硫酸镁治疗慢性阻塞性肺疾病的Meta分析

目的系统评价硫酸镁治疗慢性阻塞性肺疾病的有效性与安全性。方法计算机检索Pubmed、Cochrane Library、Embase、CBM、CNKI、VIP、中华医学会数字化期刊、ISI Web of Knowledge等数据库。纳入硫酸镁静脉给药治疗慢性阻塞性肺疾病的随机对照试验（RCT）,检索时限均为建库至2015年2月。由2位研究者按照纳入与排除标准选择文献并进行质量评价,再采用RevMan5.0软件进行Meta分析。结果共计15个RCT, 955例患者。与对照组相比,硫酸镁有较高的临床体征改善率(OR=3.22,95%CI=1.87~5.55,P<0.01),能够改善患者第一秒用力呼气容积占预计值百分比（the first second forced expiratory volume percentage of expected value,FEV1%）(MD=10.17,95%CI=9.07~11.18,P<0.01)。但是同对照组相比,硫酸镁对患者第一秒呼气量（forced expiratory volume in one second,FEV1）(MD=0.05,95%CI=0.00~0.10,P=0.03)、第一秒呼吸容积占用力肺活量百分比（the first seconds breathing volume percentage of forced vital capacity,FEV1/FVC）(MD=1.43,95%CI=0.00~2.85,P=0.05)、动脉血气pH(MD=-0.01,95%CI=-0.03~0.01,P=0.43)、动脉血气PO2(MD=-3.97,95%CI=-7.41~15.35,P=0.49)、动脉血气PCO2 (MD=0.94,95%CI=-2.69~4.57,P=0.61)的改善均无显著影响,其不良反应发生率与对照组相似(MD=-0.94,95%CI=-0.23~0.04,P=0.19)。临床体征缓解率、不良反应发生率的漏斗图两侧显示不对称,提示纳入评价的文献存在发表性偏倚。结论静脉滴注硫酸镁可以显著改善患者肺功能的FEV1%,明显改善临床体征,且不良反应发生率较低,但对其他试验指标改善不明显。受纳入研究数量及质量限制,上述结论尚需要更多高质量、大样本、多中心的RCT加以验证。     

Self‐management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study

Title. Self‐management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study. Aim. This paper is a report of a study to explore the self‐management behaviours of patients with chronic obstructive pulmonary disease (COPD). Background. Chronic obstructive pulmonary disease is a major cause of chronic morbidity and mortality throughout the world. A patient‐centred perspective calls for the investigation of self‐management behaviours as means to develop self‐management programmes and enhance quality of life for patients with COPD. Method. The participants were a convenience sample of 18 patients with COPD of various severities. Interview data were collected in the thoracic ward, outpatient department and pulmonary rehabilitation unit of a medical centre in Taiwan from November 2006 to April 2007. Findings. Participants demonstrated the ability to choose suitable disease management behaviours to prevent symptoms and complications. Five themes of disease management behaviours were identified: symptom management, activity and exercise implementation, environmental control, emotional adaptation and maintaining a healthy lifestyle. Conclusion. Participants are experts on their lives and, as such, they adopt appropriate disease control behaviours, based on their experience and knowledge, as well as integrate the illness and its symptoms into their lives. With the worldwide increase in migration, an understanding of the cultural factors that influence patients’ perspectives on self‐management behaviours is necessary and can contribute to the development of an evidence‐based programme for disease self‐management with COPD.     

Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study

Title. Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study Aim. This paper is a report of a study to describe the essential structure of the lived experience of living with severe chronic obstructive pulmonary disease (COPD) during the palliative phase of the disease. Background. Chronic obstructive pulmonary disease is one of the most common diseases throughout the world. Shortness of breath, fatigue and cough are the most troublesome symptoms, and living with COPD often imposes limitations on daily living. The disease has a great impact on quality of life and affects the extent to which people can be active in daily life. Methods. We conducted qualitative interviews of eight people with COPD and collected data over a 2‐month period in 2003. Our patients were recruited from two pulmonary disease clinics in West Sweden. We used a phenomenological methodology to analyse the interviews. Findings. Daily life for people with COPD is affected in several different ways. The patients described how their physical limitations forced them to refrain from meaningful activities in everyday life and led to social isolation. Everyday emotions vacillated between viewing life as meaningful and meaningless. A sense of involvement and the belief that life was meaningful gave the individual the energy and the desire to continue living and to envision a future. Conclusion. Nursing care should include support and facilitation, so that patients can live rather than exist to the end of their lives. It is important to learn from patients and tailor activities to their social, existential and physical priorities, where appropriate family‐centred support may be most effective.     

