哮喘儿童肺通气功能检测的临床分析

目的：通过监测哮喘儿童急性发作期与缓解期肺通气功能各指标变化情况,了解其在儿童哮喘病情评估及指导治疗中的作用。方法应用德国Jaeger Master Screen肺功能仪对43例5～12岁哮喘急性发作期和经治疗后进入缓解期的哮喘儿童进行肺通气功能检测,包括大气道指标（ FVC、FEVl、FEV1/FVC、PEF）及小气道指标（ FEF25、FEF50、FEF75、MMEF75/25）,同时收集哮喘患儿病史资料和治疗情况。结果哮喘急性发作期患儿肺功能指标FVC、FEV1、FEV1/FVC、PEF与缓解期及健康对照组儿童比较,差异有统计学意义（ P＜0.01）;哮喘缓解期患儿的FVC、FEV1、PEF与健康对照组比较,差异无统计学意义（ P＞0.05）。小气道功能指标FEF25、FEF50、FEF75、MMEF75/25在哮喘急性发作期患儿中均明显降低,与缓解期组及健康对照组儿童相比差异有统计学意义（ P＜0.01）;哮喘治疗缓解期组中FEF25、FEF50、FEF75、MMEF75/25仍低于健康对照组,差异有统计学意义（ P＜0.05）。哮喘急性发作期不同严重程度患儿的肺通气功能指标（ FVC％pred、FEV1％pred、PEF％pred、FEF25％pred、FEF50％pred、FEF75％pred、MMEF75/25％pred ）随哮喘严重程度增加各指标越低,差异有统计学意义（ P＜0.05）。结论哮喘急性发作期肺通气功能受损,治疗缓解后小气道肺功能指标仍低于正常。肺通气功能的小气道功能指标在儿童哮喘的病情评估及治疗监测指导中意义更大。     

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。     

可必特雾化吸入治疗重症哮喘临床疗效分析

目的观察雾化吸入可必特（吸入用沙丁胺醇和异丙托溴铵溶液）对缓解支气管哮喘急性发作期（重度）疗效。方法选择支气管哮喘急性发作期（重度）患者70例,分为对照组35例治疗组35例,对照组给予甲基强的松龙、茶碱、β受体激动剂等常规治疗;治疗组在常规治疗的基础上给予可必特2.5ml雾化吸入每日2次。治疗后分别观察气喘缓解时间、哮鸣音消失时间、住院日及肺功能变化等。结果治疗组的气喘缓解时间、哮鸣音消失时间、住院日及肺功能FEV1、FVC、FVC%的改善作用高于对照组,且治疗组未发现严重副反应。结论可必特雾化吸入对缓解重症哮喘疗效好,与对照组相比肺功能等指标有显著差别（P〈0.01）,可缩短住院天数,未发现副作用。     

速尿雾化吸入对哮喘发作期患者的平喘作用

速尿雾化吸入对哮喘发作期患者的平喘作用齐激扬吕冬青赵瑾为了解和评价速尿在临床上的平喘效果，我们应用不同剂量的速尿雾化吸入治疗哮喘发作期患者。对其即时平喘作用及治疗后的肺功能变化并与对照组作了比较观察。对象经临床确诊的哮喘［１］发作期患者８３例。男３９...     

速尿吸入对哮喘患者肺功能与气道反应性的影响

目的　研究速尿吸入对哮喘患者肺功能与气道反应性的影响。方法　采用双盲随机方法 ,治疗组每次吸入速尿 (2 0mg ,每日 2次 )及其赋形剂 ;对照组仅吸入其赋形剂。结果　观察治疗 10d后 ,治疗组肺功能除个别指标外 ,均有不同程度改善 ,其中肺活量 (VC)、用力肺活量 (FVC)与第 1秒钟用力呼气容积 (FEV1)改善有显著意义。对照组治疗后肺功能也能获得一定改善 ,但均无统计学意义。结论　速尿雾化吸入可缓解哮喘 ,也对阐明药物治疗机理和哮喘发病的病生机理增添了新内容。     

