维拉帕米治疗慢性阻塞性支气管炎患者的肺动脉高压

慢性阻塞性支气管炎患者的死亡原因主要是肺心病,而肺心病的发展是由于肺阻力和肺动脉压升高。为研究维拉帕米对肺动脉高压的治疗作用,观察慢性阻塞性支气管炎加重期患者30例,男20例,女10例,年龄21～65岁,平均46岁。病程5～15年,均有中度阻塞型呼吸功能障碍。临床X线和心电图检查没有查出肺心病的表现。进行多普勒超声心动图和心振动图(Kinetocardiogram)检查,查出肺阻力和肺动脉压升高(P<0.01),右心室前壁厚度增加(P<0.05),右室收缩力降低,证明有隐匿性肺心病。     

慢性肺原性心脏病与冠心病的鉴别

慢性肺原性心脏病(以下简称肺心病)和冠心病均多见于中年以上的病人,二者都可有心脏增大、杂音不明显、心力衰竭及心律失常等;且冠心病人常可有老年性肺气肿,或并有慢性支气管炎、肺气肿。肺心病患者亦可有不典型心绞痛,25%左右患者可伴发冠心病,故常可发生误诊或漏诊情况,需予鉴别。     

肺心病伴发冠心病18例病理与临床对比分析

经尸检证实肺心病伴发冠心病１８例，与单纯肺心病３０例对照，结果两组在心脏重量、右室厚度及左室厚度上差异无显著性（Ｐ＞０．０５），表明肺心病晚期也可累及左室，不管是否合并左室疾患。本组临床诊断正确率为３３．３％，漏诊冠心病为３８．９％，漏诊肺心病为２７．８％。临床单因素分析以年龄、高血压史、心绞痛史、心肌梗塞史、Ａ＿２＞Ｐ＿２、束支传导阻滞、异常Ｑ波、心电轴左偏或正常、程显声诊断标准和Ｓｅｌｖｅｓｔｅｒ心梗筛选标准对诊断伴发冠心病有显著意义（Ｐ＜０．０５）。多元前进法逐步回归分析表明心绞痛史、Ｓｅｌｖｅｓｔｅｒ心梗筛选标准和程显声标准为独立预告因子（Ｐ＜０．０３和０．０００）。上述结果缺乏特异性诊断方法，及早做冠脉造影可能是最佳选择。     

32例煤工尘肺肺心病合并冠心病诊断治疗体会

目的探讨煤工尘肺肺心病合并冠心病的发病特点和临床情况,减少临床误诊,漏诊。方法收集我院煤工尘肺肺心病合并冠心病32例的临床资料,对其诊治过程进行分析。结果本组病例经治疗好转28例,死亡4例:病因:心衰1例,心肌梗死、室颤1例,猝死1例,心衰合并呼衰1例。结论煤工尘肺肺心病合并冠心病患者临床病情复杂,常合并有多脏器功能改变,表现不典型,易发生急性或慢性左心功能不全。对于慢性肺心病并发冠心病的老年煤工尘肺患者,在诊治过程中应综合分析病情,以减少误诊、漏诊,使临床治疗发挥积极有效的作用。     

肺心病伴发急性心肌梗死误诊漏诊13例分析

肺心病伴发急性心肌梗死 (AMI)临床上比较少见 ,我院1990 - 0 1～ 2 0 0 1- 0 6收治的肺心病伴发 AMI 19例 ,误诊漏诊13例 ,误诊漏率率高达 6 8%。现对误诊漏诊原因作一分析。1　临床资料　本组 13(男 11,女 2 )例 ,年龄 5 3～ 90 (6 9± 9)岁。肺心病病程 3～ 2 1年。基础疾患为慢性支气管炎 12例 ,支气管扩张 1例 ,同时并发高血压病史 2例 ,冠心病心绞痛病史 1例。肺心病按 1980年全国第 3次肺心病会议修订标准。 AMI按 WHO AMI诊断标准。临床表现 :全部病例均有慢性咳嗽、咳痰、胸闷、呼吸困难。同时有心前区压榨样疼痛 1例 ,恶心…     

