Inhaled dopamine induces bronchodilatation in patients with bronchial asthma.

OBJECTIVE: To determine the probable bronchodilating effect of dopamine administered by inhalation route in patients with crisis of bronchial asthma and the effect of dopamine on bronchial motor tone. DESIGN AND METHOD: We have studied eighteen (18) patients with crisis of bronchial asthma, ten (10) subjects with bronchial hyperreactivity and ten (10) healthy subjects. Patients with other pulmonary or cardiac disease were excluded. All received by inhalation placebo (0.9% saline solution), dopamine at 0.5 microg/kg/min (controlled by heart rate and arterial pressure with a dynamap), and placebo. Respiratory parameters: forced vital capacity (FVC), forced expiratory volume at the first second (FEV1), forced maximal expiratory flow (FEFmax) and forced expiratory flow at the 50% of vital capacity (FEF50) were measured in each protocol period. Student's paired t test, Wilcoxon and Mann Whitney analysis were performed. RESULTS: After dopamine inhalation, there was an increase of FVC by 23% (p<0.001); an increase of FEV1 by 39% (p<0.0001); an increase of FEF50 by 33% (p<0.001) and an increase of FEFmax by 31% (p<0.001). There were no respiratory parameter changes in both, subjects with bronchial hyperreactivity and normal after dopamine inhalation. CONCLUSIONS: Inhaled dopamine induces bronchodilatation in patients with crisis of bronchial asthma. Inhaled dopamine neither alters basal bronchial tone in healthy subjects nor in subjects with bronchial hyperreactivity.     

Cardiorespiratory responses to submaximal incremental exercise are not affected by one night's sleep deprivation during the follicular and luteal phases of the menstrual cycle

The purpose of the study was to investigate the effects of one night's sleep deprivation on the cardiorespiratory responses to exercise during the follicular and luteal phases of the menstrual cycle. We have studied nine, healthy females aged 24-35 years with regular menstrual cycles. Each subject performed spirometric tests at rest and then an incremental exercise testing during 11-13 days of follicular phase and 22-24 days of luteal phase following one normal night's sleep or one night's sleep loss. Compared with resting values exercise produced significant increases in cardiorespiratory variables including oxygen uptake (VO2), carbon dioxide production (VCO2), tidal volume (VT), respiratory rate (RR), minute ventilation (VE), systolic blood pressure, heart rate (HR) and respiratory quotient (R). However, it did not alter significantly diastolic blood pressure, end-tidal PO2 (PETO2), end-tidal PCO2 (PETCO2) and arterial oxygen saturation (SaO2). Spirometric variables which include forced vital capacity (FVC), forced expiratory volume in one s (FEV1), FEV1/FVC%, forced expiratory volume in three s (FEV3), forced expired flow from 25-75% of FVC (FEF 25-75%), forced expired flow at 25% of FVC (FEF 25%), forced expired flow at 50% of FVC (FEF 50%), forced expired flow at 75% of FVC (FEF 75%), forced expired flow from 75-85% of FVC (FEF 75-85%), peak expiratory flow (PEF), expiratory reserve volume (ERV), inspiratory capacity (IC) and maximal voluntary ventilation (MVV) and cardiorespiratory variables were not different between the cycle phases after one normal night's sleep or one night's sleep deprivation. Neither menstrual cycle phase nor sleep deprivation affected spirometric and cardiorespiratory parameters. We suggest that one night's sleep deprivation does not produce alterations in spirometric parameters and cardiorespiratory responses to submaximal incremental exercise during the follicular and luteal phases.     