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。     

不同分期支气管哮喘肺功能、嗜酸粒细胞的不同表达

目的观察哮喘患者急性发作期、缓解期的肺功能和血嗜酸粒细胞（EOS）的变化，探讨其临床意义。方法对57例急性发作期哮喘患者做肺功能测定和取外周血进行EOS的计数，经治疗后选取符合缓解期标准的患者50例，也做肺功能测定和外周血EOS的计数，比较两期患者肺功能及EOS测定结果。FEV1／FVC比值≥70％为肺功能正常，50％及25％用力肺活量时呼气流速（V50、V25）实测值／预测值〈70％为小气道功能异常。结果急性发作期哮喘患者外周血EOS明显高于缓解期组（P〈0．01），急性发作期患者肺功能FEV1明显低于缓解期，差异有显著性（P〈0．05）。V50、V25在急性发作期与缓解期相比较均差异无显著性（P〉0．05）。EOS与FEV1、V50、V25呈显著负相关（P〈0．05）。结论外周血EOS在哮喘急性发作时明显增加，提示EOS是反映气道炎症程度的可靠指标。反映小气道功能的V50、V25在急性发作期与缓解期变化不大，多数患者在缓解期仍存在小气道功能异常，提示缓解期气道炎症仍持续存在，需要做长期的维持治疗。     

布地奈德雾化吸入佐治老年支气管哮喘的临床疗效研究

目的探讨老年支气管哮喘的治疗方法。方法选择90例老年支气管哮喘急性发作期患者随机分为布地奈德佐治组（试验组）和常规治疗组（对照组）,每组各45例。对照组患者接受常规治疗;试验组患者在常规治疗基础上加用布地奈德雾化吸人,共2W。分别检测两组患者的疗效、临床症状与体征消失时间、第一秒用力呼气容积／用力呼气量预计值的百分比（FEV1％）、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％）,并进行比较与统计学分析。结果布地奈德佐治组的总有效率显著高于常规治疗组（84．44％VS．73．33％,P〈0．05）,咳嗽、喘息、胸闷、肺哮鸣音等症状、体征消失时间明显少于常规治疗组（均P〈0．01、P〈0．05）。各组治疗前后比较,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,布地奈德佐治组治疗后的FEV1％、FEV1／FVC％和PEF预计值均明显升高,差异有统计学意义（P〈0．01）。结论布地奈德对老年支气管哮喘有很好的辅助疗效。     

沙丁胺醇联合布地奈德雾化吸入治疗对支气管哮喘患者肺功能及炎症水平的影响

目的 分析沙丁胺醇联合布地奈德雾雾化吸入治疗对支气管哮喘患者肺功能及炎症水平的影响.方法 选取2018年1月-2018年12月我院收治的80例支气管哮喘患者为研究对象,按分层随机法分为观察组和对照组,各40例.对照组以布地奈德雾化吸入治疗,观察组在其基础上联合使用沙丁胺醇治疗,对比两组疗效及患者肺功能和炎症水平变化.结果 治疗后两组CRP、IL-6和TNF-α明显降低其观察组水平低于对照组(P<0.05);治疗后两组PEF较治疗前降低而FEV1和FEV1/FVC水平升高(P<0.05),观察组治疗后PEF低于对照组而FEV1和FEV1/FVC水平高于对照组(P<0.05);观察组治疗总有效率高于对照组(P<0.05);两组不良反应发生率比较无显著差异(P>0.05).结论 在支气管哮喘治疗中应用沙丁胺醇联合布地奈德雾化效果良好,可改善患者肺功能,缓解炎症反应,安全性高,值得应用.     

硫酸特布他林雾化吸入治疗慢性喘息性支气管炎疗效观察

目的　观察硫酸特布他林雾化吸入治疗慢性喘息性支气管炎的临床效果。方法　将 4 6例慢性喘息性支气管炎的患者随机分成两组 ,硫酸特布他林组治疗组 2 6例 ,生理盐水对照组 2 0例 ,分别给予硫酸特布他林 0 .2 5 mg加入 0 .9%生理盐水 4 ml雾化吸入 ,对照组为 0 .9%生理水 4 ml雾化吸入。雾化前后分别观察患者喘憋症状、肺部干罗音、心率、血气 (Pa O2 、Pa CO2 、PH)和肺功能 FEV1 .0 、PVC、PEF。结果　硫酸特布他林雾化吸入对慢性喘息性支气管炎临床症状和体征有明显改善 ,血氧分压由 6 2 .73mm Hg提高到 73.3mm Hg。肺功能 FEV1 .0 、FVC、PEF明显改善 ,治疗组明显优于对照组 ,且副作用小。结论　硫酸特布他林雾化吸入能有效缓解支气管痉挛 ,改善患者的临床症状 ,及通气功能。     

Effects of inhaled corticosteroid in elderly patients with chronic obstructive pulmonary disease]

We examined the efficacy of inhaled corticosteroid (beclomethazone dipropionate: BDP) in elderly patients with chronic obstructive pulmonary disease (COPD). Eighty-six patients with COPD were divided into 3 groups: COPD treated without BDP (group 1, n = 26), COPD treated with BDP (group 2, n = 25), and BDP-treated COPD with asthmatic symptoms (group 3, n = 35). Pulmonary function test findings, symptoms, and prognosis for the 3 groups were retrospectively compared. No significant differences in yearly decline of FEV1.0 were observed. Of the patients treated with inhaled corticosteroid (groups 2 and 3), 30% exhibited improved FEV1.0. Of these patients, monthly decline of FEV1.0 correlated negatively with bronchial reversibility in FEV1.0 before and after inhalation of salbutamol (delta FEV1.0) (r = -0.28, p = 0.03). Cough and sputum scores were significantly improved in groups 2 and 3 (p < 0.01). Fewer admissions and episodes of acute exacerbation were noted in groups 2 and 3 than in group 1. From these results, we concluded that inhaled corticosteroid was effective in elderly COPD patients with bronchial reversibility and airway symptoms.     

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     

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     

己酮可可碱吸入对慢性阻塞性肺疾病患者血浆内皮素的影响

目的 探讨己酮可可碱（PTX）吸入对慢性阻塞性疾病（COPD）患血浆内皮素（ET－1）的影响及临床意义。方法 51例COPD患随机单盲分成治疗组（27例）和对照组（24例），分别给己酮可可碱（PTX）100mg加入生理盐水5ml雾化吸入和糜蛋白酶5mg加入生理盐水5ml雾化吸入。治疗前后检查肺功能、动脉血气、肝肾功能及血浆IL－8等。结果 治疗后，治疗组PaCO2下降，PaO2增高（P＜0．05）；IL－8、ET－1明显下降（P＜0．01）和（P＜0．05）；FEV1及FEV1％有所增高，但无统计学意义（P＞0．05）。两组治疗前后肝肾功能均无变化。结论 PTX价廉，吸入不良反应少，不失为临床治疗COPD的一种新方法。     

哮喘患者短期激素治疗前后高渗盐水激发试验PD20-FEV1的变化

目的观察哮喘患者在经过短期激素治疗后高渗盐水激发试验气道高反应性变化。方法60例哮喘患者随机分为高渗盐水组及乙酰甲胆碱组。每组30例，均短期使用布地奈德4周左右，使用剂量每日400～600微克。每组每名患者激素治疗前后做各自激发试验，测定FEV1和PD20。结果两组FFV1均改善，高渗盐水激发组气道高反应性下降，乙酰EP胆碱组无明显变化。结论哮喘患者在经过短期激素治疗后肺功能改善，高渗盐水激发试验气道高反应性下降，而乙酰甲胆碱激发试验变化不明显。高渗盐水激发试验有望在哮喘病情监测及判断疗效方面发挥作用。     

Effects of antireflux treatment on bronchial hyper-responsiveness and lung function in asthmatic patients with gastroesophageal reflux disease

AIM: To investigate the effects of antireflux treatment on bronchial hyper-responsiveness and lung function in asthmatic patients with gastroesophageal reflux disease(GERD).METHODS: Thirty asthmatic patients with GERD were randomly divided into two groups (group A and group B).Patients in group A (n=15) only received asthma medication including inhaled salbutamol 200μg four times a day and budesonide 400μg twice a day for 6 weeks. Patients in Group B (n=15) received the same medication as group A,and also antireflux therapy including oral omeprazole 20mg once a day and domperidone 10mg three times a day for 6 weeks. Pulmonary function tests and histamine bronchoprovocation test were performed before and after the study.RESULTS: There was no significant difference in the baseline values of pulmonary function and histamine PC2FEV1 between the two groups. At the end of the study, the mean values for VC, VC%, FVC, FVC%, FEV1, FEV1%, PEF, PEF%, PC20-FEV1 were all significantly improved in group B, compared with group A.CONCLUSION: Antireflux therapy may improve pulmonary function and inhibit bronchial hyper-responsiveness in asthmatic patients with GERD.     

