COPD急性加重导致严重呼吸性酸中毒时无创正压通气的应用

目的 对比无创正压通气（NPPV）对慢性阻塞性肺疾病（COPD）急性加重导致轻度呼吸性酸中毒与严重呼吸性酸中毒的疗效.方法 对比人选COPD急性加重导致轻度呼吸性酸中毒（pH 7.25～7.35）组患者和严重酸中毒（PH〈7.25）组患者NPPV2小时后pH值和PaCO2的变化、24小时后pH值恢复正常的人数、总的NPPV治疗时间和住院天数.结果 轻度酸中毒组和严重酸中毒组相比,NPPV 2小时后pH变化值分别为（0.04±0.01）和（0.06±0.03）,PaCO2分别为（14.3±7.4）mmHg和（18.1±11.2）mmHg,改善程度相似（P〉0.05）.两组患者NPPV 24小时后pH值恢复正常比率（分别为65.9%和59.5%）、NPPV应用时间分别为（103±8.1）小时和（106±6.6）小时,住院天数分别为（13±2.7）天和（15±4.1）天及NPPV失败率（分别为13.6%和19.0%）也无差异（P〉0.05）.结论 无创正压通气治疗对COPD急性加重导致严重呼吸性酸中毒的患者是有效的.     

大剂量厄贝沙坦治疗慢性肾脏病患者蛋白尿的疗效观察

目的探讨临床上使用大剂量厄贝沙坦对慢性肾脏病患者蛋白尿的治疗效果。方法以80例为研究对象,给予150mg／d厄贝沙坦治疗,疗程4周。24例患者为对照组维持剂量;56例患者为观察组逐渐加大剂量（300-600mg,d）,疗程为12月,对各项指标进行对比。结果治疗后尿蛋白定量及各项指标均有显著的改变（P〈0．05）;大剂量厄贝沙坦治疗有效率为78．5％（P〉0．05）。结论大剂量厄贝沙坦治疗慢性肾脏病患者可以明显的降低蛋白尿,具有很好的耐受性和安全性。     

Environmental and individual predictors of medication adherence among elderly patients with hypertension and chronic kidney disease: A geospatial approach

BackgroundFew studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals’ medication-taking behaviors in patients.ObjectiveTo explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States.MethodsThe Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence.ResultsA total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence.ConclusionsMedication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective.