆菌测定仪-AUTOBLOT SYSTEM36专用试剂盒,采用免疫印迹法检测Hp血清抗体,并分别进行肺功能检测.结果 COPD组患者血清抗Hp抗体检出率为71.25%,对照组血清抗Hp抗体检出率为43.75%(P＜0.01);去除年龄、性别、吸烟及吸烟指数等危险因素后Hp感染者患COPD的相对危险性明显增高(OR值为3.19).COPD组中Ⅰ型Hp检出率(38.75%)高于对照组(31.25%);去除年龄、性别、吸烟及吸烟指数等危险因素后Ⅰ型Hp菌株感染者患COPD的危险性显著增高(OR值为3.68);高于Hp感染阳性者患COPD危险性,但Ⅱ型Hp菌株感染组并未明显增加患COPD的危险性(OR值为1.03).Hp感染阳性COPD患者肺功能(FEV1%预计值41.173±18.118)与Hp感染阴性COPD患者肺功能(FEV1%预计值56.555±16.718)比较有显著性差异(P＜0.05);且Hp感染阳性COPD患者中Ⅰ型Hp感染者肺功能(FEV1%预计值34.597±14.163)与Ⅱ型Hp感染者肺功能(FEV1%预计值54.327±18.303)比较差异也有显著性(P＜0.05).结论 Hp感染是导致COPD的独立危险因素,Ⅰ型Hp感染可能更增加患COPD的危险性,且可能是使COPD患者肺功能恶化的因素之一.     

AECOPD血清PCT检测的临床价值及其与肺功能的关系

目的探讨AECOPD血清PCT检测的临床价值及与肺功能的关系。方法选取56例AECOPD住院患者,采用酶免法测定血清PCT水平并行痰细菌半定量培养,与同期COPD稳定期及健康成人做对照;AECOPD血清PCT浓度分别与炎症指标、FEV1%预计值行相关分析。按COPD分级标准将AECOPD再次分组,比较血清PCT浓度。结果 AECOPD患者血清PCT水平明显增高,与痰培养结果无明显关系,血清PCT水平与炎症指标呈正相关,与FEV1%预计值呈负相关,肺功能严重损害血清PCT水平明显升高。结论血清PCT水平对判断AECOPD下呼吸道细菌感染及严重程度有一定的临床价值,与肺功能急性损害有关。     

IL-8和NF-κB在慢性阻塞性肺疾病缓解期气道炎症中的作用

目的探讨白细胞介素-8(IL-8)和NF-κB在慢性阻塞性肺疾病(COPD)缓解期气道炎症中的作用。方法选择2003年3月至2005年9月河南省人民医院呼吸科COPD稳定期患者26例,诱导痰检测痰上清液IL-8水平,分离巨噬细胞并以免疫细胞化学法测定NF-κBP65的活性表达,检测外周血超氧化物歧化酶(SOD)、丙二醛(MDA)、IL-8水平,所有患者均测定肺功能(FEV1占预计值%、FEV1/FVC)。结果COPD稳定期诱导痰上清液IL-8水平显著高于正常组(P<0.01);巨噬细胞NF-κBP65胞核阳性表达显著高于正常组,痰IL-8与巨噬细胞NF-κB的激活呈正相关,而与FEV1占预计值%呈负相关(P<0.01);外周血IL-8与对照组比较差异无显著性,但MDA显著高于对照组,SOD低于对照组。结论细胞因子IL-8和NF-κB在COPD缓解期诱导痰中有较高水平,提示IL-8在COPD气道炎症、气道阻塞发生发展过程中可能起着重要作用。注重COPD稳定期的治疗(抗氧化及气道内吸入抗炎药)可能会延缓COPD的发展。     

慢性阻塞性肺疾病患者血浆及痰中P物质变化与其与肺？…

目的　探讨P物质 (SP)在慢性阻塞性肺疾病 (COPD)发病中的作用及其与肺功能的关系。方法　用放射免疫分析法观察 2 0名健康受试者 ,2 0例COPD患者血浆及痰中P物质的含量 ,同时检测肺功能 ,并分析血浆及痰中P物质的含量与一秒钟用力呼气容积占用力肺活量比值 (FEV1/FVC)的相关关系。结果　COPD患者血浆SP浓度 (8 6± 3 9)pmol/L明显高于对照组 (3 8± 2 0 )pmol/L(P <0 0 5 ) ;COPD患者痰SP浓度 (5 7 3± 14 5 )pmol/L明显高于对照组 (5 9± 2 6 )pmol/L(P <0 0 1)。COPD患者血浆SP浓度与FEV1/FVC呈负相关 (r=- 0 5 91,P <0 0 5 ) ;痰SP浓度与FEV1/FVC呈负相关 (r=- 0 6 42 ,P <0 0 5 )。结论　SP可能参与COPD的发病过程     

