心肺功能运动试验与静态肺功能判定肺损伤的比较

目的 比较心肺功能运动试验与静态肺功能测定结果的灵敏度和特异度,探讨心肺功能运动试验在尘肺伤残程度鉴定中的运用。方法 选取Ⅰ期煤工尘肺病人69名,正常对照182名,所有对象进行心肺功能运动试验和静态肺功能测定;计算灵敏度、特异度,判断肺损伤的一致性和相关性。结果 静态肺功能指标中,FVC特异度最高（91．2％）,但灵敏度最低（28．9％）;RV／TLC％灵敏度最高（84．5％）,但特异度最低（61．5％）。在运动试验指标中,最大摄氧量和调整的最大二氧化碳通气当量的特异度分别为97．4％和93．5％,灵敏度仅为34．4％和75．0％,似然比、准确率高于静态肺功能指标。运动试验指标与静态肺功能指标判断损伤之问有相关性和一致性,但相关程度和一致程度不高。结论 运动试验指标与静态肺功能指标在相同程度肺损伤评定上有很大差异,静态肺功能不能准确评定体力能力的大小和丧失,在我国尘肺伤残评定方面应考虑采用心肺功能运动试验。     

心肺运动试验在尘肺患者心肺功能评估及康复治疗中的应用

尘肺病是我国目前较为常见的一种呼吸系统职业病,心肺运动试验(CPET)在呼吸系统疾病患者的心肺功能评估及指导康复治疗中有重要价值.本文对CPET在尘肺病心肺功能评估及康复治疗中的应用进行综述,尤其是在尘肺患者心肺耐力评估、职业劳动能力鉴定、康复计划制定、预后判定等方面的实用价值进行重点介绍,认为值得被推广使用.     

矽肺并发慢性阻塞性肺疾病稳定期患者呼吸功能锻炼的护理干预

目的观察呼吸功能锻炼的护理干预措施对矽肺并发慢性阻塞性肺疾病(COPD)稳定期患者的临床治疗疗效。方法随机抽取2017年8月至2018年4月泰山医学院附属莱钢医院职业病科住院60例矽肺并发COPD稳定期患者并分为两组。对照组:30例,给予常规治疗加呼吸功能锻炼;观察组:30例,在对照组治疗的基础上给予护理干预措施。2个月后,比较干预前后两组患者的肺功能、血气分析、6 min步行距离。结果干预后观察组第1秒用力呼气容积(FEV1.0)、用力肺活量(FVC)、氧分压(PaO2)及6 min步行距离较对照组明显升高,差异有统计学意义(P<0.05),两组FEV1.0/FVC、二氧化碳分压(PaCO2)的差异无统计学意义(P>0.05)。 结论护理干预措施能有效改善矽肺并发COPD稳定期患者的FEV1.0、FVC、PaO2及6 min步行距离。     

Nutritional and pulmonary function assessment in patients with chronic obstructive lung disease

This investigation was undertaken to determine the prevalence and degree of malnutrition among patients with chronic obstructive pulmonary disease and to determine if a relationship exists between nutritional assessment parameters and pulmonary function. Thirty-seven patients admitted for the treatment of chronic obstructive pulmonary disease to a respiratory care unit of a Veterans Administration facility were studied. Nutritional status was evaluated using anthropometric measurements, laboratory data and immunologic assay. Deficits in anthropometric measurements were frequent and severe in this group of patients. Furthermore, our data demonstrated that patients with a forced vital capacity <30% of predicted value had significantly reduced lean body mass as measured by the mid-arm muscle circumference (p<0.05). Investigation of the nutritional status of patients with chronic obstructive pulmonary disease using controlled nutrition intervention trials may elucidate the relationship of nutritional state to pulmonary function in this group of patients.     

