Opioid Use in End-of-Life Care in Patients With Interstitial Pneumonia Associated With Respiratory Worsening

ABSTRACT

The authors investigated the treatment outcome of patients with severe interstitial pneumonia (IP) who received opioids during end-of-life care. Twenty-two consecutive patients were retrospectively evaluated before and after continuous administration of opioids for 24 hours. All subjects died within 21 days; the mean survival period after opioid administration was 5.6 days. Six of the 22 patients (27%) died within 24 hours after opioids were initiated. In the other 16 patients, respiratory rate was significantly decreased after opioid use and there was a small, nonsignificant improvement in dyspnea measured by the Borg scale without adequate evaluation and records (n = 6). However, hypercapnia with over 10 mm Hg of Paco₂ developed in two patients. Paco₂ tended to be elevated after opioid use in all patients, although the change was not significant. An extremely poor outcome was attributable to the disease progression of IP in six of the patients with Pao₂/F_Io₂ levels below 100. The other 16 patients showed both positive and negative effects as expected. Clinicians should assess dyspnea prior to opioid administration, since the purpose of the opioid administration is to relieve dyspnea. Dyspnea should be monitored and recorded in routine clinical practice, at least after hospitalization.     

大剂量富露施对特发性肺间质纤维化患者肺功能的影响

目的探讨大剂量富露施对特发性肺间质纤维化患者肺功能的影响。方法将特发性肺间质纤维化患者随机分为两组,A组24例,每天口服强的松0·5mg/kg,4周后减半维持,同时口服富露施600mg/次,每天3次;B组24例,每天口服强的松0·5mg/kg,4周后减半维持。疗程均为3个月。观察临床表现、肺CT、血气、肺功能改变及症状缓解时间。结果A组患者的临床表现如气短、干咳、Velcro罗音经治疗后缓解率为66·7%,B组的缓解率为37·5%(P<0·05);A组缓解时间为(16·7±4·69)d,B组为(23·7±4·87)d(P<0·05);肺CT改善率在A组为62·5%,B组为29·2%(P<0·05)。A组患者治疗前后氧分压(PaO2)、百分肺活量(VC%)、一氧化碳弥散量(DLCO%)提高(P<0·05)。B组患者治疗前后PaO2、VC%、DLCO%有所提高,但与治疗前比较无显著性差异(P>0·05)。两组治疗后比较有显著性差异(P<0·05)。结论大剂量富露施能有效改善特发性肺间质纤维化患者的肺功能。     

乙酰半胱氨酸联合泼尼松治疗特发性肺间质纤维化患者疗效

目的：观察乙酰半胱氨酸联合泼尼松治疗特发性肺间质纤维化（IPF）患者的治疗效果。方法将45例IPF 患者随机分为3组,泼尼松组15例（A 组）,每日（理想体质量）0．5 mg／kg,口服4周,然后每日0．25 mg／kg,口服8周,继之减量至每日0．125 mg／kg 口服;小剂量乙酰半胱氨酸组15例（B 组）,在上述泼尼松治疗基础上加用乙酰半胱氨酸200 mg,每日3次;大剂量乙酰半胱氨酸组15例（C 组）,在上述泼尼松治疗基础上加用大剂量乙酰半胱氨酸600 mg,每日3次;疗程6个月。观察治疗前后各组患者肺活量（VC）、6分钟步行试验（6MWT）距离变化,评价总体疗效。结果3组治疗后 VC、6MWT 较治疗前均降低。C 组疗效好于 A 组和 B 组（P ＜0．05）。C 组 VC、6MWT 较其他治疗组下降缓慢（P ＜0．05）。结论大剂量乙酰半胱氨酸联合泼尼松能延缓特发性肺间质纤维化患者肺功能下降及6MWT 距离的减少。     

