呋塞米吸入治疗对老年慢性哮喘患者肺功能和外周血T淋巴？…

目的 评价呋塞米（速尿）吸入对老年人慢性哮喘的治疗效果。方法 ７２例老年慢性哮喘患者分别给予速尿（Ａ组），速尿＋溴化异丙托品（Ｂ组）和溴化民丙托品（Ｃ组）治疗，每组各２４例，并与６０例非老年慢性哮喘患者的结果进行比较，吸入前后测肺功能（最大肺活量（ＦＶＣ），一秒钟最大呼气量（ＦＥＶ１），最大呼气流速（ＰＥＦＲ）和外周血Ｔ细胞亚群，结果 老年组总有效率（有效＋显效），Ａ，Ｂ，Ｃ组分别为７５％，９２％     

呋塞米吸入治疗对老年慢性哮喘患者肺功能和外周血T淋巴细胞亚群的影响

目的评价呋塞米（速尿）吸入对老年人慢性哮喘的治疗效果。方法７２例老年慢性哮喘患者分别给予速尿（Ａ组）、速尿＋溴化异丙托品（Ｂ组）和溴化异丙托品（Ｃ组）治疗，每组各２４例，并与６０例非老年慢性哮喘患者的结果进行比较。吸入前后测肺功能〔最大肺活量（ＦＶＣ）、一秒钟最大呼气量（ＦＥＶ１）、最大呼气流速（ＰＥＦＲ）〕和外周血Ｔ细胞亚群。结果老年组总有效率（有效＋显效），Ａ、Ｂ、Ｃ组分别为７５％、９２％、６７％。肺功能和Ｔ细胞亚群改变：Ａ组ＦＥＶ１和ＣＤ４吸入前后变化差异有显著性（Ｐ＜００５）；Ｂ组肺功能指标和ＣＤ４、ＣＤ８、ＣＤ４／ＣＤ８差异有非常显著性（Ｐ＜００１或０００１）；Ｃ组除ＰＥＦＲ有显著变化（Ｐ＜００５）外，余项也有改善，但无统计学意义。非老年组的疗效与老年组疗效基本相同。结论速尿吸入对老年人慢性哮喘有防治作用，特别是速尿＋溴化异丙托品联合吸入效果更好     

内源性一氧化氮对哮喘患者白细胞介素(IL)-4、IL-5及γ干扰素表达的影响

为探讨哮喘发病中Ｔｈ１和Ｔｈ２细胞间功能不平衡的原因及调节机制,本组观察了哮喘发作期患者外周血淋巴细胞（ＰＢＬ）白细胞介素（ＩＬ）４、ＩＬ５和γ干扰素（ＩＦＮγ）ｍＲＮＡ表达及分泌水平的变化,并观察体外实验中左旋精氨酸（ＬＡｒｇ）及Ｎω左旋精氨酸甲酯（ＬＮＡＭＥ）对其的影响。一、对象与方法１．对象：哮喘组：根据１９９７年全国哮喘会议制订的诊断标准［１］诊断的１０例哮喘发作期患者,男女各５例,平均年龄３４岁,均为支气管舒张试验１秒钟用力呼气容积占用力肺活量比值（ＦＥＶ１％）＞１５％或乙…     

二丙酸倍氯米松干粉剂治疗晚发老年哮喘的临床观察

目的 观察吸入类固醇二丙酸倍氯米松（ＤＢＰ）干粉剂对晚发老年哮喘（ＬＯＡ）的疗效。方法 将２２例ＬＯＡ患者与２３例非老年２哮喘患者进行对比研究,观察吸入β２受体激动剂沙丁胺醇干粉剂后１秒钟用力呼气容积（ＦＥＶ１）的变化以及吸入ＤＢＰ干粉剂后ＦＥＶ１及其占预计值百分比（ＦＥＶ１％）、早晚最大呼气流速（ＰＥＦＲ）及其日内变异率等变化。结果 两组患者在吸入沙丁胺醇干粉剂后ＦＥＶ１均明显增高（Ｐ〈０．０１     

吸入糖皮质激素治疗非哮喘性慢性阻塞性疾病的研究

目的 研究中等剂量二丙酸氯地米松（ＢＤＰ）短疗程吸入治疗非哮喘慢性阻塞性肺疾病（ＣＯＰＤ）是否有疗效，方法 按照随机，对照，单盲的设计，６１例非哮喘性ＣＯＰＤ患分两组，分别予ＢＤＰ（１０００μｇ．ｄ＾－１）与安慰剂吸入治疗６周，治疗前后测定肺功能一秒钟用力呼气容积（ＦＥＶ１）用力肺活量（ＦＶＣ），最大呼气中段流速（ＭＭＥＦ）值和血浆内纱（ＥＴ－１）的浓度，并记录临床症状记分，生活质量记分，结果     