Functional diagnosis of chronic obstructive pulmonary disease

Functional diagnosis of chronic obstructive pulmonary disease is important for identifying and quantifying airflow limitation, reversibility, disease severity and exacerbations. Functional diagnosis is also important for long-term therapeutic monitoring and for establishing the need for pulmonary rehabilitation. From the functional standpoint, chronic obstructive pulmonary disease is characterised by a progressive airflow limitation which is not fully reversible. Spirometry is the gold standard for diagnosing the disease and monitoring its progression as it is non-invasive, standardised, reproducible, and objective. Spirometry should measure forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the ratio of these two measurements. Post-bronchodilator FEV1 < 80% of the predicted value and FEV1/FVC ratio < 70% confirms the diagnosis of chronic obstructive pulmonary disease.     

Chlamydia pneumoniae infection in patients with chronic obstructive pulmonary disease.

The prevalence of chronic Chlamydia pneumoniae infection was assessed in 54 patients with established chronic obstructive pulmonary disease (COPD), 41 of these with severe COPD (group I), 13 with mild to moderate COPD (group II), and in 23 patients with community-acquired pneumonia (controls, group III). Specific IgG and IgA antibody levels and circulating immune complexes (ICs) were measured in paired sera, and specific secretory IgA (sIgA) levels in sputum specimens. A polymerase chain reaction (PCR) test was used for the detection of C. pneumoniae in sputum. According to our definite diagnosis criterion, 65% of the COPD patients showed evidence of suspected chronic C. pneumoniae infection and the prevalence was still higher (71%) in patients with severe disease. The occurrence of specific markers of infection was invariably highest in patients with severe COPD, next-highest in patients with mild to moderate COPD and lowest in pneumonia patients. The association between COPD and C. pneumoniae infection persisted after controlling for the potential confounding factors.     

Dietary evaluation of outpatients with chronic obstructive pulmonary disease

Protein-calorie malnutrition is prevalent among individuals with chronic obstructive pulmonary disease (COPD), and suboptimal body weight has been associated with increased morbidity and mortality. Pulmonary function, anthropometric measurements, and dietary intake were evaluated in 64 outpatients with stable COPD to assess interrelationships of those parameters. Those individuals with body weights less than 75% of standard for height, age, and sex had the greatest degree of airway obstruction, poorest lung diffusing capacity, and greatest loss of body fat and muscle mass. Contrary to what had been anticipated, calorie and protein intake levels were highest in the less than 75% of standard body weight group, decreased as relative body weight increased, and were lowest in the greater than 105% of standard body weight group. Those results indicate that caloric needs increase as COPD progresses. Intake levels of calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C were adequate in terms of the RDAs and were not related to relative body weight.     

Diaphragm dysfunction in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by alterations in the airways and lung parenchyma resulting in an increased respiratory workload. Besides an increased load and hyperinflation of the thorax, additional factors, such as systemic inflammation, oxidative stress, hypoxia and loss of muscle mass, further have a negative influence on diaphragm contractility. The diaphragm seems to adapt only partly to the altered circumstances to which it is exposed. As a consequence, several morphological, biochemical and functional alterations occur in the diaphragm, resulting in diaphragm dysfunction. In an appropriately selected group of patients, the function of the diaphragm can be improved by respiratory muscle training, oral nutritional therapy or hormonal interventions.     

Circulating ghrelin in patients with chronic obstructive pulmonary disease

OBJECTIVE: Unexplained weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Because ghrelin plays an important role in energy homeostasis, this study investigated the plasma level of ghrelin in COPD. METHODS: Plasma ghrelin levels and levels of leptin, tumor necrosis factor-alpha, and C-reactive protein were measured in 29 patients with COPD and 17 healthy controls. Body composition was assessed with bioelectrical impedance analysis. RESULTS: Body mass index and percentage of body fat were lower in patients who had COPD than in healthy controls. Plasma ghrelin and leptin concentrations were significantly lower in patients who had COPD than in healthy controls (ghrelin: 0.25+/-0.22 ng/mL versus 0.43+/-0.24 ng/mL, P=0.013; leptin: 1.77+/-0.70 ng/mL versus 2.85+/-0.96 ng/mL, P=0.000). In contrast, tumor necrosis factor-alpha and C-reactive protein were significantly higher in those with COPD than in controls. Plasma ghrelin (log transformed) was positively correlated with body mass index and percentage of body fat in patients with COPD but negatively correlated in control subjects. Plasma ghrelin was negatively correlated with tumor necrosis factor-alpha and C-reactive protein in COPD. CONCLUSION: Plasma ghrelin level was decreased in COPD and this is different from other weight-loss diseases. These data suggest that decreased ghrelin and other factors may contribute to alterations in metabolic status during inflammatory stress in this disease.     