Yield of sputum microbiological examination in patients hospitalized for exacerbations of chronic obstructive pulmonary disease with purulent sputum

BACKGROUND: Whether sputum microbiological examination should be performed systematically in hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations remains unclear. OBJECTIVES: To assess the yield of sputum microbiological examination in COPD patients hospitalized in a medical ward for an acute exacerbation with purulent sputum. METHODS: Two hundred consecutive exacerbations in 118 patients were studied. Patients underwent sputum microbiological examination on admission and baseline lung function tests and CT scans were recorded. Factors associated with positive culture were analyzed. RESULTS: Sputum culture was positive (>or=10(7) CFU/ml) in 59% of samples, Haemophilus influenzae and Streptococcus pneumoniae being the most frequent pathogens. Factors associated with positive culture were bronchiectasis, long-term oxygen therapy and low FEV1. Pseudomonas spp. were found in 8.5% of all patients, who all had a FEV1<50% of predicted and were older. Only 25% of sputum samples satisfied all quality criteria. Sputum culture was positive in a high proportion of these samples (80.5%), but also in one half of samples with >25 leukocytes but >10 epithelial cells per field. Microbiological results induced a change in antibiotic therapy in 43.9% of cases with both quality criteria but also in 25.2% of cases with only one quality criterion. Finally, a predominant aspect after Gram stain was found in all positive samples. CONCLUSIONS: These data suggest that sputum microbiological examination with direct examination and leukocyte count should be performed routinely in patients hospitalized for COPD exacerbations with purulent sputum, especially when FEV1 is less than 50% predicted and in patients with bronchiectasis.     

C反应蛋白在慢性阻塞性肺疾病中的临床意义研究

目的观察C反应蛋白（CRP）在慢性阻塞性肺疾病（COPD）急性加重中的临床意义。方法选取56例COPD急性加重期患者,观察患者CRP水平、白细胞计数（WBC）并进行痰培养。结果 CRP的异常率为98%,明显高于WBC及痰培养的异常率;COPD Ⅰ级的患者CRP水平显著低于COPDⅡ、Ⅲ、Ⅳ级患者。COPDⅡ、Ⅲ、Ⅳ级患者中,随着气流受限程度的加重,CRP水平逐渐增高,差异有统计学意义（P均〈0.05）。结论 CRP是反映COPD急性加重期患者早期感染的敏感指标;CRP与肺功能损害程度呈正相关,能够反应疾病严重程度。     

Bacterial infections in patients requiring admission for an acute exacerbation of COPD; a 1-year prospective study

STUDY OBJECTIVE: To investigate the frequency of respiratory bacterial infections in hospitalized patients, admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD), to identify the responsible pathogens by sputum culture and to assess patient characteristics in relation to sputum culture results. METHODS: We prospectively evaluated clinical data and sputum culture results of 171 patients, admitted to the pulmonology department of the University Hospital Maastricht with an acute exacerbation of COPD from 1st January 1999 until 31st December 1999. RESULTS: Eighty-five patients (50%) had positive sputum cultures, indicating the presence of bacterial infection. Pathogens most frequently isolated were: Haemophilus influenzae (45%), Streptococcus pneumoniae (27%), and Pseudomonas aeruginosa (15%). Patients with more severely compromised lung function had a higher incidence of bacterial infections (P = 0.026). There were no significant differences in age, lung function parameters, blood gas results and length of hospital stay between patients with and without bacterial infection. There were no correlations between the type of bacteria isolated and clinical characteristics. CONCLUSION: Incidence of bacterial infection during acute exacerbations of COPD is about 50%. Patients with and without bacterial infection are not different in clinical characteristics or in outcome parameters. Patients with lower FEV1 have a higher incidence of bacterial infections, but there is no difference in the type of bacterial infection. In the future, the pathogenic role of bacterial infection in exacerbations of COPD should be further investigated, especially the role of bacterial infection in relation to local and systemic inflammation.     