食管癌手术前后肺功能与血清细胞因子相关性研究

目的 探讨食管癌手术前后肺功能与血清细胞因子的相关性.方法 在行手术治疗的食管癌患者中随机选取47例,于手术前48 h日间清醒状态下检测用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、肺最大通气量(MVV％)、肺弥散功能(DLCO)、气道阻力(RAW),同时在肘正中静脉抽取静脉血2 mL两份,用酶联免疫吸附试验(ELISA)检测白介素-6(IL-6)、白介素-8(IL-8)水平.手术后6d再次检测患者肺功能中FEV、FVC、MVV％、DLCO、RAW指标;同时用ELISA方法测血清IL-6,IL-8水平.结果 手术前后肺功能中FEV、FVC、MVV％、DLCO、RAW,IL-6、IL-8的水平差异均有统计学意义(P＜0.05).血清中IL-6、IL-8水平增高与FEV、FVC、MVV％、DLCO、RAW各指标变化存在着相关性.结论 手术后患者血清细胞因子浓度的升高与肺功能下降有密切联系.患者血清IL-6、IL-8水平可作为临床评估术后肺功能的参考指标.     

维吾尔族173例与汉族163例体检者肺毛细血管膜弥散和肺毛细血管血量与肺一氧化碳弥散量差异性分析

目的 比较在我院体检的维吾尔族和汉族肺通气功能、弥散功能正常值、肺毛细血管血量(VC)与肺一氧化碳弥散量(DLCO)之间的差异.方法 对在我院体检的336例(汉族163例,维吾尔族173例)成人进行回顾性分析,常规进行肺功能及弥散功能检查,包括第1秒用力呼气容积(FEV1)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)、DLCO、单位肺泡弥散量(KCO)、肺泡毛细血管膜弥散量(Dm)及Vc.通过年龄分层比较,对年龄、身高、体重等因素进行相关分析.结果 维吾尔族组和汉族组肺通气功能呼气峰流量(PEF)比较差异有统计学意义[(7.2±2.0)L/s比(6.8 ±2.0)L/s] (P ＜0.05),弥散功能DLCO、Vc、KCO比较差异有统计学意义[(8.0 ±2.0) mmol/(min·kPa)比(8.5±1.8) mmol/(min·kPa),(70±19) ml 比(77±20) ml,(1.59±0.20)mmol/(min·kPa·L)比(1.73±0.25) mmol/(min·kPa·L)](P＜0.01);通过维吾尔族和汉族年龄分层进行比较,最大呼气中期流速(MMEF 25％～75％)、DLCO、KCO、Dm均在40岁以后与30～39岁组间比较呈下降趋势,差异有统计学意义(P＜0.05),Vcmax、FEV1、Vc则在50岁以后与30～ 39岁组间比较,差异有统计学意义(P＜0.05).结论 我院体检的维吾尔族和汉族肺通气功能差异,主要表现在弥散功能方面的差异.民族间弥散值差异是否与少数民族居住的环境、生活饮食习惯等因素相关有待于进一步分析探讨.     