噻托溴铵对轻中度慢性阻塞性肺疾病患者肺功能的影响

目的评估噻托溴铵对轻中度慢性阻塞性肺疾病（COPD）患者肺功能的影响。方法将80例轻中度COPD患者按随机数字表法分为噻托溴铵组（40例）和对照组（40例）,治疗周期为12周,两组患者均经过1周的清洗期,清洗期患者吸入0．9％氯化钠。第2～12周为治疗期,噻托溴铵组患者吸入噻托溴铵干粉胶囊（18μg／粒）,上午给药,每日1次;对照组患者则继续吸入0．9％氯化钠。分别于治疗前及治疗后第6,12周测定患者的肺功能。结果经过连续12周的治疗后,噻托溴铵组肺功能指标深吸气量、第1秒用力呼气容积和用力肺活量均得到明显改善,较治疗前分别增加了（0．43±0．15）,（0．17±0．11）和（0．41±0．14）L,而对照组上升幅度无明显改善,仅分别增加了（0．10±0．12）,（0．01±0．05）和（0．05±0．12）L,两组比较差异有统计学意义（P〈0．05）。两组不良反应发生率和COPD急性发作率比较差异无统计学意义（P〉0．05）。结论轻中度COPD患者每日1次吸入噻托溴铵（18μg）可以显著改善患者的肺功能。     

蛋白质营养不良对慢性阻塞性肺疾病患者肺功能的影响

[目的] 探讨蛋白质营养不良对慢性阻塞性肺疾病患者肺功能指标的影响。[方法] 将182例慢性阻塞性肺疾病患者分为营养正常组及营养不良组,对比分析其营养状态、肺功能及血气情况。[结果] 患者的最大通气量、第1秒用力呼气容积、用力肺活量、动脉血氧分压和二氧化碳分压等指标,两组之间差异有统计学意义。[结论]蛋白质营养不良对慢性阻塞性肺疾病患者通气功能有较大影响,临床应注意早期监测并改善其营养状况。     

瑞舒伐他汀对慢阻肺合并肺心病患者肺功能及炎症反应的影响

目的探讨瑞舒伐他汀对慢阻肺合并肺心病患者肺功能及炎症反应的影响。方法选取2016年5月—2017年5月收治的慢阻肺合并肺心病患者60例,将其随机分为观察组和对照组,各30例。对照组予以常规内科治疗,观察组在此基础上联合瑞舒伐他汀治疗,连续治疗12周后,比较两组肺功能及炎性因子水平。计量资料比较采用t检验,P0.05为差异有统计学意义。结果治疗后,观察组FEV1及FEV1/FVC水平均高于对照组,差异具有统计学意义(均P0.05);观察组TNF-α、IL-1、hs-CRP水平均低于对照组,差异具有统计学意义(均P0.05)。结论瑞舒伐他汀对慢阻肺合并肺心病患者疗效显著,可有效改善肺功能,降低炎性因子水平。     

肺部感染对慢性阻塞性肺疾病患者呼吸功能状态与细胞因子表达的影响

目的探讨肺部感染对慢性阻塞性肺疾病(COPD)患者呼吸功能状态与细胞因子水平的影响。方法2016年1月-2018年1月医院收治的COPD合并肺部感染患者54例作为试验组,COPD无肺部感染患者50例作为对照组。采用酶联免疫吸附试验检测细胞因子白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和转化生长因子-β(TGF-β)的水平,使用肺功能检测仪检测患者第一秒末用力呼气量(FEV1)、每分钟最大通气量(MVV)、最大呼气中期流速(MMF)、气道阻力(RAW)、共振频率(Fres)、动态胸肺顺应性(Cdyn)呼吸功能指标。结果试验组血清IL-6、IL-8、TNF-α和TGF-β的水平分别为(11.0±0.8)(pg/ml)、(11.3±1.1)(pg/ml)、(1.8±0.1)(ng/L)、(98.2±6.4)(ng/L),均高于对照组,试验组FEV1、MVV、MMF和Cdyn分别为(61.5±5.0)%、(46.5±3.9)%、(0.8±0.1)L/s、(30.8±5.4)ml/cmH2O,均低于对照组,试验组RAW和Fres分别为(118.3±12.4)%、(22.6±5.4)Hz,均高于对照组(P<0.05);感染程度越高,患者血清IL-6、IL-8、TNF-α和TGF-β的水平越高,FEV1、MVV、MMF和Cdyn越低,而RAW和Fres越高(P<0.05)。结论肺部感染影响了COPD患者的肺功能和炎症细胞因子水平,临床上应注重控制和预防肺部感染。     