溴化异丙托品与沙丁胺醇雾化吸入对COPD病人的支气管扩张作用

以随机公开对照试验比起对ＣＯＰＤ病人的支气管扩张作用及副作用．雾化吸入沙丁胺醇（５００μｇ）为Ａ组１６例；雾化吸入溴优异丙托品（５０μｇ）为Ｂ组１５例，雾化吸入沙丁胺醇（５０μｇ）合并异丙托品（５００μｇ）为Ｃ组１５例。结果：Ａ组１５分钟起效；Ｂ组６０分钟起效，其ＦＥＶ１（第一秒用力肺活量）及ＦＶＣ（用力肺活量）的最大改善率（２２．０％、２２．７％）与Ａ给（２１．５％、２３．２％）相比无差异（Ｐ＞０．０５），Ｃ组５、１５分钟ＦＥＶ１的改善率（８．７％、１３．０％）高于Ｂ组（０％、２％）；１８０、３６０分钟ＦＥＶ１的改善率为（２３．９％、１７．３％）高于Ａ组（１３．７％、５．８％）（Ｐ＜０．０５），ＦＶＣ与ＦＥＶ１的改变相近，三组均无严重的副反应。提示：ＣＯＰＤ患者雾化吸入异丙托品具有与沙丁胺醇相近的气道扩张作用．但起效慢．两者合用时，起效快，持续时间长，作用优于单药应用．     

哮喘患者外周血单个核细胞中白细胞介素—6mRNA表达与气道炎症的 …

目的 探讨外周血单个核细胞（ＰＢＭＣ）中白细胞介素（ＩＬ）－６ｍＲＮＡ表达与血嗜酸细胞阳离子蛋白（ＥＣＰ）和１秒用力呼气容积占用力肺活量比值（ＦＥＶ１％）的关系。方法 对１２例过敏性哮喘发作期患者、８例缓解期患者及９例健康人，采用ＲＴ－ＰＣＲ法和图像分析半定量法检测ＰＢＭＣ中ＩＬ－６ｍＲＮＡ的表达水平及ＥＣＰ和ＦＥＶ１％。结果 发作期患者ＩＬ－６ｍＲＮＡ的表达明显高于缓解期患者和健康人（Ｐ〈０．０     

外源性一氧化氮及氦—氧混合气对支气管哮喘患者通气功能的影响

目的 探讨同时吸入氦－氧混合气和不同浓度的一氧化氮（ＮＯ）对支气管哮喘患者通气功能的影响。方法 选取１８例哮喘患者随机分为两组,一组吸入氦－氧混合气的同时加入１００ｐｐｍ的ＮＯ,另一组则加入４０ｐｐｍ的ＮＯ。在不同时间检测患者的通气功能,并与吸入β２受体激动剂进行比较。结果 哮喘患者吸入氦－氧混合气后与呼吸空气比较其用力肺活量（ＦＶＣ）、１秒钟用于呼气容积（ＦＥＶ１）、呼气流速峰值（ＰＥＦＲ）和最     

糖皮质激素对哮喘患者白细胞介素—5mRNA表达与嗜酸性粒细胞激活作…

为了观察糖皮质激素对哮喘患者白细胞介素（ＩＬ）－５ｍＲＮＡ表达与嗜酸性粒细胞激活作用的影响，本研究用逆转录（ＲＴ）－聚合酶链反应（ＰＣＲ）法半定量分析了哮喘患者用糖皮质激素治疗前后外周血单个核细胞（ＰＢＭＣ）中ＩＬ－５ｍＲＮＡ表达水平的变化，检测了血清嗜酸细胞阳离子蛋白（ＥＣＰ）浓度、一秒钟用力呼气容积（ＥＦＶ１）下降２０％时的乙酰甲胆碱（ＭＣＨ）激发浓度（ＭＣＨ－ＰＣ２０值）和基础ＦＥＶ１占用力     

