阿奇霉素治疗急性加重期慢性阻塞性肺病30例

目的:探讨阿奇霉素治疗急性加重期慢性阻塞性肺病(COPD)的效果.方法:急性加重期COPD患者60例,随机分为治疗组和对照组各30例,治疗组用阿奇霉素0.5 g,对照组用克林霉素1.2 g,分别加入0.9%氯化钠注射液250 mL中,静脉滴注,qd.7 d为1个疗程.结果:治疗组临床症状缓解所需时间显著短于对照组(P＜0.05).治疗组总有效率90.0%,高于对照组70.0%,但两组疗效差异无显著性,P＞0.05.结论:阿奇霉素静脉注射治疗急性加重期COPD疗效确切.     

克拉霉素治疗下呼吸道感染36例

观察克拉霉素粉针剂治疗下呼吸道感染疗效和安全性。 36例下呼吸道感染患者 ,随机均分两组 ,分别静脉滴注国产及进口克拉霉素粉针剂 0 .5g,bid,疗程 5d。结果两组临床有效率分别为 88.89%和94 .4 4 % ,细菌清除率均为 93.33%。     

克拉霉素小剂量口服抑制慢性阻塞性肺疾病急性发作的效果

目的探讨小剂量口服克拉霉素抑制慢性阻塞性肺疾病(COPD)急性发作的效果。方法 120例COPD患者随机分为观察组与对照组,对照组采用常规疗法治疗COPD,观察组加用小剂量口服克拉霉素治疗,12周后统计两组患者COPD急性发作情况、肺功能变化、生活质量变化及不良反应发生情况。结果在治疗研究的12周中,观察组COPD总急性发作人数、2次以上发作人数及严重发作致住院人数均少于对照组(P<0.05);治疗前,两组FEV1%比较差异无统计学意义(P>0.05),治疗12周后,观察组FEV1%明显高于对照组(P<0.05);治疗前,两组SGRQ评分中呼吸症状、疾病影响、活动能力评分及总分比较差异无统计学意义(P>0.05),治疗12周后,观察组呼吸症状、疾病影响、活动能力评分及总分均低于对照组(P<0.05)。治疗前后两组患者肝肾功能指标均正常,观察组中发生恶心2例(3.33%)。呕吐1例(1.67%),纳差1例(1.67%);对照组中发生恶心4例(6.67%),纳差2例(3.33%)两组不良反应发生总例数比较差异无统计学意义(P>0.05)。结论小剂量克拉霉素疗法对急性发作的COPD可起到减少急性发作次数,缓解急性发作严重程度的效果;而对于发作间期的COPD,可明显改善肺功能,提高生活质量,且无明显不良反应。     

克拉霉素联合噻托溴铵治疗慢性阻塞性肺疾病的效果观察

目的 分析克拉霉素联合噻托溴铵治疗慢性阻塞性肺疾病 (COPD) 的临床效果。 方法 60 例慢性阻塞性肺疾病患者 , 按随机数字表法分为对照组和观察组 , 每组 30 例。对照组患者给予噻托溴铵治疗 , 观察组在对照组基础上增加克拉霉素治疗。比较两组患者治疗效果及治疗前后动脉血气指标[血氧分压 (PaO₂)、二氧化碳分压 (PaCO₂)]、肺功能指标[用力肺活量 (FVC)、第 1 秒用力呼气容积 (FEV1)]、炎性指标[肿瘤坏死因子 -α(TNF-α)、超敏 C 反应蛋白 (hs-CRP)、白细胞介素 -6(IL-6)]。结果 治疗前 , 两组 PaO₂、PaCO₂及 FVC、FEV1 比较 , 差异无统计学意义 (P>0.05) ;治疗后 , 两组PaO₂、PaCO₂及 FVC、FEV1 均优于治疗前 , 且观察组 PaO₂(84.81±7.51)mm Hg(1 mm Hg=0.133 kPa)、PaCO     