Resting energy expenditure in patients with chronic obstructive pulmonary disease

Resting energy expenditure (REE) was measured in 68 patients with stable chronic obstructive pulmonary disease (COPD) and in 34 weight-stable, age-matched (65 +/- 8 y; means +/- SD) healthy control subjects. Fat-free mass (FFM) determined by bioelectrical resistance explained 84% of the variation in REE in the control group but only 34% in the COPD patients. REE could not reliably be predicted from regression equations either developed in healthy subjects or in COPD patients. REE adjusted for FFM was significantly higher (P less than 0.05) in weight-losing (n = 34) than in weight-stable (n = 34) patients (6851 +/- 781 and 6495 +/- 650 kJ/d, respectively). Pulmonary function was more compromised in weight-losing patients. Adjusted REE in weight-stable patients was significantly higher (P less than 0.01) than in the healthy control group (6131 +/- 405 kJ/d). In patients with COPD, factors in addition to FFM are important determinants of REE. A disease-related increase in REE develops, which may contribute to weight loss in COPD in combination with a lack of an adaptive response to undernutrition in weight-losing patients.     

Dietary problems in patients with severe chronic obstructive pulmonary disease

Background and aims Low body weight and low fat-free mass-index (FFMI) are common in patients with severe chronic obstructive pulmonary disease (COPD). Several factors seem to contribute. The aims of the present observational study were to investigate dietary problems in patients with severe COPD and to compare dietary problems to nutritional status, energy intake and smoking habits. Methods Nutritional status was assessed in 73 stable outpatients using body mass index and FFMI by single-frequency bioelectrical impedance. Lung function, smoking habits, energy intake and dietary problems were also assessed. Results The most frequently reported dietary problems were ‘anorexia’, ‘dyspeptic symptoms other than diarrhoea’, ‘slimming’, ‘fear of gaining weight’, ‘dyspnoea’, ‘diarrhoea’, ’depression, anxiety, solitude’. Smoking habits and gender had impact on the kind of dietary problems reported. Reporting two dietary problems correlated to low FFMI, whereas reporting one or more dietary problems correlated to decreased energy intake. Conclusion Dietary problems are common in the group studied and related to smoking habits and gender. Dietary problems affect energy intake and FFMI negatively. It is important to recognize dietary problems and to offer intervention of the dietary problems as a part of the dietary intervention.     

血常规检测对慢性阻塞性肺疾病患者预后预测作用

目的 探讨血常规检测结果与慢性阻塞性肺疾病(COPD)患者疾病严重程度相关性。方法 从阜新市某医院病历管理信息系统中抽取2017年1—12期间有2次及以上血常规检测结果的确诊为COPD的患者完整资料(病例组)及在体检中心随机抽取与病例数相当的健康体检者100人(对照组)进行分析。结果 符合要求的COPD病例100例,对照组健康体检者100人,病例组和对照组的性别构成、年龄分布和BMI差异均无统计学意义(均P>0.05)。病例组中性粒细胞、嗜碱性粒细胞、中性粒细胞与淋巴细胞比值(NLR)与血红蛋白水平均明显高于对照组,淋巴细胞、嗜酸性粒细胞、嗜酸性粒细胞与嗜碱性粒细胞比值(EBR)水平均明显低于对照组(均P<0.01)。预后良好患者中性粒细胞、嗜碱性粒细胞及NLR均明显低于预后不良者(P<0.05或P<0.01),淋巴细胞、嗜酸性粒细胞、EBR及血红蛋白水平均明显高于预后不良者(均P<0.01)。中性粒细胞、嗜碱性粒细胞及NLR与COPD严重程度呈正相关关系(均P<0.05),淋巴细胞、嗜酸性粒细胞、EBR及血红蛋白水平与COPD严重程度呈显著负相关关系(均P<0.05)。结论 COPD患者病情严重程度与嗜碱性粒细胞及NLR显著正相关,与淋巴细胞、嗜酸性粒细胞、EBR及血红蛋白水平显著负相关,血液常规检测可作为预测COPD患者病情与预后的指标。     