99m锝-二乙三胺五乙酸气溶胶肺通气指数在慢性阻塞性肺疾病肺功能评估中的价值

目的研究99m锝-二乙三胺五乙酸(Tc-DTPA)气溶胶肺通气显像的通气指数(ventilation index,VI)与慢性阻塞性肺病(COPD)肺功能之间的关系。方法 42例COPD患者均行气溶胶肺通气显像和COPD肺功能分级。肺通气显像结束后,利用感兴趣区(region of interest,ROI)技术分析左右肺中央带、周围带的放射性分布情况,并计算得到VI。分析肺功能分级和VI之间的关系。结果 VI≥50%组第1秒用力呼气容积(FEV1%)和FEV1/用力肺活量(FVC)分别为:(51.8±18.2)%和(60.0±11.9)%,VI<50%组FEV1%和FEV1/FVC分别为(40.5±13.0)%和(51.7±9.3)%,两组之间差异有统计学意义(P<0.05)。且FEV1%和VI之间有很好的相关性(r=0.391,P<0.05),FEV1/FVC与VI之间也有很好的相关性(r=0.517,P<0.01)。但FVC与VI之间无相关性(r=0.123,P>0.05)。结论 VI和COPD肺功能分级之间有很好的相关性。VI可直接和准确的预测和显示肺内的气体分布。联合应用VI和COPD分级能更准确的评估肺功能。     

慢性阻塞性肺疾病患者肺功能曲线α角与 BODE 指数的关系

目的：对先前提出的一个描述气流阻塞程度的参数α角进一步验证其合理性,探讨此参数与 BODE 指数在慢性阻塞性肺疾病(COPD)患者中的关系。方法于2010年1月至2012年3月,电话随诊稳定期 COPD 患者,以肺功能指标为标准分为轻度阻塞、中度阻塞、重度阻塞3组,然后各组分别随机选取患者35例,查改良的英国医学研究委员会呼吸困难量表(MMRC)呼吸困难评分、6分钟步行距离(6MWD),计算 BODE 指数;测量α角。结果COPD 患者α角随着阻塞程度的加重逐渐变小,对应的流速和呼出气量与呼气1秒时的流速和呼出气量呈正相关,α角大小与 BODE 指数呈负相关。结论α角可一定程度上反映 COPD 患者气流阻塞程度、肺功能曲线形态、运动耐量水平。     

慢性阻塞性肺疾病伴呼吸衰竭患者两种通气模式应用效果比较

目的探讨两种不同呼吸机通气模式对慢性阻塞性肺疾病伴呼吸衰竭患者的影响。方法 85例COPD合并呼吸衰竭患者分为2组,观察组(n=41)患者采用适用性支持通气模式(ASV),对照组(n=44)患者采用压力支持通气模式(PSV)和同步间歇指令通气模式(SIMV)。结果 2组患者HR、呼吸频率、MAP、pH、SpO_2、p(O_2)、p(CO_2)及p(A-a)O_2指标比较无显著差异(P0.05)。观察组MRV显著高于对照组(P0.01),潮气量(VT)显著低于对照组(P0.01)。观察组患者吸气流量显著高于对照组(P0.01),呼吸比、气道闭合压显著低于对照组(P0.05)。观察组患者并发症发生率显著低于对照组(P0.05)。结论相比SIMV+PSV模式,ASV通气模式可以维持COPD伴呼衰患者自主呼吸功能。     

慢性阻塞性肺疾病CT定量参数改变及其与肺功能指标的关系

目的 观察未经治疗COPD患者CT定量参数变化及其与肺功能指标的关系。方法 回顾性分析99例未经治疗COPD患者资料;根据气流受限程度分为A组(GOLD 1级,轻度受限,36例)、B组(GOLD 2级,中度受限,37例)及C组(GOLD 3、4级,明显受限,26例);分析首检及随访胸部CT定量参数、肺功能指标的差异及其相关性。CT定量参数包括全肺容积、低衰减区百分比(LAA%)、肺血管总计数与肺表面积比值(N_total/LSA)、截面积<5 mm²的肺血管计数与肺表面积比值(N_{<5 mm²}/LSA)、理论气道内周长为10 mm的管壁面积平方根(Pi10)、全肺气道壁体积、壁厚及壁面积百分比(WA%)等,而肺功能指标包括吸入支气管舒张剂后第1秒用力呼气容积(FEV₁)、用力肺活量(FVC)及二者比值(FEV₁/FVC)和FEV₁率(FEV₁%)。结果 相比首检各项指标,随访时各组FVC、FEV_...     

