COPD合并左心功能不全患者脑钠肽水平变化及意义

目的 分析脑钠肽(hBNP)在慢性阻塞性肺疾病(COPD)合并左心功能不全的水平变化,探讨其临床应用价值.方法 选取COPD合并左心功能不全患者60例(观察组),并根据纽约心脏病协会(NYHA)分级标准分为3组,正常对照组为同期住院不合并心功能不全的COPD患者20例(对照组),测定2组的血浆BNP值,心脏彩超检测心脏...     

老年人慢性阻塞性肺疾病急性加重期B型利钠肽测定对心功能不全判断的临床分析

目的评价静脉血B型利钠肽测定,在老年人慢性阻塞性肺疾病（COPD）急性加重期对鉴别呼吸困难是单纯由呼吸系统引起还是合并心功能不全所致中的应用价值。以便临床及时诊断和治疗。方法总结分析2011年1月-2013年1月在本院呼吸内科住院的老年人COPD急性加重期的临床病例特点和静脉血B型利钠肽测定的结果。结果无论是COPD急性加重期单纯性右心功能不全或合并左心功能不全,还是潜在的心功能不全均可测定到静脉血B型利钠肽的升高,且升高程度和病情轻重呈正相关。结论老年人COPD急性加重期病情较重合并基础疾病较多,发病时搬动检查风险较大,利用床旁无创的静脉抽血测定B型利钠肽,对判断是否存在心源性呼吸困难和心功能不全有很高的临床价值,值得推广。     

老年慢性阻塞性肺疾病合并肺结核26例临床分析

慢性阻塞性肺疾病(COPD)是老年人常见慢性呼吸道疾病,常因急性加重反复住院治疗,而老年人因免疫功能下降等原因,合并肺结核的患者有逐年升高的趋势,由于老年COPD患者长期咳嗽、咳痰、喘息,当合并肺结核感染时,其肺结核表现容易被掩盖,极易造成漏诊、误诊,面延误肺结核的诊治.为提高老年COPD合并肺结核诊治水平,本研究对我院呼吸科2005年10月至2011年12月诊治的老年COPD合并肺结核患者26例进行回顾,现将其临床资料分析如下.     

老年慢性心力衰竭患者合并肾功能不全26例诊治体会

目的探讨农村老年慢性充血性心力衰竭（CHF）合并肾功能不全患者的临床特点、诊断及治疗体会。方法对该院2011年9月至2013年3月收治的26例老年慢性CHF合并肾功能不全患者的临床资料进行回顾性分析,总结其临床特点、诊治措施及预后。结果 26例患者均表现不同程度的呼吸困难、喘憋、双下肢水肿、胸腹腔积液或心包积液等症状,血气分析均为代酸合并呼碱,均出现血肌酐水平升高及二氧化碳结合率下降。治疗后,其中好转出院23例,放弃治疗1例,死亡2例。结论老年慢性CHF合并肾功能不全者须重视诊断、及早干预、改善心功能,避免肾脏持续低灌注导致的肾衰竭。     

老年人慢性阻塞性肺疾病急性加重期β-型利钠肽测定对心功能不全判断的意义

目的：探讨β-型利钠肽测定在老年人慢性阻塞性肺疾病急性加重期时心功能不全判断的意义。方法总结分析我院2010年1月-2012年1月在我院呼吸内科住院的老年人COPD急性加重期的临床病例特点和静脉血β-型利钠肽测定的结果。结果 COPD单纯组测定BNP，5例正常，1例升高。20例COPD合并肺心病组16例升高，平均值61.5pg/ml，其中11例符合心功能不全诊断。12例COPD合并其他心脏疾病者11例测定BNP增高，平均77.5pg/ml，1例正常。8例COPD伴非心脏疾病者中也有3例升高，且该3例临床无法确诊有心功能不全诊断。结论老年人COPD急性加重期病情较重合并基础疾病较多，发病时搬动检查B超心脏等风险较大。利用方便床旁无创的静脉抽血测定β-型利钠肽，对判断是否存在心源性呼吸困难和心功能不全有很高的临床价值，值得推广。     

老年人慢性阻塞性肺疾病急性加重期B-型利钠肽测定对心功能不全判断的临床分析

目的评价静脉血B-型利钠肽测定在老年人COPD急性加重期对鉴别呼吸困难是单纯由呼吸系统引起还是合并心功能不全所致的作用，以便临床及时诊断和治疗。方法对2011年1月～2013年1月在本院呼吸内科住院的老年人COPD急性加重期的临床病例特点和静脉血B-型利钠肽测定的结果进行分析。结果无论是COPD急性加重期单纯性右心功能不全或合并左心功能不全，还是潜在的心功能不全均可测到静脉血B-型利钠肽的升高，且升高程度和病情轻重呈正相关。结论老年人COPD急性加重期病情较重，合并基础疾病较多，发病时搬动检查B超、心脏等风险较大。利用方便床旁无创的静脉抽血测定B-型利钠肽，对判断是否存在心源性呼吸困难和心功能不全有很高的临床价值，值得推广。     