小气道功能指标在儿童哮喘病情严重程度评估及临床诊断中的应用

目的 探讨小气道功能指标在儿童哮喘病情严重程度评估及临床诊断中的应用价值。方法 选取2013年5月至2016年4月于郑州市第二人民医院56例哮喘急性发作期病儿作为哮喘组,并根据哮喘急性发作严重程度分为轻度(21例)、中度(20例)和重度(15例)三个亚组,同时选取同期、年龄相仿及性别相匹配的30例因其他原因引起喘息咳嗽的慢性炎症病儿和32例入院检查健康儿童分别作为非哮喘组和对照组,收集各组儿童一般资料,采用肺功能测定系统检测各组儿童用力肺活量(FVC)、最大呼气流量(PEF)、第1秒用力呼气容积(FEV1)和FEV1/FVC比值、呼出25%肺活量时呼气流速(FEF25%)、呼出50%肺活量时呼气流速(FEF50%)、呼出75%肺活量时呼气流速(FEF75%)、最大中期呼气流速(MMEF)等指标。结果 与对照组比较,非哮喘组和哮喘组病儿FVC、FEV1、PEF、FEF25%、FEF50%、FEF75%和MMEF等指标均显著降低(P<0.05),且哮喘组病儿上述指标显著低于非哮喘组[(1.42±0.36)L比(1.85±0.47)L、(1.25±0.32)L比(1.42±0.41)L、(2.68±0.64)L比(3.25±0.77)L/s、(2.54±0.65)L/s比(3.74±0.68)L/s、(1.58±0.36)L/s比(2.24±0.71)L/s、(0.61±0.37)L/s比(1.02±0.41)L/s、(1.42±0.49)L/s比(1.89±0.68)L/s)](均P<0.05),而三组病儿FEV1/FVC指标差异无统计学意义(P>0.05)。哮喘急性发作期不同程度病儿用力呼出25%肺活量的呼气流量占预计值百分比(FEF25pred%)、用力呼出50%肺活量的呼气流量占预计值百分比(FEF50pred%)、用力呼出75%肺活量的呼气流量占预计值百分比(FEF75pred%)、最大呼气中期流量占预计值的百分比(MMEFpred%)等指标比较差异有统计学意义(P<0.05),且随着病情程度增加,病儿FEF25pred%、FEF50pred%、FEF75pred%、MMEFpred%等指标呈现明显降低趋势(P<0.05),FEF25%和FEF75%指标在不同严重程度哮喘病儿中异常率比较,差异有统计学意义(P<0.05),FEF50%和MMEF指标比较差异无统计学意义(P>0.05),其中FEF25%主要表现为轻度异常,而FEF75%主要表现为重度异常。结论 小气道功能指标在儿童哮喘病情严重程度评估及临床诊断具有重要意义,随着病情加剧,小气道功能指标明显降低,且异常率显著增加。     

Effects of Ranitidine on pulmonary function tests of patients with chronic obstructive pulmonary disease

Since the incidence of peptic ulcer and gastroesophageal reflux (GER) is more common in patients with chronic obstructive pulmonary disease (COPD) than normal population, H(2) receptor blockers are given more extensively to COPD patients. This study evaluated the effects of Ranitidine on pulmonary function tests (PFT) of the patients having COPD and peptic ulcer or GER, and of healthy volunteers.Fifty milligrams of Ranitidine was given intravenously to 30 COPD patients and 25 healthy volunteers. PFT were done before and 15, 30, 60, 120min after Ranitidine injection. Although mean forced vital capacity (FVC), forced expiratory volume in 1s (FEV(1)) and forced midexpiratory flow rate (FEF(25-75%)) of COPD patients were found to be decreased 60 and 120min after Ranitidine injection, the decrements were statistically insignificant. The decrements in PFT of healthy volunteers were also not statistically significant.H(2) receptor blockers can be used safely for treatment of gastrointestinal disorders in COPD patients who have mild or moderate obstruction. Minimal decreases in FEV(1) and FVC due to treatment by H(2) receptor blockers may clinically worsen COPD patients who have severe obstruction.     

噻托溴铵粉雾剂治疗慢性阻塞性肺病的有效性及安全性

目的观察噻托溴铵粉雾剂治疗慢性阻塞性肺病(COPD)的临床疗效及安全性。方法选取122例COPD患者采用信封法随机分为2组,两组患者均给予沙丁胺醇气雾剂吸入、抗生素抗感染等常规对症支持治疗。对照组62例患者在上述治疗基础上,吸入异丙托溴铵,2喷/次,3次/d。同时采用与观察组噻托溴铵粉雾剂外观相同的安慰剂吸入。观察组60例吸入噻托溴铵粉雾剂,18μg/次,每天1次,同时采用与爱全乐气雾剂相同外观的安慰剂吸入。分别在两组患者治疗前、治疗6周后、治疗12周后测定FEV1(第一秒用力呼气量)、FVC(用力肺活量)、FEV1/FVC(第一秒率)。观察两组患者治疗期间不良反应发生情况。结果观察组临床症状改善率为93.33%,对照组为77.42%,观察组改善率明显高于对照组(P<0.05)。观察组治疗后6周及12周时,FEV1、FVC及FEV1/FVC均明显高于治疗前及对照组治疗后(P<0.05)。观察组不良反应发生率低于对照组,但差异无统计学意义(P>0.05)。结论噻托溴铵粉雾剂用于COPD患者的治疗,可明显改善患者临床症状,改善患者肺功能,不良反应发生率低,疗效确切,安全可靠。     

Pulmonary effects in man of oral prizidilol hydrochloride (SK&F 92657), a new antihypertensive agent.

