COPD康复期患者心理状况的治疗及呼吸肌功能锻炼效果观察

目的：了解慢性阻塞性肺部疾病（COPD）康复期患者心理状态及心理治疗、呼吸肌功能锻炼的效果。方法：COPD康复期患者进行心理测定，然后进行心理治疗及呼吸肌功能锻炼，1年后随访观察患者心理状态。结果：70．0％的COPD康复期患者存在心理障碍，经过心理治疗及呼吸肌功能锻炼后，患者心理状况明显改善。结论：心理治疗及呼吸肌功能锻炼确有改善患者心理状态作用。     

高原地区慢性阻塞性肺疾病患者体重对呼吸困难的影响

目的探讨高原慢性阻塞性肺疾病(COPD)低体重(UW)和正常体重(NW)患者肺功能、呼吸肌力量和血气与呼吸困难的关系.方法对高原地区COPD缓解期体重指数(BMI)＜21kg/m2的36例和BMI在21～26kg/m2的32例两组患者测定一秒钟用力呼吸气容积(FEV1)占预计值百分比(FEV1%预计值)、FEV1/用力肺活量(FVC)比值(FEV1/FVC)、口腔最大吸气压(PImax)、最大呼气压(PEmax)、最大跨膈压(Pdimax)、呼吸肌力量指数(RMS)、动脉血氧分压(PaO2)和二氧化碳分压(PaCO2),并评估了呼吸困难等级.结果UW组平均BMI(17.8±1.2)kg/m2显著低于NW组(23.2±1.4)kg/m2,P＜0.01.UW组呼吸困难平均等级(3.9±0.9)显著高于NW组(2.9±0.7),P＜0.01.两组FEV1%预计值、FEV1/FVC差异无显著性(P＞0.05).UW组PaO2(53.7±6.2)mmHg显著低于、PaCO2(37.5±3.6)mmHg显著高于NW组[分别为(57.2±6.5)mmHg、(35.2±3.4)mmHg],P均＜0.05.UW组PImax(48.2±14.4)cmH2O、PEmax(62.7±16.2)cmH2O、Pdimax(54.3±15.6)cmH2O和RMS(55.5±15.1)cmH2O较NW组显著降低[分别为(61.7±15.9)cmH2O、(72.4±18.5)cmH2O、(66.9±17.2)cmH2O、(67.1±16.5)cmH2O](P＜0.01或P＜0.05).呼吸困难等级与PImax、PEmax、Pdimax、RMS、FEV1%预计值、FEV1/FVC呈显著负相关(P均＜0.01).结论高原地区COPD低体重患者呼吸困难较正常体重患者严重,其原因与营养不良所致的呼吸肌力量降低有重要关系.     

舒利迭配合呼吸肌锻炼对COPD生活质量的影响

目的：探讨舒利迭配合呼吸肌锻炼对慢性阻塞性肺疾病（COPD）的影响。方法：将COPD稳定期患者100例,随机分为：观察组和对照1组、对照2组。观察组34例使用舒利迭配合呼吸肌锻炼,对照1组33例使用舒利迭,对照2组33例单纯呼吸肌锻炼。治疗前后通过SGRQ问卷调查表,比较治疗前后SGRQ总分的差值。结果：舒利迭配合呼吸肌锻炼治疗与单一采用舒利迭吸入或呼吸肌锻炼SGRQ总分的差异均有统计学意义（P〈0.05）。结论：对COPD稳定期患者采用舒利迭配合呼吸肌锻炼治疗比单一采用舒利迭吸入或呼吸肌功能锻炼更能提高生活质量。     

不同麻醉方法对慢性阻塞性肺疾病患者呼吸肌肌力的影响

COPD患者全身麻醉术后肺部并发症的发生率高,是麻醉医生面临的棘手问题之一。主动的术前干预、正确的麻醉管理术后适当镇痛及有效的呼吸道管理均有助于降低人肺部并发症的发生率[1,2]。本研究采用前瞻性的科研设计,比较不同麻醉方法对慢性阻塞性肺疾病患者呼吸肌肌力的影响。     