以急性左心衰竭为表现7例老年慢性阻塞性肺疾病并发自发性气胸患者的临床分析

目的分析我院慢性阻塞性肺疾病(COPD)合并自发性气胸误诊为急性左心衰竭患者的临床特点,总结误诊原因,以期提高临床诊治水平。方法收集2010年至2015年我院收治的7例老年COPD并发自发性气胸误诊急性左心衰竭患者的临床诊治资料,总结其临床特点。结果 7例患者经常规治疗后症状均得到不同程度缓解,5例查体单侧呼吸音降低,经影像学检查明确诊断,另2例呼吸困难症状改善不明显,BNP检测排除心源性因素后胸部CT明确诊断,7例患者经胸腔闭式引流术治疗后气胸吸收。结论老年COPD合并自发性气胸临床表现多样,易误诊为急性左心衰竭,常见误诊原因为临床医师诊断过于主观、缺乏典型临床表现、辅助检查不完善等。临床医师应提高对老年COPD合并自发性气胸的认知,以提高诊断率。     

曲美他嗪联合磷酸肌酸钠治疗冠心病合并慢性左心功能不全的临床观察

目的观察曲美他嗪联合磷酸肌酸钠治疗冠心病合并慢性左心功能不全的临床疗效。方法选择我院近1年来收治的116例冠心病合并慢性左心功能不全患者,随机分为观察组与对照组两组,每组均为58例。对照组常规给予强心、利尿、扩管抗心衰及冠心病二级防治等治疗。观察组在对照组治疗方法基础上加用曲美他嗪和磷酸肌酸钠。治疗半个月后比较两组患者治疗总有效率、治疗前后左心室射血分数(LVEF)及日常生活情况评分及不良反应发生情况。结果观察组治疗总有效率高于对照组(P<0.05);治疗后,两组LVEF及日常生活情况评分均较治疗前升高(P<0.01),且观察组LVEF及日常生活情况评分升高幅度大于对照组(P<0.01);两组不良反应发生率比较,其差异无统计学意义(P>0.05)。结论曲美他嗪联合磷酸肌酸钠治疗冠心病合并慢性左心功能不全疗效确切,可有效改善左心功能,且用药安全性好,无明显不良反应,可推广应用临床。     

慢性阻塞性肺疾病合并毛细血管渗漏综合征临床分析

目的:探讨慢性阻塞性肺疾病(COPD)合并毛细血管渗漏综合征(CLS)的临床特征及其早期诊断和处理方法。方法:收集2001年—2010年住院的14例COPD合并CLS患者的临床资料,分析其临床表现、治疗措施及预后。结果:14例均有不同程度肺水肿、呼吸功能不全、胸腹腔积液或心包积液、低蛋白血症;死亡10例,好转4例。结论:COPD合并CLS病情危重,死亡率高。积极预防、早期诊断、合理治疗是提高抢救成功率的关键。     

介入治疗对冠心病合并左心功能不全患者心功能的影响

目的探讨介入治疗对冠心病合并左心功能不全患者心功能的影响。方法本次临床研究选取45例2011年1月至2012年1月之间在我院就诊的冠心病合并左心功能不全患者为观察对象,所有患者均接受介入治疗,回顾分析患者临床治疗前后各项心功能指标变化。结果患者临床治疗6个月后LVEF、LVESV、LVEDV、LVEd等各项心功能指标均显著改善,且与临床治疗前相比,实验数据对比统计学差异显著（P〈0.05）。结论由本次临床研究结果可见,冠心病合并左心功能不全患者接受介入治疗后,心功能指标显著改善,治疗效果较为理想。     

B型脑钠肽在慢性阻塞性肺疾病中的临床价值观察

目的 探讨B型脑钠肽（BNP）在慢性阻塞性肺疾病（COPD）中的临床观察.方法 选取2011年6月-2013年2月COPD急性发作入我院住院的60例患者,检测60例COPD患者急性发作期血浆BNP值,分析比较发生左心室收缩功能不全组与未发生组BNP水平的区别.结果 发生左心室收缩功能不全组BNP水平为（679.6±274.5）pg/ml,未发生组BNP水平为（251.8±134.7）pg/ml,组间比较,差异有统计学意义（P＜0.05）.结论 BNP对于COPD急性发作期的患者发现左心功能不全有着肯定的作用.     