260例老年肺结核临床分析

本文对1978～1983年间住院治疗的资料较完整的260例老年肺结核进行了分析。260例中男234例,女26例,年龄50～59岁167例,60～69岁78例,70岁以上15例。病程15天～34年。初治84例,复治176例。临床症状主为咳嗽咯痰,占60.8％。病变类型以慢纤洞型为主。并发慢性支气管炎、肺气肿、肺心病者分别占8.1％、38.1％,     

106例老年肺心病伴发冠心病临床分析

慢性肺源性心脏病的并发症较多,严重缺氧及酸中毒可致多脏器损害。1993年3月—1996年5月,我院收治372例肺心病患者,其中老年肺心病伴发冠心病106例,现报告如下。 1 资料与方法 106例老年肺心病伴发冠心病患者,均符合1977年全国第二次肺心病会议所制订的心电图诊断标准。本组年龄62—84岁,平均73岁。其中男74例,女32例。肺心病病程4—9年者30例,10—19年者62例,20年以上者14例。所有病例均以急性发作入院,临床     

肺心病合并冠心病的诊治体会

慢性肺心病和冠心病均是老年常见病 ,两病伴发者临床不少见。1995～ 1999年 ,我们收治 5 0例肺心病伴冠心病 (下称肺冠心病 )患者 ,现报告如下。临床资料 :本组男 38例 ,女 12例 ;年龄 5 6～ 85岁 ,平均 6 9.3岁。患者均符合 1997年全国肺心病会议制定的肺心病诊断标准及 WHO制定的冠心病诊断标准。肺心病病史 5～ 12年 ,在原发病基础上 ,本组入院原因为心力衰竭 18例 (右心衰竭 11例 ,左心衰竭 7例 ) ,典型心绞痛 6例 ,慢性房颤、各种传导阻滞及心律失常 8例 ,慢性支气管炎伴感染 18例。查体示心率大于10 0次 / min2 4例 ,A2 >P2 12例 ,…     

肺心病患者的死亡时间分析及护理

肺心病患者的死亡时间分析及护理山东省胸科医院（２５００１３））王芳我们对２５９例肺心病患者的死亡时间进行了回顾性分析，现将结果报告如下。本组男１２８例，女１３１例；年龄３５～８２岁，平均６２．４岁；病史１０～３５年。原发病为慢性支气管炎并阻塞性肺气肿...     

慢性阻塞性肺病患者并发气胸误诊分析

1．1一般资料我院自1998年1月至2003年5月共收治慢性阻塞性肺病1920例．发生气胸36例．其中27例被误诊，误诊率高达75％。36例中男29例，女7例；年龄45～90岁，平均62．3岁。肺部基础疾病．慢性支气管炎4例．慢支气管炎并肺气肿15例．并发肺心病17例。     

慢性肺原性心脏病左心功能的临床研究

目的：探讨慢性肺原性心脏病（以下简称肺心病）左心功能的变化。方法：采用二维及脉冲多普勒超声心动图测定慢性肺心病患者的左心功能，并与健康人及阻塞性肺气肿患者进行对照。结果：肺心病右心衰竭组患者的射血分数、每搏输出量、心输出量、心脏指数及快速充盈期与心房收缩期二尖瓣口血流比值均有下降，与正常对照组、慢性支气管炎肺气肿组及肺心病右心功能代偿组比较，上述各项指标均有显著差异，Ｐ分别＜０．０１、＜０．０１和＜０．０５。结论：肺心病右心衰竭患者可合并左心功能受损。     