老年慢性阻塞性肺疾病患者肺部感染的危险因素分析

目的研究老年慢性阻塞性肺疾病(COPD)患者发生肺部感染的危险因素,为其防治提供可靠的依据。方法回顾性分析2011年12月-2012年12月住院的老年COPD患者80例,发生肺部感染30例,调查肺部感染的相关危险因素,进行多因素logistic回归分析;通过SPSSl5.0软件对数据进行统计分析。结果感染患者年龄≥60岁占83.3%、有吸烟史占33.3%、滥用抗菌药物占70.0%、侵入性操作占73.3%、并发高血压占70.0%、糖尿病占63.3%,其他呼吸系统疾病占66.7%;而多因素分析结果显示,年龄≥60岁、基础疾病、滥用抗菌药物以及住院时间的延长均导致住院老年COPD患者肺部感染发生,是其发生的独立危险因素(P<0.05)。结论住院老年COPD患者发生肺部感染同年龄≥60岁、基础疾病、滥用抗菌药物以及住院时间等因素相关。     

慢性阻塞性肺疾病患者肺部真菌感染危险因素研究

目的探讨慢性阻塞性肺疾病(COPD)患者继发医院肺部真菌感染及其危险因素,为临床治疗提供可靠的依据。方法回顾性分析2009年1月-2012年6月725例COPD患者的临床资料,对真菌感染患者危险因素进行分析;采用SPSS19.0软件对资料进行统计分析。结果 725例COPD患者中有56例发生肺部真菌感染感染率7.7%,共检出真菌83株,检出白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌、近平滑假丝酵母菌、毛霉菌属、曲霉菌属、葡萄牙假丝酵母菌,分别占60.24%、13.25%、6.02%、4.82%、7.23%、3.61%、2.41%、1.21%;真菌对制菌霉素、两性霉素B、伊曲康唑较敏感,对氟胞嘧啶、酮康唑及咪康唑的敏感性较差;低白蛋白血症、使用肾上腺糖皮质激素>500mg、广谱抗菌药物使用时间>14d、合并呼吸衰竭是COPD患者发生肺部真菌感染的独立危险因素(P<0.05)。结论提高对COPD患者继发肺部真菌感染危险因素的认识,有针对性地采取防治措施,可以减少肺部真菌感染的发生。     

慢性阻塞性肺疾病患者呼吸机相关肺部感染的临床研究

目的研究慢性阻塞性肺疾病(COPD)患者实施机械通气过程中并发呼吸机相关肺部感染(VAP)的病原菌分布和相关危险因素,为临床治疗VAP提供参考依据。方法选取2012年1月-2016年1月128例实施机械通气的COPD患者为研究对象,观察COPD患者接受机械通气过程中的VAP发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析,同时患者留取合格痰标本进行痰培养检测病原菌分布情况。结果128例COPD患者发生VAP 88例,VAP发生率为68.75%;88例VAP患者痰标本共培养出病原菌125株,其中革兰阴性细菌103株占82.4%,革兰阳性细菌3株占2.4%,19株真菌占15.2%;COPD患者实施机械通气后发生VAP的独立危险因素为气管插管、合并糖尿病、机械通气持续时间≥3d、吸烟史以及留置胃管;VAP患者的病死率为31.8%,明显高于非VAP患者的7.5%。结论 COPD患者实施机械通气VAP发生率高,发生VAP的相关危险因素较多,临床应针对感染病原菌合理应用抗菌药物。