雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

目的 首次将雾化吸入灭活草分枝杆菌用于防治中度支气管哮喘,并观察临床效果.方法 本研究为前瞻性、对照性研究.收集2009年3月至2010年12月于广西医科大学第一附属医院门诊确诊的哮喘患者,满足以下条件纳入研究:年龄≥14岁,符合2008年全球哮喘防治创议(GINA)支气管哮喘慢性持续中度标准,在1个月内无全身使用糖皮质激素、酮替芬或孟鲁斯特等抗炎抗过敏药物并无明显呼吸道感染及已知有其他任何严重的疾病或异常.选取100名哮喘患者,其中男/女比例为37/63,年龄(32.11±12.95)岁.将其随机(随机数字法)分为两组,A组为治疗组,男/女比例为16/34,年龄(33.56±14.23)岁;B组为对照组,男/女比例为21/29,年龄(30.66±11.50)岁;各50名.两组患者的年龄、性别构成差异均无统计学意义,具有可比性.A组雾化吸入灭活草分枝杆菌F.U.36注射液1.72μg/mL×2支加入3 mL生理盐水,1次/d,连续5 d.B组吸入沙美特罗替卡松粉吸入剂(50/100μg),每天两次,持续使用.观察1个月,期间两组患者均可按需吸入硫酸沙丁胺醇气雾剂缓解症状并记录使用喷数.于第0天、第6天、第31天查患者肺功能及哮喘激发试验,治疗前后测ACT评分.结果 于治疗后第6天、第31天,A组哮喘激发试验转阴率分别为82%,78%,B组分别为84%,90%,两组治疗后患者激发试验均明显转阴,经x2检验两组间相比差异无统计学意义(P＞0.05).经完全随机设计资料的方差分析:治疗后A,B组乙酰甲胆碱累积用量明显增加(P＜0.05),而两组之间无差别;A组治疗后第一秒用力呼气容积(FEV1)有改善趋势,但差异无统计学意义,B组显著增高(P＜0.05),在第31天较A组明显增高(P＜0.05);两组最大呼气流量(PEF)在治疗后第6天、第31天均显著增高(P＜0.05),在第31天B组较A组增高明显(P＜0.05);治疗后两组患者哮喘控制测试(ACT)评分均显著提高、硫酸沙丁胺醇气雾剂的使用量均明显减少(P＜0.01),B组较A组明显(P＜0.05).治疗期间仅有2例患者在治疗期间出现一过性低热的不良反应,以第3天明显.结论 雾化吸入灭活草分枝杆菌能在短期内抑制中度哮喘患者的气道高反应性并改善症状、减少发作,减少缓解药物的使用量,在一定时间内对中度哮喘发作有防治作用.

Abstract：

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.     

利多卡因雾化吸入治疗支气管哮喘的临床研究

目的 研究利多卡因雾化吸入治疗支气管哮喘的疗效。方法 在吸氧、抗炎、祛痰、纠正酸碱失衡的基础上，以0．9％生理盐水加入利多卡因100mg雾化吸入，2次／d，症状控制后减量维持7～10d。结果103例中临床控制81例（78．64％），显效10例（9．7％），有效7例（6．7％），无效5例（4．88％）。结论 利多卡因雾化吸入对支气管哮喘疗效满意。     

哮喘患儿雾化吸入的护理体会

支气管哮喘（bronchi alasthma），简称哮喘，是一种慢性气道炎症性疾病，以嗜酸粒细胞、肥大细胞反应为主的气道变应性炎症（allergic airway inflammation，AAI）和气道高反应性（broncho—hyper reactivity，BHR）为特征。临床表现为反复发作的呼气性呼吸困难伴哮喘音、胸闷或咳嗽。由于气道炎症的持续存在，哮喘需要长期的治疗与控制。而雾化吸入是治疗哮喘的主要给药途径，它可以使药物直接作用于气道，与口服药相比具有剂量小、起效快、副作用小等优点被广泛应用于临床。如何才能更合理正确地使用雾化器，达到满意的治疗效果？笔者就这一问题谈一下自己的护理体会。     