社区慢性阻塞性肺疾病缓解期患者遵医行为的调查分析

目的 了解社区慢性阻塞性肺疾病缓解期患者的遵医行为.方法 对32例患者进行问卷调查,计数资料以百分比统计.结果 慢性阻塞性肺疾病缓解期患者对纠正不良生活习惯、药物治疗、康复训练的重要性认识不足,不能按医嘱正确实施,疾病出现反复时多数患者没有立即就医.结论 慢性阻塞性肺疾病缓解期患者对疾病遵医行为和正确认知态度不仅有个体和时间段坚持性的差异,同时受亲情等因素的影响,社区卫生服务中应提供更客观、符合个体需求的有效服务措施.     

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。     

Care of patients with chronic obstructive pulmonary disease in primary health care

Aim.  This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease.
Background.  Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved.
Method.  A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease.
Findings.  In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments.
Conclusion.  The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.     

便携式纤支镜在慢阻肺合并严重呼吸衰竭治疗中的应用价值

目的 探讨便携式纤维支气管镜(简称纤支镜)在慢性阻塞性肺疾病急性加重期(AECOPD)合并严重呼吸衰竭治疗中的价值.方法 98例AECOPD合并严重Ⅱ型呼吸衰竭患者,予以抗感染等基础治疗,纤支镜组50例:纤支镜引导经鼻气管插管及经纤支镜吸痰、支气管肺泡灌洗后有创无创序贯机械通气治疗,对照组48例:喉镜直视下经口气管插管、常规负压吸痰有创无创序贯机械通气治疗.比较两组的1次插管成功率、并发症发生率、平均插管时间、痰培养阳性率、呼吸衰竭纠正时间、肺部感染控制窗(PIC)出现时间、有创通气时间、呼吸机相关性肺炎(VAP)发生率、鼻窦炎发生率及病死率.结果 纤支镜组1次插管成功率明显高于对照组(P<0.01),插管并发症和平均插管时间显著低于对照组(P<0.05);两组均无鼻窦炎发生,两组其他观察指标的差异均有显著性(P<0.05).结论 便携式纤维支气管镜引导经鼻气管插管及经纤支镜吸痰、支气管肺泡灌洗联合有创机械通气治疗在AECOPD合并严重呼吸衰竭治疗中安全有效,具有重要的临床应用价值.     

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。     

沙美特罗／丙酸氟替卡松治疗慢性阻塞性肺疾病的临床疗效

目的观察沙羡特罗／丙酸氟替卡松吸入剂（舒利迭）对稳定期、重度及重度以上的慢性阻塞性肺疾病（COPD）患者肺功能的影响和总经济费用的改变。方法将明确诊断的90例COPD患者随机分为对照组和试验组,对照组给予溴已新（必嗽平）和缓释茶碱片（舒弗美）,必嗽平16mg口服,每日3次,舒弗美0．2g口服,每12小时1次,试验组在对照组治疗基础上给予舒利迭50／500btg,每次1吸,每12小时1次。观察期为6个月,期间各组均可按需使用短效扩张剂。在疗程前后分别检测肺功能指标和症状评分,并记录两组的总经济费用。结果与对照组比较,治疗后试验组1秒用力呼气容积（FEVI）（1．68±0．28）LVS（1．46±0．16）L（P〈0．05）、用力肺活量（FVC）（3．43±0．5）LVS（3．02±0．4）L（P〈0．05）、FEV1／FVC（53．4±9．0VS48．9±5．8,P〈0．01）;症状评分（37．6±0．9）分VS（42．5±0．8）分均有不同程度的改善,差异有统计学意义（P〈0．05）。试验组的急性加重次数、住院次数及天数、总经济费用明显低于对照组（均P〈0．01）。结论舒利迭能够改善稳定期、严重程度为重度及重度以上COPD患者的肺功能,降低总经济费用。     

The use of telecare for people with chronic obstructive pulmonary disease: implications for management

AIM: To evaluate the telecare service offered by Home Care teams to patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: The use of telecare aims to support older people in remaining independent at home, reducing hospital admissions and improving the quality of life for older people and their informal carers. In the redesign of managed care for people with COPD using telecare, an evaluation of the implementation process is necessary. METHOD: A focus group with Home Care teams and social care staff was conducted. Six case studies identified by nursing staff were used to examine key issues relating to telecare implementation. FINDINGS: The experience and expectation in telecare, the usability of equipment, and changes in practice can impact on COPD care. Case studies highlight that the rapid access to care, an increased sense of personal safety and security, and the continuity of care are perceived as benefits. However, the equipment was perceived as not 'user friendly' and bulky. CONCLUSION: It is important that any service redesign to include telecare is evaluated and targeted at its specific role. IMPLICATIONS FOR NURSING MANAGEMENT: Partnership working has to be negotiated, and leadership roles include addressing tensions and motivation within the team.     

