比索洛尔对慢性阻塞性肺疾病合并慢性心衰患者心肺功能的影响

观察比索洛尔对慢性阻塞性肺疾病(COPD)合并慢性心衰(CHF)患者心肺功能的影响.方法:将58例COPD合并CHF患者分成常规治疗组和比索洛尔治疗组,常规治疗组予吸氧、抗感染、解痉平喘、化痰、扩管、利尿、强心等治疗,比索洛尔治疗组在常规治疗基础上联用比索洛尔.分别于治疗前、治疗后12周经超声心动图及肺功能仪检测心肺功能(LVEF％、FEV1％、FEV1/FVC％),测定6 min步行距离,并抽验血查血清BNP水平.结果:两组治疗后较治疗前反映心肺功能的指标(包括LVEF％、FEV1％、FEV1/FVC％、6 min步行距离、BNP)均明显改善(P＜0.05).比索洛尔治疗组治疗12周后LVEF％、BNP、6 min步行距离3项指标改善情况明显优于对照组(P＜0.05),而肺功能无明显差别(P＞0.05).结论:比索洛尔治疗COPD合并CHF有效、安全.     

老年慢性阻塞性肺疾病合并心力衰竭患者短期预后及相关因素分析

目的 观察老年慢性阻塞性肺疾病（COPD）合并慢性心力衰竭（CHF）患者短期预后,并分析影响预后的相关因素。方法 回顾性分析2019年1月至2021年12月泰州市中西医结合医院收治的58例老年COPD合并CHF患者的临床资料,患者出院后随访6个月,根据患者预后不同分为预后不良组（12例）和预后良好组（46例）。收集所有患者一般资料,包括性别、年龄、身体质量指数（BMI）、糖尿病史、高血压史、吸烟史、COPD病程、呼吸困难分级、CHF原发疾病及纽约心脏病协会（NYHA）分级等;患者入院当天检测心肺功能[左室射血分数（LVEF）、第1秒用力呼气容积（FEV1）、用力肺活量（FVC）及FEV1/FVC]及实验室指标[血清C反应蛋白（CRP）、白蛋白（ALB）、CRP/ALB及氨基末端脑钠肽前体（NT-pro BNP）];以受试者操作特征（ROC）曲线分析LVEF、FEV1/FVC、CRP/ALB、NT-pro BNP水平预测老年COPD合并CHF患者预后不良的价值;采用非条件Logistic逐步回归分析老年COPD合并CHF患者短期预后不良的影响因素。结果 预后不良组患者呼吸困难分级4级、N...     

慢性心力衰竭合并贫血的研究进展

慢性心力衰竭(CHF)患者贫血的发生率很高,它与CHF疗效、再住院率、死亡率等预后密切相关。目前已发现慢性肾脏病、铁缺乏、促红细胞生成素(EPO)生成减少及细胞因子等均与心力衰竭患者合并贫血有关;纠正贫血可以改善心力衰竭。本文将关于贫血对CHF患者预后影响的临床研究和相关机制综述如下。     

β受体阻滞剂治疗慢性心力衰竭合并COPD患者的疗效观察

慢性心力衰竭患者的合并疾病研究目前逐渐成为热点。高质量临床随机对照试验证据显示,β受体阻滞剂是慢性心衰患者左室射血分数下降的首选治疗药物。合并慢性阻塞性肺病（COPD）是临床上治疗充血性心力衰竭（CHF）患者时,     

慢性阻塞性肺疾病合并肺气肿患者血清不规则趋化因子变化及临床意义

目的 分析慢性阻塞性肺疾病(COPD)合并肺气肿患者血清不规则趋化因子(CX3CL1/FKN)变化及临床意义.方法 我院收治的106例COPD患者,按是否合并肺气肿分为COPD合并肺气肿组(n=46)和COPD组(n=60),选取同期我院体检的40例健康者作为对照组;随访28 d,根据预后将COPD合并肺气肿组分为存活...     

慢性心力衰竭合并慢性肾炎患者尿液中B型尿钠肽水平与心功能的相关性研究

目的:探讨慢性心力衰竭(chronic heart failure,CHF)合并慢性肾炎患者尿液中血清B型钠尿肽(B-natriuretic peptide,BNP)水平与心功能的相关性。方法:选取2013年6月至2015年6月在我院接受治疗的慢性心力衰竭患者为观察对象,根据其是否合并慢性肾炎分为CHF组和CHF合并慢性肾炎组。观察两组患者肾功能指标及尿BNP水平,比较两组患者心功能指标的差异,分析肾功能指标、尿BNP与心功能的相关性。结果:CHF合并慢性肾炎组患者尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,SCr)和BNP水平明显高于CHF组,而肾小球滤过率(glomerular filtration rate,GFR)水平明显低于CHF组,差异具有统计学意义(P0.05);CHF合并慢性肾炎组患者左心房直径(left atrial diameter,LAD)、右心房直径(right atrial diameter,RAD)、左室收缩末内径((left ventricular end systolic diameter,LVESD)和左室舒张末内径(left ventricular end diastolic diameter,LVEDD)水平明显高于CHF组患者,左室射血分数(left ventricular ejection fractions,LVEF)水平明显低于CHF组,差异具有统计学意义(P0.05);CHF合并慢性肾炎患者的BUN,SCr、BNP与LAD、RAD、LVESD和LVEDD正相关,与LVEF负相关,GER水平与LAD、RAD、LVESD和LVEDD负相关,与LVEF正相关。结论:慢性心力衰竭合并慢性肾炎患者尿液BNP水平较高,且与患者的心功能指标密切相关,可作为临床监测指标。     