雾化吸入治疗急性支气管哮喘

近年来本院应用中西医结合方法雾化吸入治疗急性支气管炎哮喘，取得较好疗效，现总结如下：     

负压并药物雾化吸入治疗支气管哮喘

近年来 ,支气管哮喘 (简称哮喘 )的发病率呈上升趋势 ,各种高选择性新型的 β2 受体激动剂、胆碱能受体拮抗剂和皮质类固醇等局部吸入剂型在临床上得到了广泛应用 ,不仅减少了药物的副作用 ,而且提高了临床疗效和其安全性。哮喘的各种外治法在协同治疗或巩固治疗中也发挥了一定作用。负压温吸理疗仪是根据中医气血学说和拔罐疗法而研制的理疗仪。 1998年 1月至 12月 ,我们对 6 0例哮喘轻中度急性发作患者在应用溴化异丙托品吸入基础上加穴位负压温吸治疗 ,观察其临床疗效和对第 1秒用力呼气容积 (ＦＥＶ1.0 )值的影响。资料和方法　　本院呼…     

速尿雾化吸入治疗支气管哮喘疗效观察

速尿雾化吸入治疗支气管哮喘疗效观察浙江省宁波市镇海石化总厂医院内科（３１５０００）劳波支气管哮喘是内科常见急症，由于过敏原、药物、感染、运动及职业等过敏或非过敏因素所致，不及时处理，则预后较为严重。我院应用速尿雾化吸人治疗支气管哮喘，经设对照组研究疗...     

雾化吸入酚妥拉明终止重症支气管哮喘6例报告

目的：探讨酚妥拉明雾化吸入治疗支气管哮喘的疗效。方法：对经内科常规治疗及机械通气治疗无效的重症支气管哮喘患者，经人工气道给予雾化吸入酚妥拉明5－10mg，在持续监护下给予固定潮气量，观察患者气道峰压的连续变化。结果：患者的气道峰压雾化后明显下降，喘息终止。结论：雾化吸入酚妥拉明对控制气道压、终止支气管哮喘有良好效果。     

超短波及VitK3雾化吸入对支气管哮喘患者肺功能和气道反应性影响的临床研究

支气管哮喘的病理基础是嗜酸性粒细胞、肥大细胞、T淋巴细胞、巨噬细胞等多种炎性细胞引起的气道慢性炎症。慢性气道炎症引起气道高反应性，导致气道痉挛狭窄而发病。哮喘病治疗的重点已由过去的解痉平喘治疗转变为抗炎治疗。如何阻断炎性介质的形成和拮抗其炎症效应、减轻气道炎症、降低气道高反应性是治疗支气管哮喘的重要方法。已有研究发现白三烯     

哮喘控制测试在儿童哮喘中的应用研究

目的:探讨哮喘控制测试量表在儿童临床工作中应用的可行性。方法:对65名儿童支气管哮喘患者按GINA治疗规范于治疗初期、1个月、3个月时测定FEV1%、PEF%并同时填写哮喘控制测试量表(12岁以上)或儿童哮喘控制测试量表(4～11岁),并以FEV1%和PEF%数据分组进行统计学处理,比较儿童哮喘控制测试与FEV1%和PEF%的趋同性和一致性,分析儿童哮喘控制测试与FEV1%和PEF%的相关程度和可信度检验。结果:儿童哮喘控制测试和FEV1%、PEF%具有良好的趋同性和一致性(P<0.01),具有明显相关性,且儿童哮喘控制测试与PEF%的相关性较FEV1%相关性高。结论:儿童哮喘控制测试完全可应用于儿童临床工作中,可与肺功能监测联合应用,并可在基层无肺功能医疗机构单独应用于评价哮喘状况。     

喘乐宁,速尿雾化吸入治疗发作期支气管哮喘疗效观察

将１２０例发作期支气管哮喘患者,随机分为Ａ、Ｂ组,每组６０例,Ａ组采用喘乐宁雾化吸入疗法,Ｂ组采用速尿雾化吸入疗法。结果显示：喘乐宁雾化吸入见效快、疗程短,缩短了患者住院日,疗效高于Ｂ组,可作为治疗发作期支气管哮喘的首选方法。     

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

Objective

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

Patients and methods

In a pre–post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire – PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children – STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12× 30 min.).

Results

With acupuncture, the peak expiratory flow variability differs significantly (p < 0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

Conclusion

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.     