慢性阻塞性肺疾病急性加重患者瘦素-胰岛素抵抗与肺功能的相关研究

目的 研究慢性阻塞性肺疾病急性加重(AECOPD)患者瘦素(Leptin)-胰岛素抵抗与肺功能的关系.方法 选择56例AECOPD患者,按空腹血糖(FBG)水平将其分成两组:高血糖组(FBG≥6.2 mmol/L)42例,低血糖组(FBG 3.1～6.2 mmol/L)14例,并设正常对照组20例[FBG为(5.49±1.06)mmol/L].所有入选者均常规测定FBG、C-反应蛋白(CRP)、血清白蛋白(ALB);采用放射免疫法测定Leptin、空腹血清胰岛素(FISN)、胰岛素敏感性(ISI).肺功能及呼吸阻抗测定并记录如下指标:1秒用力呼气容积(FEV1)、1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、最大呼气流量(PEF)、最大呼气中段流量(MMEF)、呼吸总阻抗(Zrs)、气道总阻力(R5)、中心气道阻力(R20)、呼吸阻抗中弹性阻力和惯性阻力之和(X5,X20)、中心阻力(Rc)、周边阻力(Rp)、共振频率(Fres).结果 与正常对照组比较,高血糖组FBG、FISN、CRP均显著升高,体质指数(BMI)、ALB、ISI均显著降低,差异均有显著性(P均＜0.01),而Leptin差异无显著性(P＞0.05);低血糖组CRP、FISN显著升高,BMI、ALB、Leptin、ISI均显著降低,差异均有显著性(P＜0.05或P＜0.01).与低血糖组比较,高血糖组FBG、FISN、Leptin、CRP均显著升高,ISI显著降低,差异均有显著性(P均＜0.01),而BMI、ALB无明显变化(P均＞0.05).相关性分析显示:Leptin与Zrs、R5、R20、Rc、BMI呈显著正相关(P均＜0.01),与FEV1、X20呈显著负相关(P＜0.01和P＜0.05),与FEV1/FVC、PEF、MMEF、X5、Rp、Fres则无显著相关性(P均＞0.05);ISI与FEV1/FVC、FEV1、PEF、MMEF呈显著正相关(P＜0.05或P＜0.01),与Zrs、R5、R20、X5、Rc、Rp、X20、BMI呈显著负相关(P＜0.05或P＜0.01),而与Fres则无明显相关性.高血糖组平均住院天数[(25.00±0.13)d]较低血糖组[(17.93±0.22)d]显著延长(P＜0.01),合并多脏器功能衰竭发生率(14%,6/42例)明显高于低血糖组(7%,1/14例),差异有显著性(P＜0.01).结论 AECOPD在应激状态下可诱发高血糖,Leptin-胰岛素抵抗可加重肺功能损害,延长患者住院天数.     

奥氮平治疗慢性阻塞性肺病呼吸衰竭伴精神兴奋症状临床分析

目的探讨奥氮平对慢性阻塞性肺病（COPD）呼吸衰竭伴精神兴奋症状的治疗效果和安全性。方法48例COPD呼吸衰竭伴精神兴奋症状患者随机分成治疗组及对照组,对照组仅行常规抗感染、平喘、化痰等药物治疗,治疗组在常规药物治疗的基础上奥氮平治疗。比较治疗前、治疗后3d两组精神兴奋症状改善及血气分析变化。结果治疗组总有效率显著高于对照组（P〈0．05）,治疗后3天两组血气分析（PaO2、PaCO2）比较无明显差异。结论奥氮平可以安全地用于COPD呼吸衰竭伴精神兴奋症状患者的治疗。     

COPD病人肺康复运动训练的质性研究

目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病人肺康复运动训练的影响因素,为更好地开展肺康复运动提供指导,从而进一步提高慢性阻塞性肺疾病病人的运动耐量和生活质量。方法:采用质性研究中现象学方法,以半结构式深入访谈了12例慢性阻塞性肺疾病病人,包括有意愿、已参与和拒绝或中途退出肺康复运动项目的病人。结果:运用Colaizzi分析程序进行分析,得到影响病人肺康复运动训练的因素,并归纳为4个主题:慢性阻塞性肺疾病病人的个人因素;客观因素;家庭成员的态度及锻炼环境因素;住院期间医护人员因素。结论:加强对慢性阻塞性肺疾病病人肺康复运动的宣教,提高病人的依从性和积极性,在临床护理中,发挥医务人员的主导作用,鼓励病人家属的支持并合理的利用社区资源,促使病人形成健康的行为习惯,以促进康复、提高生活质量。