并发症对肺心病死亡影响程度的分析

目的探讨并发症对慢性肺心病死亡的影响。方法回顾性研究237例慢性肺心病老年患者并发症和死亡的资料。结果并发症与病死率呈正相关（P=0.0000）;死亡组人均并发症数显著高于非死亡组（P〈0.0001）;多脏器功能衰竭、呼吸衰竭、心力衰竭、肾功能衰竭、电解质紊乱、心律失常、营养不良及合并肺炎为影响死亡的重要因素（P=0.0000-0.0289）。结论防治和减少并发症,纠正脏器功能衰竭等,可改善肺心病的预后。将并发症控制在3项以内,可显著降低病死率。     

Transpulmonary angiotensin II formation in patients with chronic stable cor pulmonale

The activity of the renin-angiotensin (RA) system and the ability of the lungs to generate angiotensin II (AII) were studied in 11 patients with stable cor pulmonale and respiratory failure caused by chronic obstructive bronchitis and emphysema. Angiotensin I concentrations (18.7 +/- 8.3 pmol/L) were normal, and transpulmonary AII formation rates (TRAIIFR) (14.2 +/- 18.1 pmol/min) were not significantly different from those recorded in nonedematous cardiac subjects (19.9 +/- 20.1 pmol/min), matched for sex, age, and diuretic therapy. The main determinant of TPAIIFR was the mixed venous AI concentration. Administration of oxygen for 30 min led to a small increase in TPAIIFR in the majority of patients. This increase could not be accounted for by changes in mixed venous AI. There was no correlation between serum angiotensin-converting enzyme levels and either the TPAIIFR or the systemic arterial AII concentrations.     

Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale.

Elevated plasma brain natriuretic peptide (BNP) levels have been described in patients with congestive heart failure and acute myocardial infarction. We measured plasma BNP levels in patients with chronic respiratory failure to evaluate the correlation between plasma BNP levels and pulmonary haemodynamics. Plasma BNP levels were measured in 28 patients with chronic respiratory failure accompanied by three underlying diseases [14 with chronic obstructive pulmonary disease (COPD), seven with sequelae of pulmonary tuberculosis (sequelae Tbc) and seven with diffuse panbronchiolitis (DPB)] by immunoradiometric assay methods (IRMA). Twenty-one of 28 patients had already received oxygen supplementation and 16 of 21 patients were treated as outpatients with home oxygen therapy. Plasma BNP levels were significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (81.5 +/- 13.1 pg ml-1) compared to patients without cor pulmonale (13.3 +/- 2.7 pg ml-1, P < 0.001). As controls, plasma BNP levels in 10 patients with primary lung cancer were studied, and the results (3.5 +/- 1.0 pg ml-1) were not significantly different from those of patients with chronic respiratory failure without cor pulmonale. Plasma BNP levels in 12 healthy subjects were also studied, and the results (7.2 +/- 1.0 pg ml-1) were not significantly different from those of the control subjects. Plasma BNP levels showed a weak linear correlation with systolic pulmonary arterial blood pressure, estimated by Doppler echocardiography (r = 0.43; P = 0.068), but there was no significant correlation between BNP levels and the degree of hypoxaemia (r = 0.30; P = 0.138). Plasma atrial natriuretic peptide (ANP) levels in patients with chronic respiratory failure were also measured using the same samples. Plasma ANP levels were also significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (80.8 +/- 12.1 pg ml-1) compared to patients without cor pulmonale (26.1 +/- 4.4 pg ml-1, P = 0.003). A significant correlation was found between plasma BNP and ANP levels (r = 0.68; P < 0.001). Our results suggest that the plasma BNP or ANP level may be a useful indicator for detecting the presence of cor pulmonale in patients with chronic respiratory failure.     