急性特发性肺间质纤维化在影像学上的表现

介绍急性特发性肺间质纤维化的临床表现与影像学特征,以便及早作出诊断和治疗。方法该组6例有完整的临床、实验室结果、胸片、高分辧率CT(HRCT)资料并与病理活检做对照,重点介绍该病在高分辨率CT上的表现。结果6例临床表现为咳嗽、气急、呼吸困难和低氧血征。胸片显示两肺有多发的斑片状影。高分辧率CT上的表现是:磨玻璃样影、网状影以及晚期的蜂窝样影等。病灶以中下肺、胸膜下分布为主。结论临床表现、实验室检查、影像学特征相结合,有助于作出急性特发性肺间质纤维化的诊断,一经病理证实,及时治疗,部分病例可获得好的结果。     

特发性肺纤维化患者生活质量特异性量表的汉化及信度效度的初步验证

目的：形成中文版特发性肺纤维化患者生活质量特异性量表（ATAQ-IPF）,并检验其在中国特发性肺纤维化患者中的信度、效度。方法：取得原作者同意并授权后,将量表进行翻译、回译和文化调试,应用翻译和修订的中文版量表ATAQ-IPF和圣乔治呼吸问卷（SGRQ）对75名特发性肺纤维化患者进行调查,采用项目分析方法测定中文版ATAQ-IPF量表各条目的鉴别能力,进行重测信度、内部一致性信度、内容效度、效标关联效度的初步评定。结果 ：中文版ATAQ-IPF量表含74个条目,除条目49外,各条目与其所属维度的相关系数为0.305~0.962;ATAQ-IPF量表与圣乔治呼吸问卷（SGRQ）的效标关联效度为0.611（P〈0.01）;Cronbach’sα系数为0.945。结论：中文版量表ATAQ-IPF有较好的信度、效度,可用于评价特发性肺纤维化患者的生活质量。     

Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice

Title. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim. This paper is a discussion of evidence‐based core measures for developmental care in neonatal intensive care units. Background. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease‐ and procedure‐independent measures based on the Universe of Developmental Care model. Data sources. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion. Five core measure sets for evidence‐based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family‐centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant‐family dyads. Conclusion. Standardized disease‐independent core measures for developmental care establish minimum evidence‐based practice expectations and offer an objective basis for cross‐institutional comparison of developmental care programmes.     

35例儿童百草枯中毒的急救及护理

[目的]总结儿童百草枯中毒的护理,以减少肺纤维化的发生、提高患儿存活率。[方法]对35例百草枯中毒患儿进行急救及护理。[结果]治愈出院20例,1例口服致死量患儿入院后6h经抢救无效死亡,放弃治疗14例,随访死亡14例。[结论]加强儿童百草枯中毒的急救及护理,有利于预后。     

红花黄色素氯化钠注射液联合甲基泼尼龙治疗特发性肺纤维化的疗效及安全性

目的观察红花黄色素氯化钠注射液联合甲基泼尼龙治疗特发性肺纤维化的疗效及安全性。方法将70例特发性肺纤维化患者随机分为2组。对照组采用甲基泼尼龙治疗,观察组采用红花黄色素氯化钠注射液联合甲基泼尼龙治疗。比较治疗前后2组临床症状评分、肺功能相关指标、血清肺纤维化相关细胞因子水平及不良反应发生情况。结果治疗后第4、12周,观察组患者咳嗽、呼吸困难、紫绀、啰音评分及总分均显著低于对照组(P0.05);观察组患者第1秒用力肺活量/用力肺活量(FEV1/FVC)、肺一氧化碳弥散量(Dlco)、p(O2)均显著高于对照组(P0.05),血清透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅲ型胶原(ColⅢ)、尿素氮(BUN)水平均显著低于对照组(P0.05)。结论红花黄色素氯化钠注射液联合甲基泼尼龙能有效改善特发性肺纤维化患者的肺功能和肺纤维化程度,促进临床症状的缓解,提高患者的生存质量。     

Increased serum levels of endostatin in patients with idiopathic pulmonary fibrosis

