肺康复运动用于支气管扩张急性加重患者恢复期的效果评价

目的评估肺康复运动用于支气管扩张急性加重患者恢复期的治疗效果。方法纳入支气管扩张患者共计60例。患者于支气管扩张急性发作时入院使用抗菌药物治疗14天后,依据随机数字表将患者随机分配至肺康复运动组(pulmonary rehabilitation group,P组)或标准治疗组(control group,C组)。C组患者进行宣传教育;P组患者在C组基础上进行为期4周的肺康复运动。于支气管扩张急性发作时(T0)、抗菌药物治疗结束(T2)、肺康复运动结束(T6)、肺康复运动结束后4周(T10)评估患者6 min步行试验(6 minutes walk test,6MWT)结果。使用圣乔治呼吸问卷(St.George Respiratory Questionnaire,SGRQ)评估上述时点患者生活质量。结果P组患者T6时点6MWT明显高于T2时点,而SGRQ评分显著低于T2时点,差异有统计学意义(P<0.05)。P组患者T6时点6MWT显著高于C组患者,但SGRQ评分低于C组患者,差异有统计学意义(P<0.05)。结论为期4周的肺康复运动能够有效提升支气管扩张急性加重后患者的运动耐力、改善患者生活质量,但该效果无法长期持续。     

Adherence to pulmonary rehabilitation: A qualitative study

OBJECTIVES: To explore the experiences of chronic obstructive pulmonary disease (COPD) patients invited to join a pulmonary rehabilitation (PR) programme. PR has been shown to be an effective non-pharmacological intervention; however uptake and completion of programmes is frequently low. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Twenty COPD patients aged 45-85 years, referred for PR over a 2-year period. RESULTS: In this group of patients the influence of the referring doctor was the key factor in leading patients to take up an invitation to attend a PR programme. Patients responded positively to doctors who imparted enthusiasm for, and belief in, the benefits of the intervention. Once started, ongoing adherence to the programme was positively influenced by a sense of group support, and increased self-confidence. Lack of social support at home and overcoming the effort of living with COPD in order to attend were cited as negative influences on continued adherence. CONCLUSIONS: This study has shown that the referring doctor plays a key role in the uptake of PR programmes. It suggests that a positive approach by doctors could increase the level of adherence to PR. Recognition and support in the area of social support for those living alone may also increase adherence. These simple, cost effective approaches may encourage more patients with COPD to participate in a therapeutic intervention which now has a strong evidence base.     

Surgical treatment of bronchiectasis: a retrospective observational study of 138 patients

Background

We analyzed cases of bronchiectasis; its presentation, etiology, diagnosis, indications for surgery, surgical approach, and the outcome.

Methods

A retrospective analysis of 138 patients who underwent surgery for bronchiectasis.

Results

The mean age was 30.2±15.7 years. 55.8% patients were males. Symptoms were recurrent infection with cough in all patients, fetid sputum (79.7%), and hemoptysis (22.5%). The etiology was recurrent childhood infection (38.4%), pneumonia (29%), TB (9.4%), sequestration (4.3%), foreign body obstruction (4.3%), and unknown etiology (14.5%). CXR, CT scan, and bronchoscope were done for all patients. Bronchiectasis was left-sided in (55.1%) of patients. It was mainly confined to the lower lobes either alone (50.7%) or in conjunction with middle lobe or lingual (7.2%). Indications for resection were failure of conservative therapy (71.7%), hemoptysis (15.9%), destroyed lung (8%), and sequestration (4.3%). Surgery was lobectomy (81.2%), bilobectomy (8.7%), and pneumonectomy (8%). Complications occurred in 13% with no operative mortality. 84% of patients had relief of their preoperative symptoms.