慢性阻塞性肺疾病患者诱导痰中α-防御素1—3含量与病情程度的相关性研究

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者治疗前后诱导痰中α-防御素1-3（HNP1—3）含量、中性粒细胞比例（N％）与肺功能及血气分析结果的相关性,以探讨HNP1—3在COPD发病机制中的可能作用。方法收集AECOPD患者42例（根据肺功能检测结果分为轻度组11例、中度组13例、重度组18例）治疗前后及20例急性支气管炎痊愈者（对照组）的诱导痰,分别进行痰中性粒细胞计数并计算其百分比,用ELISA方法检测诱导痰中HNP1—3的含量;测定各观察对象治疗前后的血气分析及肺功能,分析HNP1—3含量与N％、肺功能和血气分析的相关性。结果COPD患者诱导痰中HNP1-3水平、N％、PaCO2随病情严重程度的增加而增高（P〈0．01）,并明显高于对照组（P〈0．01）,FEV,％pred、FEV,／FVC、PaO2随病情严重程度的增加而降低（P〈0．01）,明显低于对照组（P〈0．01）。三组患者诱导痰中HNP1—3含量分别与N％呈显著正相关（r=0．887～0．973,P值均〈0．01）,与FEV,Yoopred、FEV,／FVC、Pa02分别呈显著负相关（r=0．721～0．973,P值均〈0．01）。经治疗一周后,轻度、中度、重度患者FEV,Voopred、FEV1／FVC、PaO2明显增高,诱导痰中HNP1—3含量、N％明显降低。结论HNPl—3参与了COPD炎症的过程,此过程与中性粒细胞有关。痰中HNPl3含量可作为COPD患者病情严重程度的指标,并有助于判断预后。     

慢性阻塞性肺疾病稳定期下呼吸道细菌定植与肺功能关系研究

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者下呼吸道细菌定植(lower airway bacterial colonization,LABC)与气道炎症和肺功能损害之间的关系.方法 在稳定期入选确诊中、重度COPD患者(男性38例,中度24例)46例,于基线期进行痰菌落计数、细菌培养,细胞因子检测和肺功能检查,随访1年后统计患者COPD急性加重次数,并于研究结束时复测肺功能.结果 在基线期痰细菌菌落计数＞104 cfu/ml的患者为15例(32.6%),提示存在LABC,以流感嗜血杆菌为主(7/15).存在LABC患者基线期痰液中的白介素6及肿瘤坏死因子α[分别为(188.33±127.19)pg/ml和(169.33±119.86)pg/ml]显著高于无LABC患者组[分别为(104.84±133.84)pg/ml和(100.97±108.85)pg/ml](P＜0.05);两组1年内急性加重次数分别为(2.92±1.11)次和(2.21±0.49)次,而第1秒用力呼气容积下降值分别为(0.063±0.12)L和(0.044±0.13)L,差异有统计学意义(P＜0.05);肺功能下降水平与急性加重发生次数呈显著正相关(P＜0.05).结论 部分COPD稳定期患者的气道中存在LABC,以流感嗜血杆菌为主,LABC可能是影响COPD病程的重要因素.     

Acute exacerbation of COPD: factors associated with poor treatment outcome

OBJECTIVES: To determine the effect of age, severity of lung disease, severity and frequency of exacerbation, steroid use, choice of an antibiotic, and the presence of comorbidity on the outcome of treatment for an acute exacerbation of COPD. DESIGN: A retrospective chart analysis over 24 months. SETTING: A university Veterans Affairs medical center. PATIENTS: Outpatients with COPD who were treated with an antibiotic over a period of 24 months for an acute exacerbation of COPD. METHODS: Severity of an acute exacerbation of COPD was defined using the criteria of Anthonisen et al: increased dyspnea, increased sputum volume, and increased sputum purulence. Severity of lung disease was stratified based on FEV(1) percent predicted using American Thoracic Society guidelines (stage I, FEV(1) > or = 50%; stage II, FEV(1) 35 to 49%; stage III, FEV(1) < 35%). Treatment outcome was judged successful when the patient had no return visit in 4 weeks for a respiratory problem. Failure was defined as a return visit for persistent respiratory symptoms that required a change of an antibiotic in < 4 weeks. RESULTS: One-hundred seven patients with COPD (mean age +/- SD, 66.9 +/- 9.5 years) experienced 232 exacerbations over 24 months. First-line antibiotics (trimethoprim-sulfamethoxazole, ampicillin/amoxicillin, and erythromycin) were used to treat 78% of all exacerbations. Treatment failure was noted in 12.1% of first exacerbations and 14. 7% of all exacerbations, with more than half the failures requiring hospitalization. Host factors that were independently associated with treatment failure included the following: FEV(1) < 35% (46.4% vs 22.4%; p = 0.047), use of home oxygen (60.7% vs 15.6%; p < 0. 0001), frequency of exacerbation (3.8 +/- 2.0 vs 1.6 +/- 0.91; p < 0. 001), history of previous pneumonia (64.3% vs 35.1 p < 0.007), history of sinusitis (28.6% vs 8.8%; p < 0.009) and use of maintenance steroids (32.1% vs 15.2% p = 0.052). Using stepwise logistic regression analysis to identify the top independent variables, the use of home oxygen (p = 0.0002) and frequency of exacerbation (p < 0.0001) correctly classified failures in 83.3% of the patients. Surprisingly, age, the choice of an antibiotic, and the presence of any one or more comorbidity did not affect the treatment outcome. CONCLUSION: The results of our study suggest that patient host factors and not antibiotic choice may determine treatment outcome. Prospective studies in appropriately stratified patients are needed to validate these findings.     