慢性阻塞性肺部疾病病程与肺动脉直径变化关系的多层螺旋CT评价

目的 评估慢性阻塞性肺部疾病(COPD)病程与肺动脉直径变化的关系.方法 在CT图像上测量66例COPD病人主肺动脉、右肺动脉、左肺动脉直径、主肺动脉/升主动脉直径比以及主肺动脉/降主动脉直径比,并分析其与COPD病程、肺功能的相互关系.结果 (1)COPD病程与肺动脉直径变化的关系:随着COPD的病程增加,肺动脉及其分支的直径增大,对照组和发病10年以上者主肺动脉直径差异有统计学意义,和发病20年以上者右肺动脉直径差异有统计学意义,和发病30年以上者左肺动脉直径差异有统计学意义,和发病10年以下者主肺动脉/主动脉直径比差异有统计学意义.(2)肺动脉与COPD分级的关系:对照组、COPDⅡ级、Ⅲ级、IV级各组间主肺动脉/降主动脉直径比两两比较,差异均有统计学意义.结论 肺动脉直径的变化与COPD病程进展程度有关.主肺动脉直径和主肺动脉/主动脉直径比是评价COPD进程及程度敏感的CT监测指标.主肺动脉/降主动脉直径比是最好的指标.     

综合呼吸功能锻炼对COPD缓解期肺功能指标的影响

 目的 观察综合呼吸功能锻炼对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)缓解期肺功能指标的影响.方法 86例COPD缓解期患者,随机分成干预组(n=42)和对照组(n=44);干预组患者常规治疗同时接受综合呼吸功能锻炼,对照组只接受常规治疗,比较两组肺功能相关指标.结果 两组患者治疗前各项肺功能指标无明显区别,疗程结束后,干预组各项肺功能指标明显优于治疗前,同时也优于对照组(P＜0.05).结论 综合呼吸功能锻可明显改善COPD缓解期患者的各项肺功能指标.     

小剂量多巴胺对高原老年慢性肺心病患者呼吸肌疲劳治疗作用的研究

目的 :观察多巴胺对高原地区老年肺心病患者呼吸肌功能的影响。方法 :4 8例老年肺心病患者随机分为观察组 (A组 )和对照组 (B组 ) ,每组 2 4例。A组用多巴胺 6 0mg加入 10 %葡萄糖溶液 15 0ml,以 5 μg·kg-1·min-1的速度静滴作为治疗。B组用等量 10 %葡萄糖溶液 ,以同样速度静滴作为对照。用药前、后测定肺功能、呼吸肌功能和心功能。结果 :用药前 ,两组一秒钟用力呼气容积占预计值百分比 (FEV1%预计值 )、动脉血氧分压 (PaO2 )、二氧化碳分压 (PaCO2 )、最大吸气压 (PImax)、最大呼气压 (PEmax)、最大跨膈压 (Pdimax)、呼吸肌力量指数 (RMS)、心脏指数 (CI )和心搏指数 (SI)差异无显著性。用药后 ,A组PI max、PEmax、Pdimax、RMS、CI、SI显著高于用药前 (P均 <0 .0 1) ,B组各项指标无显著性变化。A组用药后PImax、PEmax、Pdimax、RMS与CI呈显著正相关 (r=0 .6 74、0 .5 4 1、0 .6 6 9、0 .6 2 9,P均 <0 .0 1)。结论 :小剂量多巴胺有显著增强呼吸肌功能的作用 ,可作为高原肺心病的辅助治疗。     

慢性阻塞性肺疾病的护理干预

目的：通过对慢性阻塞性肺病患者实施系统有效的护理,降低其发病的频率,减轻发病的程度,从而提高其生存质量。方法：对患者实施系统护理干预如进行心理护理、呼吸功能锻炼、合理氧疗、有效排痰、适当运动、营养指导、健康教育等。结果：通过对117例慢性阻塞性肺疾病患者进行系统有效的护理,112例患者咳嗽、咳痰、气喘症状明显改善,在未进行氧疗时SPO2可达95%,有效率95.7%。结论：对慢性阻塞性肺疾病患者进行系统的护理干预,可延缓疾病发展,能改善症状,提高生存质量。     