甲泼尼龙治疗支气管哮喘重度发作的临床研究

目的比较甲泼尼龙(甲强龙)与地塞米松对治疗支气管哮喘重度发作的临床价值。方法将2003-05～2007-03在我科住院治疗的支气管哮喘重度发作患者89例随机分为两组,治疗组44例,对照组45例;两组均在常规治疗相同基础上,治疗组加用甲泼尼龙80mg/次,2次/d静点;对照组加用地塞米松15mg/次,2次/d静点,治疗前、治疗第3天分别记录症状、体征,测定动脉血气情况,进行相关统计学分析。结果治疗前两组患者支气管哮喘均为重度发作,两组差异无统计学意义;动脉血气分析:PaO2平均值两组比较差异无统计学意义(P>0.05);治疗第3天治疗组完全缓解率为93.2%(41/44),对照组缓解率为68.9%(31/45),两组比较差异有统计学意义(P<0.01);治疗组PaO2值为(87.1±7.4)mmHg,对照组PaO2值为(69.5±6.8)mmHg,治疗后两组PaO2比较有统计学意义(P<0.05)。结论在治疗支气管哮喘重度发作过程中甲强龙早期缓解哮喘的疗效更佳,有可能缩短住院日期。     

Efficacy and safety of salmeterol/fluticasone propionate delivered via a hydrofluoroalkane metered dose inhaler in Chinese patients with moderate asthma poorly controlled with inhaled corticosteroids

A randomised, open-label, multicentre study compared the efficacy and tolerability of salmeterol 25 microg/fluticasone propionate 125 microg (two puffs, twice daily) delivered via a hydrofluoroalkane metered-dose inhaler (HFA-MDI) and salmeterol 50microg/fluticasone propionate 250 microg (one puff, twice daily) delivered via a Diskus inhaler in Chinese patients with moderate asthma uncontrolled with inhaled corticosteroids (ICSs). Morning peak expiratory flow (PEF) was the primary efficacy endpoint. Secondary endpoints included evening PEF, forced expiratory volume in 1 s, day and night symptom scores, rescue medication and patient self-evaluation of efficacy. Safety was assessed according to adverse events recorded. Both treatments were equipotent and significantly improved morning PEF (HFA-MDI 40 l/min; Diskus 42 l/min; p < 0.05) and all secondary endpoints (p < 0.05) from baseline, over 1-4 weeks. Similarly, both treatments were well tolerated. Salmeterol/fluticasone propionate delivered via an HFA-MDI or Diskus inhaler provides a choice of efficacious delivery systems in Chinese patients whose asthma is poorly controlled on ICSs alone.     

布地奈德与特布他林治疗支气管哮喘的临床对照研究

目的探讨布地奈德和特布他林联合雾化吸入治疗支气管哮喘的临床优势。方法将确诊为支气管哮喘的90例患者,按随机数字表分为观察组和对照组,对照组在常规治疗的基础上雾化吸入布地奈德,观察组在对照组基础上雾化吸入布地奈德和特布他林,两组均治疗14d,比较两组的临床疗效、症状体征改善时间、症状评分变化情况,利用SPSSl6．0进行统计分析。结果布地奈德和特布他林联合雾化吸入组的总有效率为97．78％,单用布地奈德组的总有效率为73．33％,两组总有效率差异具有统计学意义（P〈0．01）;布地奈德和特布他林联合雾化吸入组的呼吸困难、喘息、咳嗽、哆音、哮呜音、住院时间分别为（2．1士0．8）、（3．1±1．4）、（5．3±1．7）、（5．1±1．2）、（3．8±1．4）、（5．9±2．1）d,单用布地奈德组分别为（3．4±1．2）、（4．7±1．O）、（7．3±1．6）、（6．9±1．5）、（5．9±1．3）、（9．3±2．6）d,两组各项指标差异具有统计学意义（P〈O．01）。结论布地奈德与特布他林联合雾化吸入能快速改善患者症状与体征,且没有明显不良反应,患者依从性好,吸烟患者应适当地增加剂量,推荐作为支气管哮喘的首选给药方法。     

Clinical and biochemical aspects of flixotide administration in patients with moderate bronchial asthma