Comparison of nebulized terbutaline and subcutaneous epinephrine in the treatment of acute asthma

Nineteen children who presented for treatment of acute asthma symptoms were studied. They were randomized to receive either subcutaneous epinephrine 0.01 mg/kg (0.3 mg maximum) or nebulized terbutaline 1 mg in 2 mL normal saline. The drugs were administered using the double-blind method. Each patient received either subcutaneous epinephrine with concurrent nebulized normal saline or nebulized terbutaline with a concurrent subcutaneous injection of normal saline. Depending on the patient's clinical status, up to three doses of the same drug and placebo were administered. Pulmonary functions (FEV1, FVC, FEF25-75), heart rate, respiratory rate, and pulmonary index were obtained before treatment, at 20 minutes, and at one hour after the final treatment. Except for the baseline respiratory rate, the mean number of treatments, pulmonary index, heart rate, and respiratory rate (at 20 minutes and one hour) were not statistically different. Pulmonary functions were not significantly different at any time. The one-hour post-treatment pulmonary functions (percentage of predicted normal) for terbutaline and epinephrine were FEV1, 49.2 +/- 18.4% and 49.4 +/- 16.9%; FVC, 72.7 +/- 23.4% and 62.7 +/- 21.6%; and FEF25-75, 31.8 +/- 18.6% and 39.0 +/- 12.2%, respectively. The data presented support our hypothesis that terbutaline by nebulization is at least as effective as epinephrine in the management of children with similar degrees of pulmonary obstruction.     

Effect of inhaled beclomethasone dipropionate and budesonide dry powder on pulmonary function and serum eosinophil cationic protein in adult asthmatics.

The aim of this study was to determine whether the effects of inhaled beclomethasone dipropionate and budesonide dry powder on pulmonary function correlate with those on measurement of serum eosinophil cationic protein (sECP). Thirty-two asthmatic adults in a stable phase, treated daily with 1,000 micrograms beclomethasone dipropionate metered-dose inhaler, completed a 2-week wash-out period and were then randomized to receive a 200 micrograms/dose q.i.d. of either drug, over an 8-week period. Pulmonary function tests (FEV1, FVC, PEFR, FEF25-75% and MEF50) were measured at study entry, before and after every 2 weeks of treatment, while PEFR (morning and evening), symptom scores and salbutamol use PRN were recorded daily on a dairy card. sECP was measured at baseline and after 4 and 8 weeks of treatment. Safety variables included adverse reactions, morning serum cortisol and vital signs (heart rate and blood pressure). FEV1, FVC, PEFR, FEF25-75%, MEF50 and morning PEFR significantly increased (p < 0.05) over baseline in the beclomethasone group, while only FEV1 at week 6 and evening PEFR significantly increased (p < 0.05) in the budesonide group; no significant differences between groups were reported. sECP significantly decreased (p < 0.01) in the beclomethasone group at week 4 and 8 (p < 0.05 between groups). Evidence of statistically significant negative correlation between the FEV1 percent predicted and sECP was assessed at baseline (correlation coefficient r = -0.60, p < 0.05) in the total patient sample, and in the results, expressed as percent change over baseline, obtained at both week 4 and 8 (p < 0.01). A significant decrease in salbutamol use PRN, symptom score and number of daily bronchospasm attacks was also reported in the beclomethasone group (p < 0.05). No adverse reactions or relevant changes in morning cortisol and vital signs were reported in either group. It was concluded that sECP proved to be a reliable marker for monitoring inflammatory events in asthma; inhaled beclomethasone dipropionate dry powder was at least as effective as budesonide in improving lung function and the underlying asthma inflammation.     

老年哮喘的临床特点

目的　探讨老年人哮喘症状、体征、并发症、肺功能等的临床特点。方法　回顾分析 15 8例老年哮喘病人的临床资料。结果　老年哮喘患者的呼吸困难、紫绀、哮鸣音、湿罗音更为明显 ,以上呼吸道感染为诱因者多 ,发病年龄大 ,病程长 ,有吸烟史者多 ,一年内的再入院率高 ,肺功能差 ,老年组 FEV1 ,MMEF,V2 5,V50 ,PEF降低更为显著 ,而气道阻力增加。并发冠心病、糖尿病、高血压等疾病患者多 ,中、重度发作患者多。结论　老年哮喘组更易并发呼吸衰竭 ,伴发疾病多 ,治疗难度大 ,肺功能有助于哮喘的诊断、分级和治疗。应加强对老年哮喘患者的教育和管理。