慢性阻塞性肺部疾病腹腔镜胆囊切除围术期综合干预临床意义

目的探讨综合干预措施对合并慢性阻塞性肺部疾病(COPD)的胆囊炎患者腹腔镜胆囊切除术(LC)后的肺功能影响及临床应用价值。方法筛选中度以上COPD患者3 166例,随机分为干预组和对照组。LC术前、术后,检测肺功能,并观察LC术后肺部感染的发病率。结果 (1)两组手术前后FVC、FEV1及MVV比较,差异有统计学意义(P<0.05),两组间差值比较,差异有统计学意义(P<0.01)。(2)两组术后肺部感染率比较,差异有统计学意义(P<0.05)。结论围术期进行综合干预,能有效改善COPD患者的肺功能,减少术后肺部感染率。     

健康教育对慢性阻塞性肺疾病患者肺通气功能和生活质量的影响

目的探讨健康教育对慢性阻塞性肺疾病（COPD）患者肺通气功能和生活质量的影响。方法 93例COPD患者按住院单、双日分为教育组48例和对照组45例,对照组采用常规护理治疗、体格检查及肺功能复查;教育组在此基础上进行健康教育,6个月,采用COPD生活质量评分表比较两组得分,测定肺通气功能,包括肺活量（FVC）、第1秒用力呼气量（FEV1）和呼气峰流速百分比（PEF%）。结果 （1）教育组6个月后的生活质量总分及多个维度得分较前有显著改善（P〈0.05）,与对照组比较,生活质量总分及各维度得分也有统计学差异（P〈O.05）。（2）教育组FEV1和PEF%改善优于对照组。结论健康教育干预能改善COPD患者的生活质量,提高肺通气功能。     

Hyperoxic interval training in chronic obstructive pulmonary disease patients with oxygen desaturation at peak exercise

The purpose of the study was to investigate the time trend of questionnaire-assessed moderate to vigorous physical activity (MVPA) among 12–18-year-old Finnish boys and girls from 1979 to 2005. The MVPA was defined as "at least moderately breathtaking and sweating in leisure time physical activities more than 3 times week." Data were based on the Adolescent Health and Lifestyle Survey, which is a biannual, nation-wide survey on adolescent health and health-related lifestyle in Finland. The nationally representative samples were drawn from the Finnish Population Register Centre. The numbers of participants varied from 2832 to 8390 and the response rates from 91% (girls, 1981) to 58% (boys, 2005). The main results showed that the participation rate in MVPA increased during the study period. The increase was not continuous, but showed an upward trend during the years 2001–2005. The study also revealed that boys participated in MVPA more than girls. However, the gender difference decreased during the study period. Age differences in MVPA were rather small and they decreased during the study period. However, perceived intensity of physical activity was higher among older than younger groups, whereas participation in MVPA was more frequent in younger than older groups. The results supported the findings of some previous studies that reported that especially in Finland the vigorous physical activity among young people had consistently increased. This study gave more information about this phenomenon because the study period was longer, 26 years, and the sample also included older, 16- and 18-year-old boys and girls.     

New modalities of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Pulmonary rehabilitation has been shown to be an important part of the management of patients with chronic obstructive pulmonary disease (COPD). Exercise training is the corner stone of a comprehensive, multidisciplinary pulmonary rehabilitation in COPD and has been shown to improve health-related quality of life and exercise capacity. Nevertheless, not every COPD patient responds well to pulmonary rehabilitation.Future trials should focus on new additions to conventional pulmonary rehabilitation programmes to optimise its effects on health-related quality of life, exercise capacity, body composition and muscle function in patients with COPD. Therefore, a patient-tailored approach is inevitable. Advantages and disadvantages of new modalities of pulmonary rehabilitation will be outlined in detail, including the following: endurance training and long-acting bronchodilatators; endurance training and technical modalities (inspiratory pressure support and inspiratory muscle training); interval training; resistance training; transcutaneous neuromuscular electrical stimulation; and exercise training and supplements (oxygen, oral creatine, anabolic steroids and polyunsaturated fatty acids).Based on well defined baseline characteristics, patients should most probably be individually selected. At present, these new modalities of pulmonary rehabilitation have been shown to improve body composition, skeletal muscle function and sometimes also exercise capacity. However, the translation to an improved health-related quality of life is mostly lacking, and cost effectiveness and long-term effects have not been studied. Moreover, future trials should study the effects of pulmonary rehabilitation in elderly patients with restrictive pulmonary diseases.     