慢性阻塞性肺病患者鼻腔与下气道炎症状况相关性研究

目的 探讨慢性阻塞性肺病(COPD)急性加重期患者治疗前后鼻灌洗液炎症细胞、细胞因子与生活质量评分、肺功能和下气道相应指标的相关性.方法 观察29例COPD急性加重期患者治疗前后的肺功能、SNOT-20、SGRQ评分以及鼻灌洗液、痰中性粒细胞、IL-8、IL-6含量差异,比较鼻灌洗液与部分炎症相应指标、FEV1、SNOT-20和SCRQ评分的相关性.结果 COPD患者鼻灌洗液、痰细胞总数、中性粒细胞比例(N%)、IL-8、IL-6含量和SGRQ评分随分级的增加而增高(P＜0.05),重度患者鼻部症状评分(SNOT-20)最高.治疗2周后中、重度患者FEV1%明显升高,鼻灌洗液和痰细胞总数、N%、IL-8含量显著降低;轻度患者仅痰IL-8明显降低,其它各项指标变化不明显.三组患者鼻灌洗液N%、IL-8含量皆与FEV1%呈显著负相关、与痰N%、IL-8呈正相关;中、重度组鼻灌洗液N%、IL-8与SGRQ呈显著正相关.结论 COPD患者鼻腔炎症状况可一定程度反映下呼吸道炎症情况、预测病情严重度并有助于判断预后.     

AECOPD氧化应激与肺功能、最大呼吸肌力动态变化相关性研究

目的 研究AECOPD患者氧化应激与肺功能、最大呼吸肌力动态变化的相关性.方法ELISA检测47例COPD急性加重期患者血清丙二醛(MDA)、谷胱甘肽(GSH)、氧化型谷胱甘肽(GSSG)、超氧化物歧化酶(SOD)浓度,与其第一秒钟用力呼气容积( FEV1)、用力肺活量(FVC)、最大吸气压(MIP)年下降值进行相关性分析.结果 MDA与FEV1年下降值呈正相关,GSH、GSH/GSSG与FEV1年下降值呈负相关,GSH与MIP年下降值呈负相关.结论 COPD急性加重期氧化/抗氧化失衡加速COPD的肺功能下降和呼吸肌力的减弱.     

A Prediction Model for Bacterial Etiology in Acute Exacerbations of COPD

Abstract Objectives: Bacteria play a leading role in acute exacerbations of chronic obstructive pulmonary disease (COPD), but we lack predictors of bacterial etiology. We developed a prediction model for infection with gram-negative enteric bacteria (GNEB) and Pseudomonas aeruginosa. Methods: Clinical presentation, sputum characteristics, microbial sputum patterns, lung function and previous and concomitant medication were prospectively recorded in patients with moderate to severe exacerbation of COPD. Risk factors for a specific bacterial etiology were c alculated and a prediction model developed. Results: A total of 193 patients with acute exacerbation were included. In 121 (62.6%) of them a microbial etiology could be identified, most frequently Haemophilus influenzae (32 strains), Streptococcus pneumoniae (22 strains) and P. aeruginosa (12 strains). Multivariate analysis identified severe airflow obstruction and use of systemic steroids as predictors for exacerbation due to gram-negative enteric bacilli and P. aeruginosa. A prediction model including FEV1 < 35% of predicted value, systemic steroid use and prior antibiotic therapy within preceeding 3 months had a negative predictive of 89%, being a helpful tool in excluding patients at risk of exacerbation due to gram-negative enteric bacilli and P. aeruginosa when all criteria are absent. Conclusion: A simple prediction model based on three factors may identify COPD patients at low risk for exacerbations with gram-negative enteric bacilli and P. aeruginosa. Bacterial Etiology in COPD Exacerbations.     

吸入呋塞米对急性发作期支气管哮喘患者肺通气功能的影响

目的 探讨吸入呋塞米对急性发作期支气管哮喘（哮喘）患者肺通气功能的影响。方法 将６例经、中度发作期哮喘患者随机分为Ａ、Ｂ、Ｃ三组,每组各２０例。Ａ组吸入生理盐水５ｍｌ,Ｂ组吸入呋塞米５０ｍｇ（５ｍｌ,１０ｍｇ／ｍｌ）,Ｃ组吸入０．１％沙丁胺醇溶液５ｍｌ。观察三组患者吸药后１５ｍｉｎ肺通气功能的变化。结果 吸药后１５ｍｉｎＢ、Ｃ组用力肺活量（ＦＶＣ）、第１ｓ用力呼气容积（ＦＥＶ１）、最在呼气流量（Ｐ