慢性阻塞性肺疾病患者六分钟步行试验中的心肺不良事件

【摘要】目的 探讨稳定期慢性阻塞性肺疾病(COPD)患者6 min步行试验(6MWT)过程中心肺不良事件的发生情况与不同程度肺功能和心脏合并症的关系。方法 将85例完成试验的COPD患者依合并症情况分为单纯COPD组（Ⅰ组）16例、COPD合并左心舒张功能减低组（Ⅱ组）31例、COPD合并左心舒张功能减低及慢性肺源性心脏病组（Ⅲ组）38例,分别对3组患者6MWT前、试验结束时与试验结束后10 min的心率（HR）、血氧饱和度（SpO2）进行比较。结果 85 例中共27 例（31.76%）休息1～3 次后完成试验,19 例（22.35%）HR 异常;14 例（16.47%）SpO2<0.90;15 例（17.65%）先后出现HR>120 次/min、SpO2<0.90。Ⅰ组、Ⅱ组、Ⅲ组患者试验结束时HR较试验前、试验后10 min HR较试验结束时,Ⅲ组患者试验后10 min较试验前差异均有统计学意义（均P < 0.05）。Ⅱ组和Ⅲ组患者试验结束时SpO2较试验前、试验后10 min SpO2较试验结束时与试验前差异有统计学意义（P < 0.05）。结论 重度以上COPD合并左心舒张功能减低及慢性肺源性心脏病者在6MWT过程中易发生心肺不良事件,且试验结束后HR和SpO2不易恢复到试验前状态。     

β-adrenoceptor blockers in chronic heart failure—a review

There are now considerable clinical trial data to support the use of β-adrenoceptor blockers in patients with chronic heart failure due to systolic left ventricular dysfunction. Increases in ejection fraction, improved well-being as judged by both patient and physician and reduced progression of ventricular dysfunction have been demonstrated. From meta-analyses of available trial data, a mortality reduction of approximately 30% is obtained when these drugs are added to standard heart failure therapies. Furthermore, reductions in cardiovascular morbidity associated with decreased hospitalization rates suggest pharmacoeconomic benefits with these agents.
This review addresses the following issues regarding β-adrenoceptor blockers in chronic heart failure: the known adverse effects of chronic sympathetic activation in heart failure, the theoretical benefits of blockade of this neurohormonal system, the current clinical database of β-adrenoceptor blockers in heart failure and practical issues regarding the administration of these agents to these patients.     

以慢性咳嗽为主诉的左心室舒张功能不全120例临床分析

目的探讨以慢性咳嗽为主诉的左心室舒张功能不全患者的临床特点。方法回顾性研究我院呼吸内科门诊以咳嗽为主诉,心脏彩色B超示左心室舒张功能不全患者的临床特点并给予抗心力衰竭治疗。结果所有患者咳嗽,咳痰症状明显改善,心功能改善。结论呼吸内科门诊医师应重视老年人慢性咳嗽患者合并左心室舒张功能不全可能,积极进行心脏彩色B超检查,及时抗心力衰竭治疗。     

Challenges in the management of asthma associated with smoking-induced airway diseases

ABSTRACT

Introduction: Smoking-induced airway diseases such as chronic bronchitis, emphysema, and small airway dysfunction contribute to the chronic respiratory symptoms experienced by adults with asthma, including those with spirometric chronic obstructive pulmonary disease (COPD), termed asthma-COPD overlap (ACO). Drug treatment of symptomatic smokers with asthma or ACO is uncertain due to their exclusion from most clinical trials.

Areas covered: This review summarizes evidence for the efficacy of small molecule drugs used in the clinic to treat current and former smokers with a diagnostic label of asthma or ACO. Other therapeutic interventions are reviewed, including smoking cessation and biologics.

Expert opinion: Clinical trials and observational studies suggest that smoking cessation and approved drugs used to treat non-smokers with asthma produce clinical benefits in smokers with asthma or ACO, although the overall quality of evidence is low. The efficacy of some treatments for asthma is altered in current smokers, including reduced responsiveness to short-term inhaled corticosteroids and possibly improved responsiveness to leukotriene receptor antagonists. Preliminary findings suggest that low-dose theophylline, statins, and biologics, such as omalizumab, mepolizumab, and dupilumab, may improve clinical outcomes in smokers with asthma or ACO. Improved phenotyping and endotyping of asthma and smoking-induced airway diseases should lead to better targeted therapies.     

Anti-TNF-α therapies in chronic obstructive pulmonary diseases

Background: Chronic obstructive pulmonary disease (COPD) and asthma are chronic diseases in which inflammation of the airways leads to progressive transient airway obstruction and TNF-α plays an important pro-inflammatory role. Objective: To assess the plausibility of anti-TNF-α therapies playing an anti-inflammatory role in asthma and COPD. Methods: Scientific rationale of TNF-α targeting in asthma and COPD was assessed individually and the available data on the use of anti-TNF-α in each disease were reviewed. Results and conclusion: Anti-TNF-α therapies demonstrate different efficacies in asthma and COPD and further supportive preclinical and clinical data are needed, especially about subsets of certain diseases which could benefit the most from these therapies.     

Emerging oligonucleotide therapies for asthma and chronic obstructive pulmonary disease

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are disorders of the airways largely related to the presence of persistent inflammation. The approval of inhaled corticosteroids in the early 1970s pioneered a new age of therapy in treating chronic inflammatory airway diseases. This was the first time that an anti-inflammatory product was available to reduce the characteristic lung inflammation in airways and the associated obstruction, inflammation and hyper-responsiveness. Fast forward 40 years: corticosteroids are still an important therapeutic intervention; however, they exhibit limited use in moderate to severe asthma and COPD. Oligonucleotide therapies are an emerging class which include the antisense, the RNAi (siRNA and miRNA), the immunomodulatory, the aptamer and the decoy approaches. As these approaches are rather recent in the respiratory field, most are still early in development. Nevertheless, with limitations of current small molecule therapies and the hurdles faced with biologics, the use of oligonucleotides is relevant and the door is open to the development of this category of therapeutics. This review focuses on the major classes of oligonucleotides that are currently in late stage preclinical or clinical development for the treatment of asthma and COPD, and discusses the implications for their use as therapies for respiratory diseases.     

1例妊娠期合并哮喘、慢性阻塞性肺病患者的药学服务

目的探索临床药师对妊娠期合并呼吸系统疾病患者的药学服务模式。方法临床药师通过入院药学评估、用药干预和用药教育等途径对1例妊娠期合并支气管哮喘急性发作期、慢性阻塞性肺疾病急性加重期患者进行药学服务,总结临床药师服务于妊娠期患者用药的工作经验。结果通过医师、护士与临床药师的相互配合,患者病情得到控制并好转出院。结论通过此病例治疗过程表明临床药师很有必要参与妊娠期及其他特殊患者的药物治疗。     

Oxidants in asthma and in chronic obstructive pulmonary disease (COPD)

Experimental and clinical evidences suggest that oxidants play a role in the pathogenesis of respiratory disorders characterised by chronic airway inflammation such as asthma and chronic obstructive pulmonary disease (COPD). The respiratory system is chronically exposed to environmental pollutants, including oxidants. Exogenous sources of oxidants are particularly relevant to the pathogenesis of COPD, being cigarette smoke an extremely rich source of oxidants. In addition, the inflammatory cells recruited to the airways of patients with asthma and COPD, have an exceptional capacity to produce oxidants. Many decades of research have produced a significant amount of data indicating pro-oxidative molecular mechanisms putatively relevant in the pathogenesis of the oxidative stress which characterises these diseases, both locally and systemically. As a consequence, a drug therapy able to restore the redox imbalance in asthma and COPD would probably exert clinical and functional benefits. Indeed, currently available therapies for asthma and COPD can exert an inhibitory effect on oxidant production in the airways. However, it is unknown whether the efficacy of the treatment is somehow linked to the pharmacological modulation of the oxidant/antioxidant balance. So far, it appears that the potential role of antioxidant compounds in the treatment of asthma and COPD has not been fully explored.     

Phosphodiesterase-4 inhibitors in the treatment of inflammatory lung disease

Phosphodiesterases (PDE) belong to an important family of proteins that regulate the intracellular levels of cyclic nucleotide second messengers. Targeting PDE with selective inhibitors may offer novel therapeutic strategies in the treatment of various conditions, and in the context of respiratory disease these include asthma and chronic obstructive pulmonary disease (COPD). The rationale for such an approach stems, in part, from the clinical efficacy of theophylline, an orally active drug that is purportedly a nonselective PDE inhibitor. In addition, intracellular cyclic adenosine monophosphate (cAMP) levels regulate the function of many of the cells thought to contribute to the pathogenesis of respiratory diseases such as asthma and COPD, and these cells also selectively express PDE4. This has offered pharmaceutical companies the opportunity to selectively targeting these enzymes for the treatment of these diseases. Finally, the success of targeting PDE5 in the treatment of erectile dysfunction provides clinical proof of concept for the targeting of PDE in disease. Whether a 'Viagra' of the airways can be found for the treatment of asthma and COPD remains to be seen, but positive results from recent clinical studies examining the efficacy of selective PDE4 inhibitors such as cilomilast and roflumilast offer some optimism. However, one of the major issues to be resolved is the tolerability profile associated with this drug class that is a consequence of PDE4 inhibition. While cilomilast and roflumilast have low emetic potential they are not free from emesis and various strategies are being investigated in the hope of developing a PDE4 inhibitor without this adverse effect.