The effects on heart rate, blood pressure and pulmonary function of single oral doses of prizidilol hydrochloride (400 mg SK&F 92657) and propranolol (40 mg) were compared with placebo in nine healthy volunteers, in a double blind crossover study. Prizidilol had no effect on heart rate while propranolol caused a significant reduction compared with placebo. Diastolic blood pressure was lowered to the same extent by both prizidilol and propranolol. Propranolol significantly reduced the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and the maximal expiratory flow at 50% vital capacity (MEF 50). Prizidilol had no effect on flow-volume loop parameters. Effective pulmonary blood flow was not altered by propranolol, but it was significantly increased by prizidilol. Oral prizidilol exerts its hypotensive effect by vasodilatation without reflex tachycardia. It does not cause airways obstruction in healthy subjects.     

Chronically inhaled salmeterol improves pulmonary function in heart failure

Inhaled beta-agonists are commonly prescribed for the symptoms of exercise intolerance in heart failure despite a paucity of data regarding their safety and efficacy. This was a prospective, randomized, double-blind, double-dummy, placebo-controlled 14-day cross-over study to determine if chronic inhaled salmeterol therapy 84 microg every 12 hours improved pulmonary function without augmentation of neurohormonal systems or ventricular ectopy in 8 symptomatic heart failure subjects with left ventricular ejection fraction (LVEF) <40% and FEV1 相似文献   

噻托溴铵干粉吸入剂与异丙托溴铵定量气雾剂治疗慢性阻塞性肺病近期疗效对比研究

目的 探究与分析噻托溴铵干粉吸入剂与异丙托溴铵定量气雾剂治疗慢性阻塞性肺病的近期疗效.方法 选取本院自2014年6月至2016年6月收治的90例慢性阻塞性肺病患者,采取随机数字表法分为对照组与观察组,各45例.对照组给予异丙托溴铵治疗,观察组给予噻托溴铵治疗,对比两组圣乔治呼吸问卷(SGRQ)评分、6 min步行试验(6MWT)、呼吸困难分级指数(MRC)、血氧分压(PaO2)、血二氧化碳分压(PaCO2)、用力肺活量比预计值(FVC％pred)、用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV 1％pred)、用力呼气量占用力肺活量比值(FEV1/FVC).结果 与治疗前相比,两组治疗后SGRQ评分及MRC分级降低,6MWT升高,观察组上述指标比对照组改善更显著,差异具有统计学意义(均P＜ 0.05).与治疗前相比,两组治疗后FVC％pre、FVC、FEV 1％pred、FEV1/FVC、PaO2升高,PaCO2降低,观察组上述指标比对照组改善更显著,差异具有统计学意义(均P＜ 0.05).结论 相比于异丙托溴铵定量气雾剂,噻托溴铵干粉吸入剂治疗慢性阻塞性肺病可充分发挥更好的支气管扩张作用,缓解临床症状及体征,患者耐受性较好.     

类风湿性关节炎患者间质性肺疾病的临床概况

目的了解类风湿性关节炎肺间质病变的发生情况、特征及相关因素分析,以便早期发现类风湿性关节炎的肺部病变。方法类风湿性关节炎患者45例,免疫比浊法检测类风湿因子、C反应蛋白、免疫球蛋白及补体;间接免疫荧光法和免疫印迹法检测抗核抗体及亚类。血气分析测定氧分压、动脉血二氧化碳分压和肺泡-动脉血氧分压差。肺功能仪测定潮气容积、最大肺活量、用力肺活量、第1秒用力呼气容积、最大呼气中段流量、最大通气量和一氧化碳弥散功能。放射学检查包括胸部正侧位X线片、双手像和肺高分辨率CT扫描。结果45例类风湿关节患者中,14例存在肺间质病变,其中10例有呼吸道症状。肺功能检测异常主要为弥散功能降低和限制性通气障碍。8例胸部X线片存在异常,14例高分辨率CT发现异常。肺高分辨率CT在发现类风湿性关节炎肺间质病变病变时优于普通胸部X线片。结论类风湿性关节炎肺间质病变的发生与疾病活动性和严重性相关,肺弥散功能、高分辨率CT在早期发现病变时有诊断意义。     