克拉霉素对慢性阻塞性肺疾病稳定期细胞免疫和肺功能的影响

目的 探讨克拉霉素在慢性阻塞性肺疾病(COPD)治疗中的作用.方法 108例COPD随机分为两组:A组56例,在基础治疗的基础上加服克拉霉素;B组52例,仅用基础治疗.C组45例,为健康体检者对照组.治疗前及治疗8周后测定血清白细胞介素(IL)-8、IL-6,肿瘤坏死因子(TNF)-α、T淋巴细胞亚群(CD3+,CD4+,CD8+)和CD4+/CD8+比值及FEV1.0和FEV1.0/FVC.结果 治疗前,A、B组患者血清IL-8、TNF-α、IL-6、CD8+T淋巴细胞较C组升高,FEV1.0、FEV1.0/FVC较C组下降.克拉霉素治疗后,A组IL-8、TNF-α、IL-6、CD8+T淋巴细胞减低,FEV1.0、FEV1.0/FVC高于治疗前及B组(P＜0.01).IL-8、TNF-a、IL-6、CD8+T淋巴细胞与FEV1.0、FEV1.0/FVC呈负相关,CD4+/CD8+比值与FEV1.0、FEV1.0/FVC呈正相关.结论 应用克拉霉素可以降低稳定期COPD患者的IL-8、TNF-α、IL-6的含量,抑制炎症反应,调节细胞免疫功能并能改善肺功能.     

噻托溴胺与克拉霉素联合治疗慢性阻塞性肺疾病的临床观察

目的:针对噻托溴胺与克拉霉素联合治疗慢性阻塞性肺病的临床疗效进行观察,为临床治疗提供参考.方法:随机选取2013年1月~2015年1月在我院接受治疗的90例慢性阻塞性肺疾病患者,并将其随机分为45例观察组和45例对照组,对对照组应用噻托溴胺进行治疗,对观察组应用噻托溴胺联合克拉霉素进行治疗,比较两组临床疗效.结果:两组治疗前肺功能指标变化情况比较,差异不显著(P>0.05);两组治疗后肺功能指标变化情况比较,观察组改善情况明显优于对照组,差异具有统计学意义(P<0.05);两组临床疗效比较,观察组明显优于对照组,差异具有统计学意义(P<0.05).结论:噻托溴胺与克拉霉素联合治疗慢性阻塞性肺疾病,临床疗效较佳,对患者肺功能的改善作用较为显著,提高了患者的生活水平,值得在临床推广.     

头孢哌酮／舒巴坦治疗慢性阻塞性肺疾病下呼吸道感染的疗效评价

目的评价头孢哌酮／舒巴坦治疗慢性阻塞性肺疾病（COPD）下呼吸道感染的临床疗效和安全性。方法将COPD急性加重期患者64例完全随机分为治疗组和对照组各32例,分别给予头孢哌酮／舒巴坦2g和头孢他啶注射液2g静脉滴注,用法均为2次／d,疗程均为7～14d。结果治疗组和对照组有效率分别为90．6％和87．5％;治疗组细菌清除率为88．2％,略高于对照组的81．8％;2组均无明显药物不良反应,组间差异无统计学意义（P〉0．05）。结论头孢哌酮／舒巴坦注射液治疗COPD患者下呼吸道感染,疗效好,使用安全,有临床应用价值。     

克拉霉素联合噻托溴胺治疗慢性阻塞性肺疾病(COPD)疗效分析

目的探讨克拉霉素联合噻托溴胺治疗慢性阻塞性肺疾病(COPD)的临床疗效。方法将我院自2009年1月至2011年2月收治的COPD患者60例随机分为对照组和治疗组,每组30例。对照组单独使用噻托溴胺治疗,治疗组使用克拉霉素+噻托溴胺治疗。观察临床疗效,比较两组患者治疗前后的肺功能指标(FEV1、FCV、FEV1%、FEV1/FCV)及6min步行距离(6MWD)。结果两组患者治疗后的指标检测均明显高于治疗前(P<0.05);治疗组治疗后的疗效显著高于对照组(P<0.05)。结论克拉霉素联合噻托溴胺治疗慢性阻塞性肺疾病,二者合用能增强药物的协同治疗作用,临床疗效显著,值得在临床应用中推广。     