Exercise training in patients with chronic obstructive pulmonary disease.

Most patients with chronic obstructive pulmonary disease (COPD) demonstrate positive responses to exercise conditioning. Dyspnea is reduced and work tolerance is extended with little or no change in pulmonary function noted. Possible explanations for the increased ability to better tolerate exercise and activities of daily living (ADL) after training include: 1) psychological encouragement, 2) improvements in mechanical efficiency, 3) improved cardiovascular conditioning, 4) improved muscle function, 5) biochemical adaptations responsible for reducing glucose utilization, 6) desensitization to dyspnea, and 7) contributions from better self-care. However, not all patients respond positively to exercise conditioning. This may represent differences in patient selection, training approaches, and/or comorbidity issues commonly seen in patients with COPD. Alternatively, the answer may reside in devising an optimal training intensity, duration, and frequency combination for patients with COPD. This is not an easy matter because of the diversity of patients categorized as COPD. We have reviewed these issues from the available data and presented areas where additional research is warranted. What is needed at present is a series of well-controlled studies that focus on identifying and improving training responses in patients with COPD. Secondary to this issue is the long term epidemiologic surveillance of trained patients to document sustained effects.     

The impact of exercise training intensity on change in physiological function in patients with chronic obstructive pulmonary disease

Pulmonary rehabilitation incorporating exercise training is an effective method of enhancing physiological function and quality of life for patients with chronic obstructive pulmonary disease (COPD). Despite the traditional belief that exercise is primarily limited by the inability to adequately increase ventilation to meet increased metabolic demands in these patients, significant deficiencies in muscle function, oxygen delivery and cardiac function are observed that contribute to exercise limitation. Because of this multifactorial exercise limitation, defining appropriate exercise training intensities is difficult. The lack of a pure cardiovascular limitation to exercise prohibits the use of training guidelines that are based on cardiovascular factors such as oxygen consumption or heart rate.Current recommendations for exercise training intensity for patients with COPD include exercising at a 'maximally tolerable level', at an intensity corresponding with 50% of peak oxygen consumption (V-O2peak), or at 60-80% of peak power output obtained on a symptom-limited exercise tolerance test. In general, it appears that higher intensity training elicits greater physiological change than lower intensity training; however, there is no consensus as to the exercise training intensity that elicits the greatest physiological benefit while remaining tolerable to patients.The 'optimal' intensity of training likely depends upon the individual goals of each patient. If the goal is to increase the ability to sustain tasks that are currently able to be performed, lower to moderate-intensity training is likely to be sufficient. If the goal of training, however, is to increase the ability to perform tasks that are above the current level of tolerance, higher intensity training is likely to elicit greater performance increases. In order to perform higher intensity exercise, an interval training model is likely required. High-intensity interval training involves significant anaerobic energy utilisation and, therefore, may better mimic the physiological requirements of activities of daily living. Also, high-intensity interval training is tolerable to patients and may, in fact, reduce the degree of dyspnoea and dynamic hyperinflation through a reduced ventilatory demand. Another factor that will determine the optimal intensity of training is the relative contribution of ventilatory limitation to exercise tolerance. If peak exercise tolerance is limited by a patient's ability to increase ventilation, it is possible that interval training at an intensity higher than peak will elicit greater muscular adaptation than an intensity at or below peak power on an incremental exercise test. More research is required to determine the optimal training intensity for pulmonary rehabilitation patients.     