类风湿性关节炎患者间质性肺疾病的临床概况

目的 了解类风湿性关节炎肺间质病变的发生情况、特征及相关因素分析,以便早期发现类风湿性关节炎的肺部病变.方法 类风湿性关节炎患者45例,免疫比浊法检测类风湿因子、C反应蛋白、免疫球蛋白及补体;间接免疫荧光法和免疫印迹法检测抗核抗体及亚类.血气分析测定氧分压、动脉血二氧化碳分压和肺泡-动脉血氧分压差.肺功能仪测定潮气容积、最大肺活量、用力肺活量、第1秒用力呼气容积、最大呼气中段流量、最大通气量和一氧化碳弥散功能.放射学检查包括胸部正侧位X线片、双手像和肺高分辨率CT扫描.结果 45例类风湿关节患者中,14例存在肺间质病变,其中10例有呼吸道症状.肺功能检测异常主要为弥散功能降低和限制性通气障碍.8例胸部X线片存在异常,14例高分辨率CT发现异常.肺高分辨率CT在发现类风湿性关节炎肺间质病变病变时优于普通胸部X线片.结论 类风湿性关节炎肺间质病变的发生与疾病活动性和严重性相关,肺弥散功能、高分辨率CT在早期发现病变时有诊断意义.     

噻托溴铵治疗慢性阻塞性肺疾病的疗效及安全性评价

目的:研究临床使用噻托溴铵治疗慢性阻塞性肺疾病(COPD)的疗效及安全性。方法:使用随机、双盲、多中心、安慰剂平行对照的研究方法。2008年10月～2010年10月期间入院治疗的同意参与实验的患者191例,随机分为实验组和对照组。实验组给予噻托溴铵18μg,每日1次;对照组给予相同剂量剂型安慰剂。实验时间为16周。实验前及6周、16周时分别检测肺功能,16周时观察呼吸困难、胸闷气短、咳嗽咳痰、肺部干湿罗音等症状体征及实验室检查。结果:用药6周后实验组肺功能指标,第1秒用力呼气容积(FEV1)(1.59±0.33)L和第1秒用力呼气容积/用力肺活量(%)(FEV1/FVC(%))(61.17±7.81)%均高于对照组,肺功能有明显改善(P<0.01)。用药16周后,实验组肺功能指标FEV1(1.62±0.28)L和FEV1/FVC(%)(63.35±9.22)%与对照组比较亦有明显改善,差异有显著性(P<0.01)。且用药16周后,实验组呼吸困难、胸闷气短、咳嗽咳痰、肺部干湿啰音等症状体征的治愈率高于对照组,且差异有显著性(P<0.01)。不良反应的发生率实验组和对照组分别为7.8%、6.6%,两组差别没有统计学意义(P>0.05)。结论:临床一线使用噻托溴铵治疗慢性阻塞性肺疾病(COPD),可以有效改善患者的临床症状体征及肺功能,减少并发症,并且使用安全性较高。     

补肺活血胶囊联合布地奈德福莫特罗及噻托溴铵治疗慢性阻塞性肺疾病稳定期的临床效果研究

目的 探索补肺活血胶囊联合布地奈德福莫特罗及噻托溴铵治疗慢性阻塞性肺疾病(COPD)稳定期患者的临床效果研究.方法 回顾性分析87例慢性阻塞性肺疾病稳定期患者临床资料,将所有患者根据治疗方法不同分为对照组(43例)和实验组(44例).对照组采用采取布地奈德福莫特罗联合噻托溴铵治疗,实验组在对照组的基础上结合补肺活血胶囊...     