克拉霉素治疗呼吸道细菌感染的疗效

目的：评价国产克拉霉素片治疗呼吸道感染的临床疗效及其安全性。方法：采用单盲对照方法，将１０４例呼吸道细菌感染患者配对并随机分入试验和对照组。试验组给予克拉霉素０。５ｇ，ｂｉｄ，ｐｏ，对照组给予琥乙红霉素０．３７５ｇ，ｔｉｄ，ｐｏ。疗程为７￣１０ｄ。结果：试验组的综合临床疗效显著优于对照组（Ｐ〈０．０１）；试验组痊愈率为７１．２％，有效率为９４．２％，均显著高于对照组（Ｐ〈０．０５）；试验组不良反应     

克拉霉素片治疗小儿呼吸道感染104例

呼吸道感染是小儿常见病,以急性扁桃体炎、咽炎、气管炎、肺炎多见,临床上大部分以青霉素类、头孢菌素类抗生素治疗,但随着耐药性的产生,有的疗效欠佳。笔者以克拉霉素片(利迈先)口服治疗小儿呼吸道感染104例,疗效显著,报告如下。1资料与方法1.1一般资料:200例病人均为门诊病人,以就诊先后随机分成两组:治疗组,104例,男50例,女54例;对照组96例,     

慢性阻塞性肺疾病继发肺部真菌感染62例临床分析

目的：探讨慢性阻塞性肺疾病（COPD）患者肺部感染真菌的种类、易患因素、治疗。方法：应用回顾性调查的方法对62例并发肺部真菌感染的患者进行分析。结果：长期的疾病导致机体免疫力下降;长期应用广谱抗生素和激素;侵人性操作等使COPD患者并发肺部真菌感染的几率增加。综合治疗、合理用药是控制真菌感染的有效方法。结论：近年来真菌感染成为肺部疾病严重的并发症,其临床表现缺乏特异性,应引起实验室和临床医生的高度重视。     

生脉注射液治疗慢性阻塞性肺病急性加重期的临床疗效

目的:探讨生脉注射液治疗慢性阻塞性肺病(COPD)急性加重期的临床疗效。方法:60例COPD患者随机分为两组,对照组(n=28)患者给予氧疗、抗炎、平喘、解痉、止咳化痰等常规治疗,试验组(n=32)在对照组治疗的基础上给予生脉注射液60mL 5%葡萄糖溶液(GS)或0.9%氯化钠溶液(NS)250mL中静脉滴注,qd,连用2周。结果:与对照组比较,治疗后试验组HR,RR,PaCO2均明显下降,白细胞、中性粒细胞明显降低,住院天数缩短,PaO2和SaO2明显上升。试验组与对照组总有效率分别为93·8%(30/32)和75·0%(21/28)(P<0·05)。结论:生脉注射液治疗COPD疗效确切。     

Economic evaluation of tiotropium and salmeterol in the treatment of chronic obstructive pulmonary disease (COPD) in Greece

ABSTRACT

Objective: The objective of the study was to assess the cost-effectiveness of two therapeutic alternatives for chronic obstructive pulmonary disease in the Greek National Health Service (NHS) setting.

Methods: A Markov probabilistic model was used to compare tiotropium with salmeterol. A Monte Carlo simulation with 5000 cases was run in the probabilistic analysis. The model was designed to compute the expected time spent in each state, the expected number of exacerbations occurring and the expected treatment cost per patient. Probabilities were extracted from clinical trials, resource utilisation and cost data from a Greek university hospital.

