乙酰半胱氨酸联合低分子肝素治疗对间质性肺炎患者临床症状及肺功能的影响

目的探讨乙酰半胱氨酸联合低分子肝素治疗对间质性肺炎患者的临床症状及肺功能的影响。方法选取2014年6月至2016年6月在我院就诊的间质性肺炎患者90例作为研究对象,将患者随机分为观察组及对照组,每组45例。两组患者均给予常规治疗,对照组患者在此基础上口服强的松治疗,观察组患者在对照组治疗的基础上给予乙酰半胱氨酸联合低分子肝素治疗,两组患者均治疗3个月。比较两组患者的临床症状、肺功能改善情况。结果治疗3个月后,两组患者咳嗽自评分、呼吸困难自评分情况显著改善,观察组患者的改善情况优于对照组,差异有统计学意义(P0.01);两组患者VC%pred、FVC%pred、FEV1%pred、TLC%pred水平均高于治疗前,观察组患者的肺功能改善情况优于对照组,差异有统计学意义(P0.05);两组患者6min步行试验距离长于治疗前、血清Ⅲ型胶原水平、HRCT病变评分低于治疗前,观察组患者的改善情况优于对照组,差异有统计学意义(P0.01)。结论在常规治疗的基础上,乙酰半胱氨酸联合低分子肝素治疗间质性肺炎患者,疗效显著,可明显缓解患者临床症状,改善肺功能,提升运动耐力。     

乌司他丁联合口服激素治疗间质性肺炎临床疗效

目的探讨乌司他丁联合口服激素治疗间质性肺炎疗效。方法将52例间质性肺炎患者随机分为常规组和乌司他丁联合口服激素治疗组,所有患者在治疗前后均进行白介素17(IL-17)、Ⅲ型胶原(Ⅲ-C)及肺功能一氧化氮弥散量DLCO(%)测定。比较两组患者治疗前后上述指标的变化。结果两组治疗后IL-17及Ⅲ-C较治疗前降低,乌司他丁联合口服激素组优于常规治疗组(P<0.05),乌司他丁联合口服激素组患者DLCO较治疗前升高,但与常规组比较差异无统计学意义(P<0.05)。结论联合口服激素治疗间质性肺炎改善体内炎症反应,减轻肺间质纤维化,在一定程度上改善弥散功能。     

乙酰半胱氨酸与低分子肝素联合治疗特发性间质性肺炎患者疗效观察

目的探讨乙酰半胱氨酸与低分子肝素联合治疗特发性间质性肺炎患者的临床效果。方法选取2016年6月至2018年6月我院收治的特发性间质性肺炎患者86例为研究对象,采用随机数字表法分成对照组和观察组,每组43例。对照组患者给予常规治疗;观察组患者在常规治疗的基础上,给予乙酰半胱氨酸与低分子肝素联合治疗。连续治疗1个月,比较两组患者肺功能、动脉血氧分压(PO_2)、动脉血二氧化碳分压(PCO_2)、临床疗效以及不良反应发生情况。结果治疗1个月后,两组患者的FVC%、VC%、DLCO/VA%均显著升高,观察组患者的FVC%、VC%、DLCO/VA%均显著高于对照组,差异有统计学意义(P0.05)。两组患者的PO_2均显著升高、PCO_2显著降低;观察组患者PO_2显著高于对照组,PCO_2显著低于对照组,差异有统计学意义(P0.05)。观察组患者的治疗总有效率(90.70%)显著高于对照组(72.09%),差异有统计学意义(P0.05)。治疗期间,观察组患者不良反应发生率(6.98%)显著低于对照组(23.26%),差异有统计学意义(P0.05)。结论在常规治疗的基础上,乙酰半胱氨酸与低分子肝素联合治疗可有效改善特发性间质性肺炎患者的肺功能,显著提高动脉血氧分压,降低动脉血二氧化碳分压,提高临床治疗效果,减少不良反应的发生。     

乌司他丁治疗重症间质性肺炎疗效观察

目的观察乌司他丁治疗重症间质性肺炎的临床疗效。方法将60例重症间质性肺炎患者随机分为常规治疗组和乌司他丁治疗组,所有患者在治疗前后均进行白介素17(IL-17)、白介素12(IL-2)及6分钟步行距离测定。比较两组患者治疗前后上述指标的变化。结果两组患者治疗后IL-17较治疗前降低,IL-2较治疗前升高,6分钟步行距离延长,乌司他丁治疗组患者治疗后上述指标改善优于常规治疗组(P<0.05)。结论乌司他丁治疗重症间质性肺炎患者可以更好的改善体内炎症,提升机体免疫功能,改善患者运动能力。     

银杏叶提取物联合泼尼松对特发性肺间质纤维化患者细胞因子及肺纤维化程度的影响

目的探讨银杏叶提取物联合泼尼松对特发性肺间质纤维化患者细胞因子及肺纤维化程度的影响。方法特发性肺间质纤维化患者76例,采用随机数字表字法分为观察组与对照组各38例,观察组给予银杏叶提取物联合泼尼松治疗,对照组给予泼尼松治疗,对比治疗前后两组肿瘤坏死因子(TNF)-α、白细胞介素(IL)-4、IL-10、干扰素(IFN)-γ、Ⅲ型前胶原肽(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C)、透明质酸(HA)、层黏连蛋白(LN)水平。结果两组治疗前TNF-α、IFN-γ、IL-4、IL-10水平比较差异无统计学意义(P>0.05)。两组治疗后IL-4、IL-10、TNF-α水平较治疗前均显著降低,且观察组显著低于对照组,IFN-γ水平显著增加,且观察组水平显著高于对照组(均P<0.05)。治疗前两组PC-Ⅲ、Ⅳ-C、HA、LN水平比较差异无统计学意义(P>0.05);治疗后,两组均显著降低,且观察组显著低于对照组(均P<0.05)。结论银杏叶提取物联合泼尼松治疗特发性肺间质纤维化患者,能够有效调节患者的细胞因子水平,降低肺纤维化程度。     