哮喘患者外周血单个核细胞中白细胞介素-6 mRNA表达与气道炎症的研究

目的探讨外周血单个核细胞（ＰＢＭＣ）中白细胞介素（ＩＬ）６ｍＲＮＡ表达与血嗜酸细胞阳离子蛋白（ＥＣＰ）和１秒用力呼气容积占用力肺活量比值（ＦＥＶ１％）的关系。方法对１２例过敏性哮喘发作期患者、８例缓解期患者及９例健康人，采用ＲＴＰＣＲ法和图像分析半定量法检测ＰＢＭＣ中ＩＬ６ｍＲＮＡ的表达水平及ＥＣＰ和ＦＥＶ１％。结果发作期患者ＩＬ６ｍＲＮＡ的表达明显高于缓解期患者和健康人（Ｐ＜００１），而缓解期患者无明显升高。发作期患者ＩＬ６ｍＲＮＡ的表达水平与血清ＥＣＰ呈中度正相关（ｒ＝０６７９，Ｐ＜００１），而与ＦＥＶ１％呈中度负相关（ｒ＝－０５８９，Ｐ＜００５）。结论过敏性哮喘发作期患者ＰＢＭＣ中ＩＬ６ｍＲＮＡ表达水平显著增强。其气道炎症程度与ＩＬ６基因转录增强有关     

综合排痰护理改善老年支气管哮喘急性发作期患者肺功能的研究

目的 探讨综合排痰护理对老年支气管哮喘急性发作期肺功能的影响,为寻求有效的护理手段提供依据。方法选择2011年11月至2013年4月老年支气管哮喘急性发作期住院患者100例,随机分为常规护理组（n=50）和排痰护理组（n=50）,常规护理组患者仅采用常规护理,排痰护理组在常规护理基础上再加综合排痰护理,连续7d。分别对2组患者的临床疗效、肺功能变化[（1秒用力呼气容积／用力呼气量预计值的百分比（FEV1％）,1秒用力呼气容积／用力肺活量百分比（FEV1／FVC）,最大呼气峰值流速实测值占预计值的百分比（PEF％）]等进行检测及统计分析。结果排痰护理纽显效29例、有效14例、无效7例、总有效率为86％,而常规护理组显效22例、有效15例、无效13例、总有效率为74％,排痰护理组总有效率高于常规护理组,但差异无统计学意义（P〉0．05）;与治疗前比较,2组治疗后FEV,％、FEV,／FVC和PEF％均明显升高（P〈0．05）;与常规护理组治疗后比较,排痰护理组治疗后的FEV1％、FEV1／FVC和PEF％皆显著升高,差异有统计学意义（P〈0．05）。结论 综合排痰护理对老年支气管哮喘急性发作期患者肺功能有较显著的改善效果。     

Determination of bronchodilation in the clinical pulmonary function laboratory. Role of changes in static lung volumes

Improved airway resistance following bronchodilator inhalation is not always accompanied by improvement in forced expiratory flow. We studied 241 patients with airways obstruction to learn whether changes in static lung volumes (vital capacity and function residual capacity measured by body plethysmography [FRCB]) would reveal bronchodilation not demonstrated by expiratory flow rates (the ratio of forced vital capacity at one second to the total forced vital capacity [FEV1/FVC]), and the forced expiratory flow for the midportion of the forced vital capacity (FEF25--75%). A significant fall in Raw occurred in 129 patients, 46 of whom had a significant increase in vital capacity (mean of + 465 ml +/- 43, P less than 0.001) and a fall in FRCB (mean of -763 ml +/- 78 P less than 0.001) with no change in FEV1/FVC% of FEF25--75%. We interpret these data to indicate that improvement in static lung volumes can reflect bronchodilation in the absence of improved expiratory flow.     

细辛脑雾化吸入佐治老年支气管哮喘急性发作期的临床疗效

目的探讨细辛脑雾化吸人佐治老年支气管哮喘急性发作期的临床疗效。方法选择住院治疗的支气管哮喘急性发作期老年患者70例,其中男性43例,女性27例,年龄60～78岁,平均（69．2±4．8）岁。随机分为常规治疗组（对照组）和细辛脑佐治组（试验组）,每组各35例。常规治疗组患者接受常规治疗;细辛脑佐治组患者在常规治疗基础上加用细辛脑注射液雾化吸人,共7d。对两组患者的疗效、临床症状与体征消失时间、肺功能变化[（第一秒用力呼气容积／用力呼气量预计值的百分比（FEV,％）,第一秒用力呼气容积／用力肺活量百分比（FEV1／FVC％）,最大呼气峰值流速实测值占预计值的百分比（PEF％）]等进行比较及统计学分析。结果细辛脑佐治组的有效率明显高于常规治疗组（P〈0．05）,喘息、咳嗽、胸闷、肺部哮鸣音等症状、体征消失时间明显少于常规治疗组（均P〈0,01、P〈0．05）。与两组治疗前比较,两组治疗后FEV1％、FEV1／FVC％和PEF％均显著升高（P〈0．01）;与常规治疗组治疗后比较,细辛脑佐治组治疗后的FEV1％、FEV1／FVC％和PEF预计值皆明显升高,差异有统计学意义（P〈0．01）。结论细辛脑对老年支气管哮喘有很好的辅助疗效。     