Lungenemphysem—Silikose—Cor pulmonale Ergebnisse statistischer Untersuchungen

Clinical and pathologic-anatomical investigations show differing results regarding the question, as to whether or not pulmonary emphysema and silicosis produce cor pulmonale. Therefore we have investigated the autopsy findings over a 10-year period with statistical methods. We wanted to determine correlations between cor pulmonale and pulmonary emphysema and between cor pulmonale and silicosis; also to be determined was if the combination of such pulmonary changes with cor pulmonale is statistically accidental and/or significant. Finally, we wanted to know, if there are correlations between the frequency of cor pulmonale and grading of silicosis.The documentation of the lung findings was done in most cases after fixation of the lungs and slicing of the discs. The hearts were fixed in formaldehyde; the amount of fat-free myocardium of the right and left ventricle and the septum was determined (method W. Müller, 1883).From 1960 to 1969 there were 5,983 autopsies evaluated in our institute. Of these cases, 1,507 cases were with lung emphysema and anthraco-silicosis. We have not evaluated the autoptic findings in children and young adults up to 30 years of age, or in patients with heart failure and hearts weighing more than 500 gr., myocarditis, tuberculosis, lung fibrosis, bronchus carcinoma and patients with diseases of the hemopoetic system.Our investigation showed the following results: 1,430 patients had different types of lung emphysema. 40.5% of these cases were combined with a cor pulmonale. With the “two-point-two-table chi-square-test” we found a significant correlation between lung emphysema and cor pulmonale.There were 542 patients with anthraco-silicosis from the Aachen area. 511 of these 542 patients also had concurrent lung emphysema. In 48.5% of those patients with silicosis, we found morphological signs of cor pulmonale. The correlations between silicosis and cor pulmonale had a high statistical significance. In contrast to these findings, we found no statistical correlation between grading of silicosis and cor pulmonale. These results are discussed and compared with the results from the literature.     

肺心病慢性呼吸衰竭患者脑诱发电位的研究

目的用诱发电位方法检测肺心病慢性呼吸衰竭患者在发生临床肺性脑病前脑功能的改变。方法对２８例老年肺心病慢性呼吸衰竭无肺性脑病临床表现的患者、２０例老年肺炎患者及３０例老年健康人同时进行脑干听觉、体感诱发电位（ＢＡＥＰ、ＳＥＰ）检查。结果ＢＡＥＰ异常：肺心病组２３例（８２％），肺炎组７例（３５％）；ＳＥＰ异常：肺心病组２４例（８６％），肺炎组８例（４０％）。经统计学检验，肺心病组ＢＡＥＰ、ＳＥＰ与健康组、肺炎组差异有显著性，肺炎组与健康组差异无显著性。结论肺心病慢性呼吸衰竭患者有脑干功能受损和弥漫性脑功能障碍。     

Lungenemphysem—Silikose—Cor pulmonale Ergebnisse statistischer Untersuchungen

Clinical and pathologic-anatomical investigations show differing results regarding the question, as to whether or not pulmonary emphysema and silicosis produce cor pulmonale. Therefore we have investigated the autopsy findings over a 10-year period with statistical methods. We wanted to determine correlations between cor pulmonale and pulmonary emphysema and between cor pulmonale and silicosis; also to be determined was if the combination of such pulmonary changes with cor pulmonale is statistically accidental and/or significant. Finally, we wanted to know, if there are correlations between the frequency of cor pulmonale and grading of silicosis. The documentation of the lung findings was done in most cases after fixation of the lungs and slicing of the discs. The hearts were fixed in formaldehyde; the amount of fat-free myocardium of the right and left ventricle and the septum was determined (method W. Müller, 1883). From 1960 to 1969 there were 5,983 autopsies evaluated in our institute. Of these cases, 1,507 cases were with lung emphysema and anthraco-silicosis. We have not evaluated the autoptic findings in children and young adults up to 30 years of age, or in patients with heart failure and hearts weighing more than 500 gr., myocarditis, tuberculosis, lung fibrosis, bronchus carcinoma and patients with diseases of the hemopoetic system. Our investigation showed the following results: 1,430 patients had different types of lung emphysema. 40.5% of these cases were combined with a cor pulmonale. With the “two-point-two-table chi-square-test” we found a significant correlation between lung emphysema and cor pulmonale. There were 542 patients with anthraco-silicosis from the Aachen area. 511 of these 542 patients also had concurrent lung emphysema. In 48.5% of those patients with silicosis, we found morphological signs of cor pulmonale. The correlations between silicosis and cor pulmonale had a high statistical significance. In contrast to these findings, we found no statistical correlation between grading of silicosis and cor pulmonale. These results are discussed and compared with the results from the literature.     