沙美特罗/丙酸氟替卡松对哮喘儿童肺功能的改善及临床意义

目的:观察沙美特罗/丙酸氟替卡松对哮喘儿童肺功能改善情况。方法:采用德国Jaeger公司的MasterscreenIOS测定仪,对61例支气管哮喘患儿在沙美特罗/丙酸氟替卡松治疗前后进行通气肺功能(F-V)和脉冲振荡(IOS)检测。观察用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、最大呼气流速(PEF)、呼出25%肺活量时最大呼气流量(FEF25)、呼出50%肺活量时最大呼气流量(FEF50)、呼出75%肺活量时最大呼气流量(FEF75);呼吸阻抗(Zrs)、气道总阻力(R5)、中心气道阻力(R20)、响应频率(Fres)。结果:沙美特罗/丙酸氟替卡松治疗后FVC、FEV1、PEF均明显升高(P<0.001),而Zrs、R5、R20、Fres均明显降低(P<0.05),两者检查结果均有显著统计学意义。结论:吸入沙美特罗/丙酸氟替卡松能改善哮喘儿童的肺通气功能,降低气道阻力,是治疗儿童哮喘的理想药物之一。     

老年心力衰竭合并肺部感染患者病原菌分布及其对血炎性因子水平影响研究

目的 分析老年心力衰竭（心衰）合并肺部感染的病原菌分布、心肺功能变化以及血炎性因子水平变化。方法 回顾性分析2014年3月—2017年9月在我院就诊的153例老年心衰患者的临床资料。依据患者是否并发肺部感染,将患者分为感染组（76例）及非感染组（77例）,同时纳入同期体检健康者作为对照组（82例）。采集感染组患者呼吸道分泌物样本进行病原菌鉴定,比较3组患者心、肺功能和外周血炎性因子水平变化。结果 76例感染组患者共分离致病菌110株,其中革兰阴性菌81（73.63%）株,革兰阳性菌27（24.55%）株,真菌2（1.82%）株。与对照组和非感染组相比,感染组患者的第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、FEV1/FVC、一氧化碳弥散量（DLCO）及最大呼气中期流量（MMEF）等肺功能指标均明显下降;左心室舒张末期内径（LVEDD）和收缩末期内径（LVESD）增大,左室射血分数（LVEF）降低。同时感染组患者外周血肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6 及降钙素原（PCT）水平均高于未感染组及对照组,差异具有统计学意义（P＜0.05）。结论 合并肺部感染的老年心衰患者以革兰阴性菌感染为主,且感染后患者心肺功能显著降低,其血炎性因子水平显著升高,对判断感染程度具有辅助价值。     

综合康复护理措施在噻托溴铵治疗稳定期COPD患者中的应用

目的:探讨综合康复护理措施在噻托溴铵治疗稳定期慢性阻塞性肺病(COPD)患者中的应用。方法:选取本院2017年1月至2019年2月80例给与噻托溴铵治疗的稳定期COPD患者,随机分为观察组(n=40)和对照组(n=40)。对照组40例患者采用常规护理,观察组40例患者在常规护理基础上使用综合康复护理。比较圣乔治呼吸问卷(SGRQ)评分、呼吸功能指标、患者满意程度。结果:观察组干预后2个月日常活动评分、患者症状评分、疾病影响评分、SGRQ总分低于对照组(P<0.05);观察组干预后2个月第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FVC)比值(FEV1/FVC)、最大呼吸峰流速(PEF)均高于对照组(P<0.05);观察组满意程度高于对照组(P<0.05)。结论:综合康复护理在噻托溴铵治疗稳定期COPD患者中可以有效缓解患者临床症状、显著改善呼吸功能指标、提高患者满意度。     

The study of in vitro-in vivo correlation: pharmacokinetics and pharmacodynamics of albuterol dry powder inhalers