Endostatin is an angiogenesis inhibitor that is an endogenously produced proteolytic fragment of type XVIII collagen. Serum levels of endostatin have been studied extensively in patients with malignant diseases. Recently, elevated serum endostatin levels were observed in patients with systemic sclerosis accompanying pulmonary fibrosis. To determine whether elevated serum endostatin can be observed in patients with idiopathic pulmonary fibrosis (IPF), we measured serum levels of endostatin in 69 patients with benign respiratory disease using an ELISA kit. The median of the serum endostatin levels in these patients was 50.8 pg/mL. Seven of 11 patients (63.6%) with collagen disease-associated pulmonary fibrosis (CDPF), and 19 of 24 patients (79.2%) with IPF had higher serum endostatin levels than the median level of the 69 patients. There was no statistical difference in serum endostatin levels between the patients with IPF and those with CDPF (P=0.7898). Serum endostatin levels in 24 patients with IPF were significantly higher than those in 34 patients with respiratory diseases other than IPF and CDPF (P=0.0001). Elevated serum levels of endostatin were observed in patients with IPF. Although the mechanisms are unclear, elevated serum levels of endostatin may be related to the fibrosing process in the lung.     

特发性肺间质纤维化患者康复效果的最佳护理证据总结及实证研究

目的 探讨特发性肺间质纤维化(IPF)患者康复效果的最佳护理证据总结及实证研究.方法 选取2018年6月-2020年6月我院收治的88例IPF患者为研究对象,采用双盲法将其分为对照组和观察组,各44例.对照组行常规护理干预.观察组在此基础上给予康复效果最佳护理证据应用干预.比较两组干预前后的肺功能 、生活质量以及康复效...     

气泵雾化吸入普米克令舒治疗特发性肺间质纤维化

目的探讨气泵雾化吸入普米克令舒治疗特发性肺间质纤维化（IPF）的临床疗效。方法将72例特发性肺间质纤维化患者随机分为三组,各24例,A组普米克令舒2ml（含布地奈德1mg）气泵雾化吸入,每日2次;B组吸入普通普米克气雾剂,每次4喷,2次/d;C组每天口服强的松1mg/kg,4周后减半量维持,疗程均为3个月。观察三组患者的临床表现、肺CT、血气、肺功能改变及副作用。结果治疗后,临床表现缓解率为A组70.8%、B组25%、C组50%,A组与B组比较差异有显著性意义（P〈0.0125）,A组与C组比较差异无显著性意义（P〉0.0125）;肺CT改善率为A组66.7%、B组29.2%、C组45.8%,A组与B组比较差异有显著性意义（P〈0.0125）,A组与C组比较差异无显著性意义（P〉0.0125）;A组和C组患者PaO2、VC%、DLCO%提高（P〈0.05）,但两组间比较差异无显著性意义（P〉0.05）,B组PaO2、VC%、DLCO%也有提高,与治疗前比较差异无显著性意义（P〉0.05）。副作用发生率为A组8.3%、B组8.3%、C组58.3%,A组与C组比较差异有显著性意义（P〈0.0125）。结论气泵雾化吸入普米克令舒代替口服用药治疗特发性肺间质纤维化副作用少且临床疗效确切。     

特发性肺纤维化CT评分与Ⅰ～Ⅲ期非小细胞肺癌患者术后复发的关系

探讨合并特发性肺纤维化（IPF）对非小细胞肺癌（NSCLC）患者术后预后的影响。

选择2018年3月至2019年3月在西安交通大学附属红会医院接受根治性手术治疗的NSCLC患者98例,分为IPF组、无IPF组。比较两组临床病理资料及手术相关情况。随访至2024年3月31日,终点事件为NSCLC相关死亡或NSCLC复发,记录随访期间死亡及复发情况。绘制Kaplan-Meier生存曲线,采用log-rank检验比较两组生存率。采用Cox回归分析影响NSCLC患者术后死亡、复发的相关因素。