Results: Quality adjusted life years were 0.70 (95% Uncertainty Interval [UI]: 0.63 to 0.77) in the tiotropium arm and 0.68 (95% UI: 0.60 to 0.75) in the salmeterol arm; a difference of 0.02 (95% UI: –0.08 to 0.13). Exacerbations reached 0.85 (95% UI: 0.80 to 0.91) in the tiotropium arm and 1.02 (95% UI: 0.84 to 1.21) in the salmeterol arm, a difference of –0.17 (95% UI: –0.37 to 0.02). Estimates of the mean annual cost per patient were €2504 (€2122 to €2965) in the tiotropium arm and €2655 (€2111 to €3324) in the salmeterol arm, a difference of –€151 (–€926 to €580). Stochastic analysis showed that tiotropium may have an advantage in reducing exacerbations. The probability that tiotropium is cost-effective was 65% at a ceiling value of €0 and reached 77% at a ceiling ratio of €1000. Results stay fairly constant in various sensitivity analyses.

Conclusion: Even though tiotropium is more expensive to buy than salmeterol in the Greek NHS (using Greek costs there was no statistically significant difference in total costs between tiotropium and salmeterol), overall, during the course of a year, it is actually associated with a lower prevalence of exacerbations and lower treatment costs and thus may represent a viable and cost-effective alternative in the Greek NHS setting.     

Long-term use of inhaled corticosteroids and risk of upper respiratory tract infection in chronic obstructive pulmonary disease: a meta-analysis

Recent studies have suggested that inhaled corticosteroids (ICS) may be associated with higher risks of tuberculosis and pneumonia in patients with COPD. However, it is not known whether ICS increases the risk of upper respiratory tract infection (URTI). Aim of this study was to explore the relationship between ICS and URTI. Through a comprehensive literature search of PubMed, EMBASE, Cochrane Library, and Google Scholar from inception to March 2016, we identified randomized controlled trials of ICS therapy lasting at least 6 months. A meta-analysis by the Peto approach was also conducted to generate summary estimates comparing ICS with non-ICS treatment on the risk of URTI. A total of 14 studies involving 19,777 subjects were considered in the meta-analysis. Compared with non-ICS treatment, ICS were associated with a significantly increased risk of URTI (Peto OR: 1.16; 95% CI: 1.05–1.29; I²?=?9%; p?=?.004). Subgroup analyzes were performed for different dose, high-dose ICS was associated with a significantly increased risk of URTI (Peto OR: 1.19; 95% CI: 1.05–1.34; I²?=?0%; p?=?.005), whereas low-dose ICS showed a non-significant increased risk of URTI (Peto OR: 1.10; 95% CI: 0.91–1.33; I²?=?0%; p?=?.32). Moreover, fluticasone was observed with an increased risk of URTI but not mometasone; high-dose fluticasone treatment was associated with a significantly higher risk of URTI but not low-dose. These results suggested to us that ICS use may increase the risk of URTI in patients with COPD, but it should be further investigated.     

苏黄止咳胶囊辅助治疗慢性阻塞性肺疾病急性加重期患者的临床评价

目的: 观察苏黄止咳胶囊辅助治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效。方法: 将60例AECOPD患者随机分为治疗组和对照组各30例,2组在给予基础药物(抗感染、平喘等药物)治疗的同时,治疗组加用苏黄止咳胶囊,观察2组患者治疗前后症状的改善以及血常规、中性粒细胞和C-反应蛋白的变化。所得数据中定性资料用χ²检验,定量资料用t检验。结果: 治疗组总有效率96.7%(29/30),对照组总有效率80.0%(24/30),2组患者治疗后,血常规、中性粒细胞、C-反应蛋白均较治疗前下降(P<0.05),且治疗组临床效果优于对照组(P<0.01)。结论: 苏黄止咳胶囊治疗AECOPD患者疗效显著,值得临床推广。     