Conclusions

Surgery for bronchiectasis can be performed with acceptable morbidity and mortality at any age for localized disease. Proper selection and preparation of the patients and complete resection of the involved sites are required for the optimum control of symptoms and better outcomes.KEY WORDS : Bronchiactesis, pneumonia, TB, lobectomy, bilobectomy, pneumonectomy     

The role of tolvaptan in pulmonary hypertension: A retrospective study

Pulmonary hypertension (PH) is a severe form of pulmonary vascular disease that can lead to right heart failure (RHF). Nearly 2-thirds of patients with PH die within 5 years. Studies suggest that a new diuretic medication, called tolvaptan (TLV), can be used to treat PH. However, there is still insufficient evidence to confirm its effectiveness. Therefore, we investigated the role of TLV in patients with PH. This retrospective study included 73 patients with PH hospitalized in Shanghai Pulmonary Hospital between November 2019 and March 2022. All patients received 7.5 to 15.0 mg of TLV for 3 to 21 days starting at admission, in addition to targeted drugs and traditional diuretic therapy. The outcomes included the blood pressure, urine and water intake volumes, electrolyte concentrations, and renal, liver, and cardiac function indexes before and after TLV treatment. In addition, we assessed the clinical symptoms and adverse reactions during the treatment. After TLV treatment, the water intake and urine volumes significantly increased, and body weight, diastolic blood pressure (DBP) and mean arterial pressure significantly decreased. Total bilirubin, direct bilirubin, N-terminal pro-brain natriuretic peptide, and serum uric acid (UA) levels after TLV treatment were significantly lower than before treatment. After TLV treatment, dyspnea significantly improved in 71 of 73 patients, and lower limb edema disappeared in 42 of 53 patients. No obvious adverse reactions occurred during the TLV treatment period. These results suggest that adding TLV to targeted drug and traditional diuretic therapies is effective for patients with PH. However, more data are required to support these findings.     

Etiology and clinical features of children with bronchiectasis in China: A 10-year multicenter retrospective study

Introduction

The current study aims to investigate the etiology spectrum and the clinical characteristics of bronchiectasis in Chinese children.

Methods

The study is designed as a multicenter retrospective study. 193 cases were enrolled in 13 centers in China between 2008 and 2017. The inclusive cases must meet the clinical as well as the HRCT criteria. Only if both two radiologists confirmed the diagnosis, the case could be enrolled. The cases that could not provide clinical and imageology data were excluded. The data were entered into the specialized system and then analyzed.

Results

One hundred sixty-nine cases (87%) were found to have the underlying etiology. Post-infective (46%), primary immunodeficiency (14%), and PCD (13%) were the common causes. All cases came from 28 provinces in Mainland China. The median age of symptom onset was 5.8 (2.0, 8.9) years. The median age of diagnosis was 8.4 (4.5, 11.6) years. The main symptoms were cough, sputum expectoration, and fever during the exacerbation. Nineteen percent of patients suffered from limited exercise tolerance. Clubbing was found in 17% of cases. Nearly 30% of patients presented growth limitations. On the HRCT findings, 126 cases had diffused bronchiectasis, and bilateral involvement was found in 94 cases. The lower lobes and right middle lobes were most commonly involved. Approximately 30% of cultures of sputum and bronchoalveolar lavage were positive.

Conclusion

A majority of cases could be found the underlying etiology. Post-infective, primary immunodeficiency, and PCD were the most common causes. Some clinical figures might indicate a specific etiology.     

15例老年人肺动脉栓塞临床病理分析

目的分析尸检中６５岁以上老年人肺动脉栓塞（以下简称肺栓塞）的临床、病理资料，探讨老年人肺栓塞的特点及误诊原因。方法收集我院１９５１～１９９２年尸检１１１１例中老年人肺栓塞１５例，对照分析其临床、病理特点。结果男性１４例，女性１例，年龄６５～８２岁。误诊率８６．７％。原有基础病以冠心病、慢性阻塞性肺疾病（ＣＯＰＤ）、糖尿病为多。结论老年人肺栓塞病情重且复杂、临床表现不典型、各种疾病表现相互掩盖可能是误诊的主要原因     

肺血栓栓塞52例临床分析

目的提高对肺血栓栓塞（ＰＴＥ）的认识。方法经肺核素显像、肺动脉造影和Ｘ线胸片等方法，对５２例ＰＴＥ进行回顾性分析。结果近年ＰＴＥ发病率似有升高趋势。引发深静脉血栓性静脉炎是导致ＰＴＥ的危险因素，除手术、下肢创伤（２６９％）、慢性心、肺疾病（２３１％）和恶性肿瘤（１５４％）外，肾病综合征占１９２％；肺灌注显像呈ＰＴＥ低度可疑（ＬＰ）者中，１３３％（２／１５）被诊断为ＰＴＥ；如按其中临床上ＰＴＥ高度可疑者计算，则４０％（２／５）为ＰＴＥ。本组病死率为１９２％，未治疗者为７７８％，治疗者为７０％。结论ＰＴＥ仍是一个被人们认识不足的疾病，因此应给予重视     