Pulse oximetry in the preflight evaluation of patients with chronic obstructive pulmonary disease

INTRODUCTION: In a British Thoracic Society (BTS) statement on preflight evaluation of patients with respiratory disease, sea level pulse oximetry (Spo2sl) is recommended as an initial assessment. The present study aimed to evaluate if the BTS algorithm can be used to identify chronic obstructive pulmonary disease (COPD) patients in need of supplemental oxygen during air travel, i.e. patients with an in-flight PaO2 < 6.6 kPa (50 mmHg). METHODS: There were 100 COPD patients allocated to groups according to the BTS algorithm: Spo2sl > 95%, Spo2sl 92-95% without additional risk factors; Spo2sl 92-95% with additional risk factors; Spo2sl < 92%; and patients using domiciliary oxygen. Pulse oximetry, arterial blood gases, and an hypoxia-altitude simulation test (HAST) to simulate a cabin altitude of 2438 m (8000 ft), were performed. RESULTS: The percentage of patients in the various groups dropping below 6.6 kPa during HAST were: Spo2sl > 95%: 30%; Spo2sl 92-95% without additional risk factors: 67%; Spo2sl 92-95% with additional risk factors: 70%; Spo2sl < 92%: 83%; and patients using domiciliary oxygen: 81%. In patients dropping below P(a)o(2) 6.6 kPa, supplemental oxygen of median 1 L x min(-1) was needed to exceed this limit. DISCUSSION: If in-flight P(a)o(2) > or = 6.6 kPa is regarded as a strict requirement, the use of pulse oximetry as an initial assessment in the preflight evaluation of COPD patients, as suggested by the BTS, might not discriminate adequately between patients who fulfill the indications for supplemental oxygen during air travel, and patients who can travel without such treatment.     

胃癌合并慢性阻塞性肺病的围手术期处理

目的：探讨胃癌合并慢性阻塞性肺病（COPD）的围手术期处理。方法：回顾性总结了35例胃癌合并COPD患者围手术期的处理。结果：35例患者中术后13例发生并发症（37．1％）,其中肺部并发症11例,占术后并发症的84．6％。肺部感染10例,其中肺部感染合并呼吸衰竭6例、肺不张2例、胸腔积液2例。死亡1例,为严重肺部感染并呼吸衰竭。结论：当胃癌患者合并COPD时,手术虽非禁忌,但属高危人群。应完善术前评估,加强围手术期的监测,即时处理肺部并发症。     

慢性阻塞性肺疾病合并肺动脉高压炎性介质研究

目的探讨高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子α(TNF-a)及白介素6(IL-6)血清表达水平与慢性阻塞性疾病(COPD)及COPD所致的肺动脉高压的相关性。方法选取自2015年1月至2016年5月收治的COPD患者96例为研究对象,根据患者患病情况将其分为单纯COPD组(A组,n=56)及COPD合并肺动脉高压组(B组,n=40)。另选取20例健康研究对象作为健康组。采用第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、FEV1/用力肺活量百分比(FEV1/FVC%)评价各组研究对象的肺功能;用超声心动图测定肺动脉压力;采用酶联免疫吸附试验检测各组研究对象血清HMGB1、TNF-a、IL-6水平并进行比较,分析血清HMGB1、TNF-a、IL-6水平与肺功能、肺动脉压力的相关性。结果 B组肺动脉压明显高于A组和健康组,组间比较,差异均有统计学意义(P <0. 05); B组的FEV1%及FEV1/FVC%均低于A组和健康组,且A组低于健康组,组间比较,差异均有统计学意义(P <0. 05)。B组的HMGB1、TNF-a及IL-6均高于A组、健康组,且A组上述指标均高于健康组,组间比较,差异均有统计学意义(P <0. 05)。相关性分析结果显示,HMGB1、TNF-a、IL-6与肺动脉压呈正相关,与FEVI%、FEV1/FVC%呈负相关。HMGB1与TNF-a、IL-6呈正相关。结论 HMGB1、TNF-a、IL-6介导了COPD全身炎症反应,这些细胞因子在COPD、肺动脉高压的发生、发展过程起重要作用。     

Athletic training in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease in the United States. COPD is characterized by plugging of airways with secretions, impaired airway integrity with airway collapse with effort, bronchospasm, frequent infections, destruction of alveolar tissue, and ventilation-to-perfusion inequality. This results in abnormalities in pulmonary mechanics and respiratory gas exchange, all of which make hyperventilation much less effective. However, research has shown that the pulmonary patient can improve work capacity in an exercise training program. Training also alleviates the severe emotional problems of anxiety, depression, and social isolation frequently present in COPD sufferers. Even the lowest level patient can frequently improve in a training program, and guidelines for the implementation of such a therapeutic regimen are provided.