98例患者中,有IPF 45例（45.92%）。与无IPF组相比,IPF组年龄较大,女性患者比例、术前血清C反应蛋白（CRP）水平较高,术前血清白蛋白水平较低（P＜0.05）。中位随访3.7（0.7,5.6）年,IPF组患者的1、3、5年总生存率、无复发生存率均低于无IPF组（P＜0.05）。Cox回归分析显示,中高分化程度、合并IPF是NSCLC患者生存的危险因素（P＜0.05）;血管浸润、肿瘤较大、有IPF是导致NSCLC复发的危险因素（P＜0.05）。

对于NSCLC患者,合并IPF可降低总生存率与无复发生存率,是导致其术后死亡、复发的共同危险因素。

     

妇科恶性肿瘤患者支持性照顾需求的调查性研究

【】目的：探讨妇科恶性肿瘤患者治疗期间支持性照顾需求状况及需要帮助情况【方法】采用描述性研究设计,用癌症患者支持性照顾需求问卷(SCNS)对治疗期间的101例妇科恶性肿瘤患者进行问卷调查。【结果】妇科恶性肿瘤患者支持性照顾需求程度得分依次为健康信息维度(3.267±0.679)分, 照顾与支持维度(3.043±0.668)分,心理维度(2.272±0.838)分,生理与日常生活维度(1.993±1.079)分,性维度(1.823±0.956)分;上述维度需要帮助程度得分依次为(2.261±0.754)分,(2.032±0.808)分,(1.602±0.800)分,(1.406±0.962)分,(1.293±1.069)分。【结论】妇科恶性肿瘤患者治疗期间对健康信息、照顾与支持方面的需求程度及需要帮助情况较高,各方面均存在需求及需求未满足情况,需求程度越高,越需要得到帮助。有必要采取护理措施满足患者的需求,帮助患者树立起战胜病魔的勇气和信心。     

肺纤维化患者血清及诱导痰肺表面活性蛋白水平测定及意义

目的检测特发性肺纤维化患者急性加重期血清及诱导痰肺表面活性蛋白D(SP-D)水平并探讨其临床治疗意义。方法选择特发性肺纤维化患者急性加重期住院治疗26例,分别收集纳入患者入院时及治疗后病情缓解血清及诱导痰液标本,采用酶联免疫吸附试验检测血清及诱导痰SP-D水平。选择42例健康人群作为对照组。结果特发性肺纤维化患者急性加重期及病情缓解期血清SP-D平均水平分别为(196±82)、(125±69)ng/mL,健康对照组为(96±47)ng/mL,诱导痰SP-D平均水平为(153±71)、(106±64)ng/mL,急性加重期与缓解期及健康对照组SP-D水平比较差异有统计学意义(P0.05)。结论血清SP-D检测可作为特发性肺纤维化患者急性加重诊断的生物学指标。     

补肺活血法治疗特发性肺间质纤维化的临床研究

【】目的：分析探讨补肺活血法治疗特发性肺间质纤维化的临床疗效。方法：选取2014年6月~2018年8月期间我院收治的60例特发性肺间质纤维化患者,随机分为观察组(n=30)和对照组(n=30)。观察组予以经典方剂血府逐瘀汤合补肺汤以补肺活血,同时予以常规内科基础治疗。对照组仅予以常规内科基础治疗。分析比较两组患者的治疗前后肺功能、血气分析、临床疗效和不良反应情况。结果：治疗后,两组患者的肺功能、血气分析和临床疗效均明显改善,观察组患者的FVC、DLCO、PaO2大于对照组(P<0.05);观察组患者的治疗有效率高于对照组(P<0.05);两组患者均未发生明显不良反应。结论：补肺活血法有助于改善特发性肺间质纤维化患者的肺功能、血气分析,具有提高患者的临床疗效的作用。     

lncRNA PFAR Promotes Lung Fibroblast Activation and Fibrosis by Targeting miR-138 to Regulate the YAP1-Twist Axis

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