肺假性淋巴瘤5例报告及文献复习

目的：探讨肺假性淋巴瘤的临床特点。方法：回顾性分析5例病理学诊断的肺假性淋巴瘤患者的临床表现。影像学，纤维支气管镜检查的结果及其转归。结果：所有患者无肺门、纵隔淋巴结肿大，其中1例胸片及CT片显示双肺多个椭圆形巨大肿块外，余均表现为双肺多灶性片状浸润阴影，边缘模糊不清，内见支气管充气征，均经纤支镜肺活检明确诊断，病理提示“大量成熟淋巴细胞浸润”，该5例患者中有3例最终发现成恶性淋巴瘤，另2例存活至今，病程为8－9年，5例患者中3例接受过COP等方案化疗，其中1例转恶性淋巴瘤死亡，结论：肺假性淋巴瘤罕见，临床表现无特异性，一般实验室检查无异常，确诊需依赖纤支镜肺活检，部分患者最终转归为恶性淋巴瘤，对明确诊断的患者可应用化疗并密切随访。     

Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

Background and objective:   Although pulmonary rehabilitation is effective for patients with COPD, its efficacy in patients with IPF is unknown. The purpose of this study was to evaluate the effects of pulmonary rehabilitation in IPF.
Methods:   Thirty patients diagnosed with IPF, according to the consensus statement, were randomly assigned to the rehabilitation group or the control group. The pulmonary rehabilitation mainly consisted of a 10-week programme of exercise training. Pulmonary function, blood gas analysis, 6MWD, dyspnoea rating with the baseline dyspnoea index and health-related quality of life score on the St George's Respiratory Questionnaire were evaluated at baseline and after the programme.
Results:   Assessment of efficacy was carried out on 13 patients who completed the programme and 15 patients in the control group. There were no significant effects of the programme on measures of pulmonary function, values of arterial blood gas analysis or dyspnoea rating. Although there were some differences in the baseline 6MWD and total health-related quality of life score which were not statistically significant, marked improvements were observed in the 6MWD (mean difference 46.3 m (95% CI: 8.3–84.4), P  < 0.05) and the total health-related quality of life score (−6.1 (95% CI: −11.7 to −0.5), P  < 0.05).
Conclusions:   Pulmonary rehabilitation improves both exercise capacity and health-related quality of life in patients with IPF.     

Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension: A preliminary study

BackgroundManagement of chronic thromboembolic pulmonary hypertension (CTEPH) has recently improved because of advances in pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and disease-targeted medications. However, patients with inoperable CTEPH or persistent pulmonary hypertension (PH) after these interventions continue to exhibit impaired exercise capacity and limited quality of life (QOL).MethodsEight patients with inoperable or residual CTEPH (mean age, 64±12 years; WHO functional class II/III, 6/2; mean pulmonary artery pressure, 47±13 mmHg) in stable condition and receiving disease-targeted medications participated in a 12-week home-based pulmonary rehabilitation program (muscle strength training, respiratory exercises, and walking) with supervised hospital sessions from March 2012 to January 2014. Efficacy parameters were prospectively evaluated at baseline and at completion of the 12-week program.ResultsAfter completion of the pulmonary rehabilitation program, the 6-minute walking distance (6MWD) (33.3±25.1 m), St. George׳s Respiratory Questionnaire activity score, quadriceps force, and 7-day physical activity level were significantly improved compared with baseline. All subjects completed the rehabilitation program. Although one patient experienced presyncope during the in-hospital exercise sessions, no other severe adverse events or complications of pulmonary rehabilitation were observed.ConclusionsThese findings suggest that home-based pulmonary rehabilitation with closely supervised sessions may safely improve exercise capacity, leg muscle strength, general activity in daily life and health-related QOL in CTEPH patients.     