补阳还五汤联合N-乙酰半胱氨酸胶囊治疗特发性肺纤维化患者的效果评价

目的探讨补阳还五汤联合N-乙酰半胱氨酸胶囊治疗特发性肺纤维化患者的效果。方法选取确诊为特发性肺间质纤维化的患者120例,随机分为实验组和对照组,每组60例。对照组患者给予N-乙酰半胱氨酸胶囊口服治疗,实验组患者给补阳还五汤联合N-乙酰半胱氨酸胶囊治疗,持续治疗6个月。观察比较两组患者治疗前、治疗3个月、6个月后的呼吸困难评分、肺功能各项指标变化、支气管肺泡灌洗液相关炎症因子水平以及治疗效果。结果实验组患者治疗6个月后,呼吸困难评分、肺功能指标以及支气管肺泡灌洗液中TNF-α、IL-8、IL-4、IL-10水平均较对照组显著降低,而IFN-水平较对照组明显升高(P0.05);实验组治疗总有效率为95.0%,明显高于对照组的75.0%(P0.05)。结论采用补阳还五汤联合N-乙酰半胱氨酸胶囊治疗特发性肺纤维化患者可以有效缓解呼吸困难、改善肺功能各项指标、调节支气管肺泡灌洗液相关炎症因子水平,增强治疗效果,值得在临床中推广应用。     

大剂量N-乙酰半胱氨酸治疗特发性肺间质纤维化的临床效果分析

目的观察大剂量N-乙酰半胱氨酸治疗特发性肺间质纤维化的临床效果。方法选取时间2014年4月20日—2017年4月20日四川省雅安市人民医院收取的80例特发性肺间质纤维化患者,采取随机的方式将本院所有观察对象分为两组,各40例。对照组采用常规治疗,观察组采用大剂量N-乙酰半胱氨酸治疗,比较两组治疗效果、临床指标改善情况。结果观察组特发性肺间质纤维化患者治疗总有效率为97.50%,与对照组比较,差异具有统计学意义(P0.05)。观察组特发性肺间质纤维化患者临床指标改善情况均优于对照组(P0.05)。结论采用大剂量N-乙酰半胱氨酸治疗特发性肺间质纤维化患者取得了显著的疗效,同时还能有效改善患者各项临床指标,值得研究。     

药物联合肺康复治疗老年间质性肺炎的临床效果

目的探讨药物治疗联合肺康复治疗在老年间质性肺炎治疗中的临床效果探讨老年间质性肺炎的有效治疗方案。方法 80例老年间质性肺炎患者,入选病例均符合间质性肺炎的诊断标准,随机分成康复组和对照组,每组40例,对照组采用乙酰半胱氨酸、硫唑嘌呤、泼尼松基础药物治疗,康复组采用基础药物治疗的同时给予肺康复四步疗法,观察记录所有患者治疗前和治疗24 w后的BODE指标和指数。结果治疗前两组的BODE指标及BODE指数分值差异无统计学意义,而治疗24 w后两组均较治疗前有所改善,康复组指标改善显著高于观察组(P<0.05)。结论药物治疗联合肺康复治疗在老年间质性肺炎治疗中有显著效果。     

TGF-β1的表达与特发性间质性肺炎关系分析

目的探讨特发性间质性肺炎患者TGF-β1的表达水平。方法对我院治疗的特发性间质性肺炎患者和健康体检人群的TGF-β1的表达水平进行检测,探讨TGF-β1在特发性间质性肺炎患者中的表达强度。结果特发性间质性肺炎患者TGF-β1水平高于健康体检人群,PaO2和SaO2均低于健康体检人群,组间资料比较,差异有统计学意义(P0.05)。特发性间质性肺炎各型患者中TGF-β1的表达水平不一,以脱屑性间质性肺炎表达强度最高,其次为普通型间质性肺炎和急性间质性肺炎。结论特发性间质性肺炎患者TGF-β1表达水平高于正常健康体检人群,TGF-β1在各个类型的特发性间质性肺炎患者中表达强度不同,在脱屑性间质性肺炎表达程度明显高于其他类型。     

丹红注射液治疗特发性肺纤维化患者的临床分析

目的观察丹红注射液联合甲基强的松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两组,对照组和观察组各35例。对照组采用强的松龙治疗,观察组则采用丹红注射液联合强的松龙治疗。比较治疗前后两组间临床症状评分、肺功能相关指标和血清肺纤维化相关细胞因子水平,并比较两组间不良反应发生情况差异。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;观察组患者FEV1/FVC、Dlco、Pa O2均显著高于对照组;血清HA、LN、PCⅢ、ColⅢ、BUN水平均显著低于对照组,P0.05。结论丹红注射液联合甲基强的松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。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.