巨噬细胞迁移抑制因子与慢性阻塞性肺疾病合并抑郁的相关性分析

目的 探讨慢性阻塞性肺疾病(COPD)合并抑郁与血清巨噬细胞迁移抑制因子(MIF)、白细胞介素(IL)-6、C反应蛋白(CRP)水平的相关性。方法 选取2021年1月至2022年4月在该院呼吸科就诊的69例稳定期COPD患者作为研究对象。根据汉密尔顿抑郁量表(HAMD)评分结果将69例COPD患者分为COPD合并抑郁组(HAMD评分≥7分)和COPD非抑郁组(HAMD评分<7分)。比较COPD非抑郁组与COPD合并抑郁组患者血清MIF、IL-6、CRP水平,以及慢性阻塞性肺疾病自我评估测试(CAT)评分。并进行血清MIF水平与HAMD评分及CAT评分的相关性分析。采用受试者工作特征曲线(ROC曲线)评估血清MIF、IL-6、CRP水平预测COPD患者发生抑郁的价值,采用多因素Logistic回归分析影响COPD患者发生抑郁的相关因素。结果 (1)COPD非抑郁组与COPD合并抑郁组患者BMI、CAT评分、血氧分压(PO₂)、HAMD评分、合并症、受教育程度、既往1年急性加重次数比较,差异均有统计学意义(P<0.05)。(2)与COPD非抑郁组比较,CO...     

家庭无创通气长期治疗COPD合并慢性呼吸衰竭的临床研究

目的探讨长期家庭无创机械通气治疗对慢性阻塞性肺疾病(COPD)合并慢性呼吸衰竭患者预后的影响。方法选取2009年1月～2012年1月在我科治疗的慢性阻塞性肺疾病合并慢性呼吸衰竭患者37例,将长期进行家庭无创通气治疗的患者分为治疗组(12例),未使用无创通气的患者为对照组(25例)。两组患者采用的基础治疗无差异性,均进行1年随访,比较两组治疗前后病人的生活质量评分、肺功能、血气指标及COPD急性发作频率、年住院费用等指标。结果慢性呼吸衰竭患者应用家庭无创通气后生活质量评分、肺功能、血气指标较对照组均有明显改善(P相似文献   

老年慢性阻塞性肺疾病合并糖尿病患者临床资料与分析

目的探讨老年慢性阻塞性肺疾病(COPD)合并糖尿病(DM)的临床特点和治疗转归。方法回顾性分析2006年1月至2013年4月收治的63例老年COPD急性发作期患者、COPD合并DM 34例与单纯COPD 29例的临床资料。结果 COPD并DM急性发作期合并细菌感染较单纯COPD增加25.76%;合并营养不良低蛋白血症较单纯COPD增加15.93%;合并低氧血症及高碳酸血症较单纯COPD分别增加9.74%和15.11%;D-二聚体(D-D)增高较单纯COPD增加7%,且其中2例发生下肢静脉血栓;平均住院日较单纯COPD增加4.94 d;抗生素使用时间较单纯COPD增加3.22 d。有效率较单纯COPD下降9.23%,死亡率较单纯COPD增加6.8%。结论老年COPD患者合并DM急性发作期合并细菌感染多,病情重,加重和增加营养不良低蛋白血症,加重低氧导致呼吸衰竭,患者常常处于高凝、低氧状态,更易发生静脉血栓等并发症。患者平均住院时间及抗生素应用时间长,病死率高。     

慢性阻塞性肺疾病合并肺癌的临床特点分析

目的分析慢性阻塞性肺疾病(COPD)合并肺癌患者的临床特点,提高临床对COPD合并肺癌的认识。方法回顾性分析COPD合并肺癌患者98例和同期住院单纯COPD患者108例,对两组患者临床资料进行统计学分析。结果 COPD合并肺癌组患者的咯血或痰中带血、胸痛、肺不张、声音嘶哑、胸腔积液、消瘦均显著高于单纯COPD组患者(P0.05);COPD合并肺癌组男性患者显著多于单纯COPD组(86.7%vs 71.3%,P0.05);单纯COPD组患者年龄高于COPD合并肺癌组(P0.01);COPD合并肺癌组吸烟指数显著高于单纯COPD组(P0.01);COPD合并肺癌组患者肺功能分级在Ⅰ级、Ⅱ级的人数显著多于单纯COPD组(62.9%vs 54.3%,P=0.047;78.7%vs 21.3%,P0.01);COPD合并肺癌组的患者,肺鳞癌比例最高(43.9%),男性以肺鳞癌常见(48.2%),女性以肺腺癌多见(53.8%)。结论当具有COPD病史的患者出现咯血或痰中带血、胸痛、肺不张、声音嘶哑、胸腔积液、消瘦的临床表现及体征时,要注意警惕合并肺癌的可能。COPD合并肺癌好发于男性大量吸烟的患者,气道阻塞较轻的COPD患者容易发生肺癌,病理类型以肺鳞癌最常见。     

Therapy of primary chronic headache: chronic migraine, chronic tension type headache and other forms of daily chronic headache

The criteria of the International Headache Society (IHS) define four different primary headache syndromes with daily chronic headaches: chronic migraine, episodic and chronic tension type headache, hemicrania continua, new daily persisting headache. A further important differential diagnosis is medication overuse headache (previously known as analgesia headache). The German, Austrian, and Swiss headache societies now present the first joint guidelines for therapy of these headache syndromes. The current literature was reviewed and a summary is presented. The therapy recommendations do not only include the scientific evidence but also the practical relevance.     

The course of chronic glomerulonephritis in chronic opisthorchiasis

AIM: To characterize clinical, functional and morphological features of chronic glomerulonephritis (CGN) running with chronic opisthorchiasis (CO) and to justify dehelminthization. MATERIAL AND METHODS: Clinical, functional and morphological examinations of the kidneys, immunological characteristics were studied in 100 patients with primary CGN and CO (group 1), 30 patients with CGN free of CO (group 2) and 40 patients with long-term CO. RESULTS: CGN in CO runs with frequent rise of creatinine, glomerular filtration and canal reabsorption fall. Pathogenetic therapy with addition of pulse cyclophosphamide in a dose 10 mg/kg and conduction of dehelminthization a year later lead to long-term remission and inhibition of nephrosclerosis development. CONCLUSION: Clinicofunctional and morphological characteristics of the kidneys in mixed pathology necessitate addition of immunosuppressor cyclophosphamide in a dose 10 mg/kg and dehelminthization in combined treatment of patients with glomerulonephritis and opisthorchiasis.     

Nutrition in chronic heart failure with coexisting chronic kidney disease

BACKGROUND AND RESEARCH OBJECTIVES: Patients with heart failure (HF) may be predisposed to malnutrition. Little is known about the nutritional status of patients with HF, particularly patients who have coexisting major medical conditions such as chronic kidney disease. The purposes of this study were to (1) describe the nutritional status of 211 patients with chronic HF, (2) examine relationships between nutrition variables and health-related quality of life, and (3) evaluate the nutritional status of the subset of HF patients with coexisting chronic kidney disease. SUBJECTS AND METHODS: The sample included 211 patients with chronic HF recruited for a larger study about health-related quality of life. Clinical data were retrieved retrospectively from the computerized medical records system at the study site. RESULTS AND CONCLUSIONS: Mean body mass index of the 122 patients for which height was available was 31.4, and no differences in body mass index were noted among patients with varying New York Heart Association class functional status. Evaluation of the mean laboratory values indicated that patients had abnormal elevations of serum glucose, hemoglobin A1C, creatinine, and low-density lipoprotein cholesterol. Higher hemoglobin A1C levels were significantly correlated with poorer health-related quality-of-life scores, although the magnitude of the correlations was modest. Estimated glomerular filtration rate indicated that 54 (27%) of the HF patients likely had coexisting chronic kidney disease, and these patients had significantly lower serum albumin and worsening anemia. The results indicate the need for future prospective studies that incorporate evaluation of nutritional status and the ways in which coexisting chronic kidney disease influences outcomes.     

Does the MMPI differentiate chronic illness from chronic pain?

This study examines the relationship between MMPI scales and functional limitation for the chronic illness populations of chronic low back pain, migraine headache, hypertension and diabetes. Average MMPI profiles for these groups approximate those of previous studies with the chronic low back group having the most disturbed profile and showing elevations especially on the Hs, Hy and D scales. Several kinds of analyses, however, demonstrate that, in general, the MMPI group differences can be accounted for by individual self-rated functional limitation. The data do not support attempts at defining a low back pain or chronic pain personality profile apart from the emotional disturbance associated with chronic limitation and disruption of activity.     

Depression and chronic fatigue in the patient with chronic pain

Chronic benign pain is commonly associated with chronic fatigue and depression. Depression and chronic fatigue syndrome are also associated with each other and often include pain. Psychologic factors are prominent in these conditions, and they may share neurobiologic factors as well. Management requires separately addressing each component of patients' distress and usually includes physical rehabilitation, education, administration of nonhabituating medications and often counseling. Depression may be a favorable prognostic sign, as it suggests a treatable condition and provides incentive for recovery.     

Assessing chronic fatigue

Sir, Naschitz et al.¹ studied patients with chronic fatigue syndrome(CFS) in comparison with some controls ‘exhibiting sharedclinical features with CFS’,