AIM: To compare clinical, device and biochemical aspects of monotherapy with flixotide vs combination of flixotide with serevent in patients with moderate bronchial asthma (MBA). MATERIAL AND METHODS: 18 patients with MBA received flixotide and 18 MBA patients flixotide plus serevent for two weeks of lead-in and eight weeks of basic treatment. A special study was made of neutrophils which were examined for activity of LPO-antioxidants and phospholipid spectrum of membranes. RESULTS: There were similar changes in function of the system LPO-antioxidants and lipid structure in neutrophilic membranes of moderate BA patients of both the groups. CONCLUSION: Clinicobiochemical efficacy of mean doses of a new topic inhalation glucocorticoid flixotide alone or in combination with prolonged beta 2-adrenostimulator serevent is demonstrated. There were positive trends in metabolic processes in neurophilic membrane. Use of flixotide in combination with serevent is clinically preferable.     

布地奈德雾化混悬液治疗支气管哮喘的临床观察

目的研究布地奈德雾化混悬液治疗支气管哮喘的疗效。方法选择146例支气管哮喘患者为研究对象,随机分为治疗组和对照组,各73例。治疗组给予布地奈德雾化混悬液雾化吸入,对照组给予丙酸倍氯米松喷雾剂,治疗2周后观察治疗前、后临床症状变化。结果治疗2周后治疗组和观察组的多数患者均痊愈,治疗组的总有效率为94.5%,对照组的总有效率为86.3%,治疗组总有效率明显高于对照组,差异存在显著性(P<0.05)。结论雾化吸入布地奈德混悬液相比于丙酸倍氯米松喷雾剂改善哮喘患者的症状更快、更有效,值得临床推广应用。     

Lung function after acute and repeated exposures to extremely cold air (-110 degrees C) during whole-body cryotherapy

Whole-body cryotherapy (WBC) is one mode of cold therapy, during which rheumatic patients are exposed to very cold air (-110 degrees C) in minimal clothing. It is also proposed to have a bronchodilatory effect. The aim was to examine the effects of WBC on lung function in healthy humans after acute and repeated exposures. Twenty-five healthy, non-smoking subjects participated in the study. They were exposed to WBC for 2 min three times per week for 12 weeks. The peak expiratory flow rate (PEF) and forced expiratory volume in 1 s (FEV1) were measured before and after (at 2 and 30 min) the first WBC, and then similarly at 4, 8 and 12 weeks. At all time points, after 30 min of the WBC the PEF values were slightly lower compared with values before the WBC, and the reductions reached statistical significance at 1 month (5.1 +/- 1.2%), and at 3 months (3.2 +/- 1.7%). After 30 min of the first WBC, the FEV1 was significantly reduced by 2.3 +/- 0.8%, but no other changes were observed during the study. In conclusion, the WBC induced minor bronchoconstriction in healthy humans instead of proposed bronchodilatation. The WBC seems not to be harmful for lung function, but should be used with caution in susceptible individuals.     

慢性阻塞性肺疾病患者用力肺活量最佳替代指标的探讨

目的 评估第6秒用力呼气容积(FEV6)是否为替代用力肺活量(FvC)用于诊断慢性阻塞性肺疾病(COPD)的最佳指标.方法 对2011年10月至2012年10月河北省胸科医院收治的142例舒张后用力呼气时间达6s以上的COPD患者(轻度7例,中度60例,重度48例,极重度27例)肺功能检查结果进行回顾性分析,在时间-容量曲线上测量FEV6、FEV5、FEV4、FEV3,对其诊断效能进行分析.结果 FEV6、FEV5、FEV4、FEV3与FVC高度相关(r值分别为0.994、0.939、0.935、0.923,P均＜0.001).以70％为诊断界点,FEV1/FEV6的诊断率为92.96％,假阴性率为7.04％,FEV1/FEV5 FEV1/FEV4、FEV1/FEV3的假阴性率更高,分别为9.86％、13.38％、27.46％.轻、中度组和重度、极重度组COPD患者的FEV1/FEV6-FEV1/FVC值差异无统计学意义(t=1.376,P=0.171).结论 FEV6与FVC高度相关,为替代FVC用于诊断COPD的最佳指标,适当提高诊断界值可减降低假阴性率.