Furosemide Given by Inhalation Ameliorates Acute Exacerbation of Asthma

Previous studies have suggested that inhaled furosemide may have a protective effect against a wide variety of bronchoconstrictor agents, but a therapeutic effect has not been established in acute exacerbation of asthma. The purpose of this study was to investigate whether inhaled furosemide would exhibit any therapeutic benefit in acute asthma. We conducted a double-blind, placebo-controlled, randomized study in 40 patients with acute mild or moderate exacerbation of asthma. All patients received intravenous (IV) aminophylline 250 mg for 90 min and IV hydrocortisone 100 mg at entry. After randomization, 3 patients were excluded from the final analysis. At 30 min after starting IV aminophylline, 20 patients were given inhaled furosemide 20 mg and 17 patients received normal saline as placebo-control. Both inhalations were given by a jet nebulizer. The baseline forced expiratory volume at 1 sec (FEV₁), peak expiratory flow rate (PEFR), and serum concentration of theophylline did not differ between the two groups. An increase in FEV₁ in the furosemide group by 28.2 ± 5.9% (mean ± SE) was noted at 60 min, and this was significantly higher than in the control group. PEFR at 60 min was also significantly higher in the furosemide group than in control group. We conclude that inhaled furosemide has a bronchodilator effect on mild to moderate exacerbation of asthma when it is used with IV theophylline. Inhaled furosemide may benefit certain acute asthma patients, especially those suffering complications from the adverse effects of β₂-agonists.     

Furosemide plus albuterol compared with albuterol alone in children with acute asthma.

Several reports have shown that inhaled furosemide protects patients with asthma from different bronchoconstrictor agents. However, the effect of this widely used diuretic in acute exacerbation in adults is unproven. There are no reports of furosemide's therapeutic effect in acute asthma in children; thus, the objective of this study was to determine the effectiveness of the combined treatment of furosemide and albuterol in pediatric patients. Using a double-blind design, 20 emergency room patients with an asthmatic exacerbation were studied and randomly assigned to one of the following treatments: (1) furosemide + albuterol (1 and 0.15 mg/kg, respectively) or (2) albuterol (0.15 mg/kg). The forced expiratory volume in one second (FEV1) was measured in each patient before medication and then 30 and 60 minutes after inhalation of the individual drug or drug combination. Neither group differed in age or baseline FEV1. An increase in FEV1 of 22.8 +/- 4.3% (mean +/- SE) in the drug combination group was noted at 60 minutes, and an increase in FEV1 of 18.0 +/- 2.6% in the albuterol group was obtained at the same time. Although the increase in FEV1 was greater in the first group after 1 hour of treatment, this was not significant. These results suggest that inhaled furosemide does not have a synergistic effect with albuterol in the treatment of asthmatic exacerbations in children.     

血液透析患者肺功能与炎性标志物的关系

目的探讨血液透析患者的肺功能与血清超敏C-反应蛋白（hs-CRP）、白蛋白（Alb）及铁蛋白（Ferr）水平之间的相关性。方法选择安徽医科大学第一附属医院血液净化中心门诊和住院血液透析超过3个月的患者108例,根据患者的血清hs—CRP、白蛋白、铁蛋白水平将其分别为两组（hs—CRP≥10mg／L、hs-CRP〈10mg／L;Alb≥35g／L、Alb〈35g／L;Ferr≥150μg／L、Ferr〈150μg／L）,测定并比较两组间患者肺功能差异。结果通过测量用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、呼吸峰流量（PEF）来检测肺功能,数据以FVC％,FEV1％,和PEF％呈现,CRP≥10μg／ml的患者相比CRP正常患者年龄更大;FEV1％,FVC％和PEF％水平更低（P=0．005,P=0．001,P=0．015）。铁蛋白≥150仙g／L和铁蛋白正常患者相比,FEV1％（P=0．035）、FVC％（P=0．019）和PEF％（P=0．021）三项也均有显著差异,白蛋白和肺功能检测指标间无显著统计学意义差异。结论血液透析患者血清CRP、铁蛋白水平增高可能与肺功能障碍具有相关性。     

Effects of inhaled steroids on methacholine-induced bronchoconstriction and gas trapping in mild asthma.