Effects of pulmonary rehabilitation in patients with pulmonary tuberculosis sequelae]

Pulmonary rehabilitation was evaluated for a mean period of 3.9 weeks in 37 inpatients with pulmonary tuberculosis sequelae. The rehabilitation program consisted of relaxation, breathing retraining, exercise training, respiratory muscle training and instruction. Significant improvement was shown in VC (n = 37) on average from 1.48 l to 1.59 l, in FEV1.0 (n = 37) from 0.93 l to 1.02 l, in PaO2 (n = 35) from 67.1 Torr to 72.4 Torr, in 6-minute walking distance (n = 29) from 303 m to 339 m, in Pimax (n = 17) from 38.5 cmH2O to 47.5 cmH2O, in activity (n = 23) from 19.6 points to 22.5 points, in dyspnea (n = 22) from 18.4 points to 22.5 points and in QOL (n = 25) from 39.0 points to 44.2 points. The effects of pulmonary rehabilitation did not depend on past thoracic surgery for tuberculosis, pattern of ventilatory impairment, findings of chest radiography, or degree of insufficiency. These data suggest that pulmonary rehabilitation is of benefit for improving pulmonary function, exercise tolerance, symptoms and QOL in patients with pulmonary tuberculosis sequelae.     

Evaluation of severe adverse events during rehabilitation for acute-phase patients: A retrospective cohort study

Early mobilization decreases the likelihood of negative outcomes for acute-phase inpatients. Adverse events occurring during intensive care unit rehabilitation have previously been reported; however, no study has reported the incidence rates for adverse events during the acute rehabilitation phase. This study aimed to investigate the incidence of severe adverse events during acute-phase rehabilitation and evaluate them in detail.Reports of adverse events occurring during acute-phase rehabilitation in a university hospital from April 1, 2011 to March 31, 2018 were retrospectively assessed.Nine severe adverse events occurred during this period (incidence rate, 0.032%), comprising 2 cardiopulmonary arrests, 2 pulseless electrical activity events, 2 deterioration in consciousness events, 1 deterioration in consciousness event due to cerebral infarction, 1 fracture due to a fall, and 1 event involving removal of a ventricular drain. Pulmonary thromboembolism was implicated in 1 adverse event involving pulseless electrical activity and 1 deterioration in consciousness event. The causes for the 6 other adverse events could not be identified. The mean days from admission and the onset of rehabilitation to adverse event occurrence were 22.0 ± 18.2 and 17.9 ± 13.5 days (mean ± standard deviation), respectively. Four of 9 patients died, and 5 patients were discharged home or transferred to other stepdown facilities. When assessed retrospectively, there were no conflicts between patient conditions and the cancellation criteria of rehabilitation by the Japanese Association of Rehabilitation Medicine.The occurrences of severe adverse event may not be related to early mobilization (or onset time of rehabilitation) and compliance status of cancellation criteria.     

Impact of intensive rehabilitation on long-term prognosis after stroke: A Korean nationwide retrospective cohort study

An increasing number of patients are receiving rehabilitation after stroke. But the impact of intensive rehabilitation on the long-term prognosis of patients with stroke remains to be elucidated. The purpose of this study was to identify the impact of intensive rehabilitation on the long-term prognosis of patients with stroke using data from the National Health Insurance Service database. This is a register-based, retrospective cohort study. Using data from the National Health Insurance Service database, we included the patients who received rehabilitation for stroke from 2006 to 2013. Of the 14,984 patients diagnosed with stroke, 2483 died within 1 year, and 2866 did not receive rehabilitation; hence, they were also excluded. The final sample included 9635 (49.2% men, 50.8% women) patients. After correcting for covariates, the Cox model was used to evaluate the effects of physical therapy (PT) and occupational therapy (OT) on survival. We estimated the independent contribution of each factor to the risk of death from the initiation of rehabilitation. Significant differences in mortality were observed according to age, Charlson comorbidity index (CCI), income level, and stroke type. Patients with stroke who received both PT and OT had a better long-term prognosis than those who received either treatment alone. Therapy performed by a physical therapist with more than 120 hours of training effectively improved the patients’ long-term prognosis. Intensive PT and OT will help improve the long-term prognosis of patients with stroke. This study emphasizes the importance of intensive rehabilitation in these patients.