利尿合剂在慢性肺心病合并右心衰治疗中的疗效分析

目的探讨利尿合剂治疗慢性肺心病合并右心衰的疗效。方法54例慢性肺心病合并右心衰病人,随机分成治疗组28例,对照组26例。对照组给予一般治疗和强心、利尿、扩血管等常规治疗;治疗组在对照组治疗基础上静脉用利尿合剂替代口服利尿药,2周后观察比较组的疗效。结果治疗组显效16例,有效10例,总有效率92.8%;对照组显效12例,有效6例,总有效率69.2%,两组的疗效在统计学上存在显著性差异(P<0.05)。结论利尿合剂治疗慢性肺心病合并右心衰疗效明显,不仅改善心功能,并且可以缩短纠正心衰的时间。     

Prognosis in chronic obstructive pulmonary disease

Although many factors have been shown to relate to survival in patients with COPD, the patient's age and baseline postbronchodilator FEV1 are the best predictors of mortality. The presence of mild obstructive airway disease is not indicative of a progressive downhill course and shortened survival. Mortality in patients with a baseline postbronchodilator FEV1 greater than or equal to 50% of predicted was only slightly greater than that of a group of healthy smokers. Investigators attempting to compare survival in patients with COPD should attempt to exclude patients with asthma or asthmatic bronchitis, because these individuals have a much better prognosis than those with typical COPD (emphysema and chronic bronchitis). Patients should be matched closely for age and severity of impairment, because younger individuals and those with milder impairment are likely to live longer. Other factors besides age and baseline FEV1 have been shown to affect survival. Patients who stop smoking are likely to survive longer than those who continue to smoke. The presence of malnutrition has clearly been shown to worsen survival. Further studies will be necessary to determine if corticosteroid therapy can slow down progression of disease in patients with typical COPD. Oxygen therapy improves survival in COPD patients with significant hypoxemia, many of whom also have CO2 retention, polycythemia, and cor pulmonale. There are now multiple studies in the literature suggesting that the type of comprehensive respiratory care provided by pulmonary rehabilitation programs can not only improve the quality of life but also survival in patients with chronic obstructive pulmonary disease.     

Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults

OBJECTIVE: The aim of this study was to assess the prevalence of chronic obstructive pulmonary disease in middle aged and older adults. METHODOLOGY: A random sample of 7,005 adults aged between 45 and 69 years was drawn from electoral rolls for Melbourne, Victoria, Australia. A postal survey was conducted using the European Community Respiratory Health Survey respiratory screening questionnaire with additional questions on chronic bronchitis and emphysema. Participants were asked to return the survey by reply mail. Non-responders were sent a reminder postcard after 2 weeks, a replacement questionnaire after 4 weeks and then contacted by telephone. RESULTS: Completed questionnaires were returned by 4,906 (70.0%) participants. The commonest symptoms were exertional dyspnoea (27.2%) and wheezing (20.5%). Chronic bronchitis was reported by 12.0% and emphysema by 1.2%. Males were significantly more likely to report cough and sputum, while females were more likely to report asthma. The prevalence of exertional dyspnoea, cough and sputum, emphysema and heart disease increased with age. Chronic bronchitis, emphysema and most respiratory symptoms were associated with smoking. CONCLUSIONS: Self-reported chronic bronchitis or emphysema affect one in eight middle aged and older adults. Differences between men and women are partly explained by differences in smoking. These findings require confirmation with lung function tests.