The pharmacokinetics and pharmacodynamics of albuterol were studied following inhalation of three different in-house dry powder formulations in healthy volunteers and in asthmatics. Albuterol in plasma was measured using liquid chromatography-mass spectrometry (LC-MS). The plasma concentration time profiles were fitted to a two-compartment model with first-order kinetics. Oral absorption of swallowed albuterol was eliminated by oral dosing of 560 mg activated charcoal 1 h prior to albuterol aerosol administration. The peak concentration was reached within 15-20 min. Mean peak concentrations in healthy volunteers (six males and six females) were 1.74 +/- 0.34, 2.01 +/- 0.35, and 2.59 +/- 0.27 ng/mL following inhalation of formulations with fine particle doses (FPDs) of 100, 120, and 160 microg of albuterol, respectively. The corresponding peak plasma concentrations of 1.23 +/- 0.29, 1.37 +/- 0.13, and 1.53 +/- 0.11 ng/mL were obtained when asthmatics (six males and six females) were dosed with the same three formulations. The FPD of each formulation correlated well with the area under the curve of plasma concentration-time (AUC(0-8)) profile. Plasma potassium did not show any significant change over a period of 8 h. The forced vital capacity (FVC), the force expiratory volume in 1 s (FEV(1)), and mid expiratory flow (FEF(25-75)) did not correlate with FPD for the three different formulations.     

肺高分辨率CT马赛克样灌注与小气道功能指数的相关分析

目的探讨肺小气道病变时高分辨率CT（HRCT）所示马赛克样灌注与小气道功能指标的相关性。方法选择HRCT上显示马赛克样灌注病例80例,由3位放射诊断医师对马赛克样灌注与小气道功能指标的相关性进行分析。结果马赛克样灌注与FEF 25%呈负相关（r=-0.48,P〈0.05）,与FEV1、FEF50%无相关性（r值分别为-0.27和-0.19,P〉0.05）。而空气潴留的程度与FEF25%、FEV1呈负相关（r值分别为-0.62和-0.41,P〈0.05）,与FEF 50%无相关性（r=-0.29,P〉0.05）。结论马赛克样灌注作为小气道病变的主要征象,其与FEF 25%具有良好的相关性,而空气潴留作为小气道阻塞的直接后果,其程度与FEV1、FEF 25%具显著相关性,即使肺功能检查结果正常时,也可以辅助诊断临床可疑的小气道阻塞。     

Tiotropium: an inhaled anticholinergic for chronic obstructive pulmonary disease.

PURPOSE: The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, dosage and administration, and formulary considerations of tiotropium are discussed. SUMMARY: Tiotropium, a long-acting inhaled anticholinergic, recently received approval from the Food and Drug Administration for the management of chronic obstructive pulmonary disease (COPD). In patients with COPD, increased parasympathetic nervous system activity leads to bronchoconstriction and mucus secretion. Tiotropium induces relaxation of the airway smooth muscle, as does ipratropium, but differs in receptor association and dissociation rates, allowing for once-daily administration. After inhalation, tiotropium reaches maximal plasma concentrations within five minutes, but clinical improvements in forced expiratory volume in one second (FEV(1)) are maintained over 24 hours. Clinical trials of tiotropium with placebo, ipratropium, and salmeterol have demonstrated the efficacy of tiotropium in improving FEV(1) and forced vital capacity values and health-related quality of life. The most commonly observed adverse effect is dry mouth. No increase in adverse effects was observed when tiotropium was administered concomitantly with other drugs for COPD, including sympathomimetic bronchodilators and oral and inhaled corticosteroids. The combination of tiotropium and other anticholinergics has not been studied and is not recommended. The recommended dosage of tiotropium is the inhalation of an 18-mug capsule with a HandiHaler breath-actuated inhalation device once daily. CONCLUSION: Tiotropium appears to be at least as effective as currently available alternatives in the treatment of patients with COPD who require daily bronchodilator treatment. Its simplified dosing and tolerable adverse-effect profile can potentially lead to enhanced patient compliance.