慢性阻塞性肺疾病合并支气管肺癌的临床研究

目的探讨慢性阻塞性肺病（COPD）合并原发性支气管肺癌的发病机制、临床特征、早期诊断及治疗方法。方法对48例COPD合并肺癌患者发病年龄、性别、临床表现及选择的治疗方法进行回顾性分析。结果48例患者中,男39例（81.3%）,女9例（18.7%）,大量吸烟史37例（77.1%）。病理类型：鳞癌26例（54.2%）,腺癌11例（22.9%）,小细胞癌5例（10.4%）,未定型癌6例（12.5%）。TNM分期：I期2例（4.2%）,Ⅱ期3例（6.2%）,ⅢA＋B期32例（66.7%）,Ⅳ期11例（22.9%）。出现可疑症状到确诊时间：1个月内1例（2.1%）,2～6个月29例（60.4%）,7～12个月12例（25.0%）,1年以上6例（12.5%）。治疗方法：手术切除2例（4.2%）,姑息性放和/或化疗13例（27.1%）,射频消融治疗5例（10.4%）,中医治疗15例（31.3%）,仅做对症、支持治疗9例（18.7%）,放弃治疗4例（8.3%）。结论COPD患者合并肺癌的症状无特异性,早期确诊率低。COPD患者伴胸痛、血痰、咳嗽性质的改变、胸腔积液、进行性消瘦应警惕合并肺癌的可能;定期X线和痰脱落细胞筛查对COPD合并肺癌的早期发现有一定的临床意义;胸部CT和纤支镜检查对COPD合并肺癌的临床诊断价值大。COPD合并肺癌的治疗以改善生活质量为主。     

吸入制剂在哮喘和慢性阻塞性肺疾病治疗中的作用及地位

在欧美等发达国家哮喘与慢性阻塞性肺疾病(COPD)患者普遍使用吸入制剂,我国大陆地区吸入制剂的应用尚未得到广泛推广,同时还面临着定量吸入气雾剂抛射剂氟利昂淘汰的困境。本文综述哮喘与COPD治疗中常用的吸入制剂,及其与非吸入制剂相比不可替代的临床地位。     

Patient preference for chronic obstructive pulmonary disease (COPD) treatment inhalers: a discrete choice experiment in France

Objectives: Understanding inhaler preferences may contribute to improving adherence in COPD patients and improving long-term outcomes. This study aims to identify and quantify preferences for convenience-related inhaler attributes in French moderate-to-severe COPD patients, with discrete choice experiment (DCE) methodology.

Methods: Attributes were defined from a literature search, clinician and patient interviews: shape, dose insertion, dose preparation, dose release, dose confirmation, dose counter and reusability. An online DCE was conducted in respondents with self-reported COPD stage 2–4 recruited through a panel. The study questionnaire included twelve choice scenarios per respondent and questions on patient characteristics, treatment and disease severity. Statistical analyses used a mixed logit regression model with random effects. Utility scores were estimated for four types of inhalers: Inhaler A – soft mist inhaler; Inhaler B – reusable soft mist inhaler; Inhaler C – multi-dose dry powder inhaler; and Inhaler D – single dose dry powder inhaler.

Results: The study was completed by 153 patients (50 females); respondents were 50.4?years old on average; 13 different inhaler devices were reported. The most preferred inhaler is L-shaped, has dose preparation with capsule insertion and a dose counter, and is reusable. Inhaler profiles A and B had the highest utilities (mean of 1.2533 and 0.9578 respectively) compared to inhaler C (0.6315) and D (0.2200).

Conclusions: This study showed statistically significant results that the strongest drivers of preference in French users of inhalation devices for COPD are shape, dose counter and reusability. Convenience-related characteristics are important to patients and should be taken into account by clinicians prescribing these devices.     

慢性阻塞性肺病患者抑郁障碍的临床研究

目的 探讨慢性阻塞性肺病(COPD)患者抑郁的发病率以及治疗。方法 153例COPD患者,用Zung抑郁自量表进行抑郁评分,抑郁指数≥0.5者诊断为抑郁。将抑郁组病人随机分为2组,治疗组在常规药物治疗的基础上加用百忧解治疗,对照组仅予常规治疗。结果 153例COPD患者中患抑郁者40例,发病率为26.1%,治疗组抑郁症状、肺功能改善较对照组明显,其差异有显著性(P<0.05)。结论 COPD患者常伴有抑郁症状,重视和兼顾抗抑郁诊治颇有必要。