According to a recent hypothesis, airway smooth muscle regulates airway calibre mostly at high lung volume, whereas the mucosa and adventitia dimensions dominate at low lung volumes. It was thought that if inhaled steroids decrease the thickness of airway wall in asthma, then forced vital capacity (FVC), which reflects the functional changes at low lung volume, should decrease less during induced bronchoconstriction than flow at high volume. The study was conducted in 31 mild asthmatics under control conditions and during a methacholine challenge before and after 4-weeks treatment with inhaled fluticasone dipropionate (1.5 mg daily, 16 patients) or placebo (15 patients). After fluticasone dipropionate treatment, control forced expiratory volume in one second (FEV1), and maximal flow at 50% of control FVC during forced expiration after a maximal (V'max,50) and a partial inspiration (V'p,50) significantly increased. During methacholine challenge, FVC decreased less than did FEV1 or V'max,50, and so did inspiratory vital capacity compared to V'p,50. Both the provocative dose of methacholine causing a 20% fall in FEV1 and the bronchodilator effect of deep inhalation significantly increased. The latter was assessed by means of the regression coefficient of all V'max,50 plotted against V'p,50. No significant changes in these parameters occurred after placebo. These data show that inhaled steroids remarkably blunt the occurrence of gas trapping during induced bronchoconstriction in mild bronchial asthma, possibly due to their effect on airway wall remodelling.     

速尿雾化吸入对哮喘发作期患者肺功能的影响

目的：观察速尿雾化吸入对哮喘发作期患肺功能的影响。方法：将哮喘发作期患64例，随机分为治疗组和对照组，治疗组以速尿60mg 生理盐水4ml雾化吸入，对照组以生理盐水10ml雾化吸入；两组均于吸药前及吸药后30min记录症状、肺部罗音及测量肺功能（FVC、FEV1、PEF、V50、V25），其占预计值百分比依次为（FVC％，FEV1％、PEF％、V56％及V25％），同时治疗组分别没量心率、血压及呼吸频率，并观察各项指标的变化。结果：治疗组经速尿雾化吸入后临床症状及肺功能有明显改善，差异有非常显性（P＜0．01），吸药前、后心率、血压及呼吸频率比较差异不明显（P＞0．05）。结论：吸入速尿对急发期哮喘患有非常明显的平喘作用，并能改善肺功能，而又不增加心率及升高血压。     

Definition of Asthma: A Critical Review: One Brief and One Comprehensive Definition

Previous studies have suggested that inhaled furosemide may have a protective effect against a wide variety of bronchoconstrictor agents, but a therapeutic effect has not been established in acute exacerbation of asthma. The purpose of this study was to investigate whether inhaled furosemide would exhibit any therapeutic benefit in acute asthma. We conducted a double-blind, placebo-controlled, randomized study in 40 patients with acute mild or moderate exacerbation of asthma. All patients received intravenous (IV) aminophylline 250 mg for 90 min and IV hydrocortisone 100 mg at entry. After randomization, 3 patients were excluded from the final analysis. At 30 min after starting IV aminophylline, 20 patients were given inhaled furosemide 20 mg and 17 patients received normal saline as placebo-control. Both inhalations were given by a jet nebulizer. The baseline forced expiratory volume at 1 sec (FEV₁), peak expiratory flow rate (PEFR), and serum concentration of theophylline did not differ between the two groups. An increase in FEV₁ in the furosemide group by 28.2 ± 5.9% (mean ± SE) was noted at 60 min, and this was significantly higher than in the control group. PEFR at 60 min was also significantly higher in the furosemide group than in control group. We conclude that inhaled furosemide has a bronchodilator effect on mild to moderate exacerbation of asthma when it is used with IV theophylline. Inhaled furosemide may benefit certain acute asthma patients, especially those suffering complications from the adverse effects of β₂-agonists.     

Diagnosis of upper airway obstruction by pulmonary function testing.

We compared 11 patients with upper airway obstruction (obstruction at or proximal to the carina) to 22 patients with chronic obstructive pulmonary disease and to 15 normal subjects utilizing spirometry, lung volumes, airway resistance, maximal voluntary ventilation, single-breath diffusion capacity, and maximal inspiratory and expiratory flow-volume loops. Four values usually distinguished patients with upper airway obstruction: (1) forced inspiratory flow at 50 percent of the vital capacity (FIF50%) less than or equal to 100 L/min; (2) ratio of forced expiratory flow at 50 percent of the vital capacity of the FIR50% (FEF50%/FIF50%) larger than or equal to 1; (3) ratio of the forced expiratory volume in one second measured in milliliters to the peak expiratory flow rate in liters per minute (FEV1/PEFR) larger than or equal to 10 ml/L/min; and (4) ratio of the forced expired volume in one second to the forced expired volume in 0.5 second (FEV1/FEV0.5) larger than or equal to 1.5. The last ratio can be determined with a simple spirometer.