肺康复对非小细胞肺癌行肺切除术患者术后免疫功能和生活质量的影响

目的 观察肺康复对非小细胞肺癌（NSCLC）行肺切除术患者术后免疫功能和生活质量的影响。方法 选取我院2017年4月~2018年8月收治的72例NSCLC并接受肺切除术患者,随机分为观察组和对照组,各36例。两组患者都遵医嘱给予常规药物治疗,观察组在此基础上给予肺康复干预。记录患者术后住院期间的并发症发生情况和肋间导管置留时间,分别在术前1 d、术后4周记录患者改良版伯格呼吸困难量表（MBS）评分、免疫功能指标（CD3、CD4、CD8）和生活质量评分。结果 观察组并发症发生情况（27.73% vs 52.74%）和肋间导管置流的时间[（5.48±0.87）d vs （7.34±0.92）d]均少于对照组,差异有统计学意义（P＜0.05）;术后4周,两组患者免疫功能、生活质量评分和MBS评分较治疗前改善,差异有统计学意义（P＜0.05）;且治疗组免疫功能、生活质量评分和MBS评分改善情况优于对照组,差异有统计学意义（P＜0.05）。结论 NSCLC行肺切除术患者术后肺康复干预可以降低术后肺部并发症的发生率,减短患者术后肋间导管置留时间,改善其免疫功能和生活质量。     

紫杉醇治疗对老年非小细胞肺癌患者生活质量的影响

目的探讨紫杉醇合并放疗方案对老年晚期非小细胞肺癌(NSCLC)患者近期生活质量的影响.方法88例NSCLC患者,按性别、年龄、UICC-TNM分期和细胞病理11配对,分成两组,实验组应用紫杉醇化疗加胸部放疗,对照组应用足叶甙化疗加胸部放疗,治疗前和治疗后第1、3个月分别用肺癌患者生活质量(QOL)评估表测量.结果共配成31对,实验组治疗后1、3个月QOL评分均明显优于对照组(P<0.05),其中前者与肺癌症状和治疗副作用有关的分项评分也明显低于对照组(P<0.05).结论紫杉醇合并放疗方案对NSCLC患者QOL影响优于足叶甙加卡铂放疗方案.     

居家护理对慢性阻塞性肺部疾病患者生活质量的影响

目的:探讨居家护理对慢性阻塞性肺部疾病(COPD)患者生活质量的影响。方法:将86例(COPD)患者按出院奇偶数分为观察组和对照组各43例,对照组出院后采用常规护理方法,观察组在此基础上采用居家护理方法,对其生活方式进行干预,采用COPD患者生活质量评定量表,评价两组患者的生活质量,结果:干预6个月后,两组日常生活、社会活动、抑郁、焦虑及生活质量总均分比较,差异有显著性意义(均P<0.05)。结论:居家护理能提高COPD患者的生活质量。     

心肺运动试验在慢性阻塞性肺疾病中的应用

目的：探讨心肺运动试验在慢性阻塞性肺疾病中的应用意义。方法对我院收治的46例慢性阻塞性肺疾病患者(COPD组)和46例健康志愿者(对照组)进行心肺运动试验,比较两组在心肺运动试验后的心、肺功能指标。结果 COPD组患者的心功能指标Wmax、VO2max、VO2max/kg、VO2/HR max、SpO2、AT均显著低于对照组患者,<0.05;心肺运动试验中COPD组患者的肺功能指标VEmax、VTmax、VCO2max均显著低于对照组患者,<0.05;BFmax、VE/VO2AT、VE/VCO2 AT均显著高于对照组患者,<0.05。结论心肺功能试验能全面的反映慢性阻塞性肺疾病患者的疾病状况,对疾病的治疗和预后起到客观的评估作用。     

家庭护理干预对提高稳定期慢性阻塞性肺疾病患者 生活质量的研究

目的 研究家庭护理干预对提高稳定期慢性阻塞性肺疾病患者生活质量的影响。方法 选取2017年1月~2018年12月在我院诊治的180例稳定期慢性阻塞性肺疾病患者为研究对象,将其随机分为对照组和观察组,各90例。对照组采用常规护理干预,观察组在对照组基础上实施家庭护理干预,两组均随访3个月。比较两组患者出院1个月时生活质量评分及治疗依从性,出院3个月时两组复发率。结果 干预后观察组心理状态、社会功能、躯体功能、工作情况评分均高于出院前,差异有统计学意义（P＜0.05）,对照组生活质量评分低于出院前,且观察组高于对照组,差异有统计学意义（P＜0.05）;观察组合理饮食、坚持氧疗、用药依从、情绪稳定评分均高于对照组,差异有统计学意义（P＜0.05）;出院3个月观察组复发率为8.88%,低于对照组的32.22%,差异有统计学意义（P＜0.05）。结论 家庭护理干预可提高稳定期慢性阻塞性肺疾病患者生活质量,有效降低复发率,改善患者预后效果,具有一定的临床应用价值。     

健康教育对慢性阻塞性肺疾病患者生命质量的影响

目的 探讨健康教育对慢性阻塞性肺疾病患者生命质量的影响.方法 选择108例门诊就诊的慢性阻塞性肺疾病患者,在常规治疗的基础上,进行健康教育:心理护理、家庭支持、饮食指导、体育锻炼、用药指导.健康教育前及健康教育后3个月由专科护士采用交谈法对生命质量进行评估,同时测定肺功能.结果 经过3个月的健康教育,患者的活动受限、回避刺激物、哮喘症状、心理情绪、刺激物反应、对疾病的担心等指标与健康教育前比较,差异有统计学意义(P＜0.01);健康教育后肺功能FVC、FEV1和PEFR均有显著提高(P＜0.01).结论 健康教育可以提高慢性阻塞性肺疾病患者对疾病的认识,提高生命质量.     

慢性阻塞性肺疾病患者生存质量的对照研究

目的 :评估慢性阻塞性肺疾病 (ChronicObstructivePulmonaryDisease ,COPD)患者的生存质量 (QualityOfLife ,QOL)的变化。方法 :采用世界卫生组织生存质量测定量表简表 (WorldHealthOrganizationQualityOfLifeBrefQuestion naires ,WHOQOL -BREF)和COPD患者QOL评估表以及抑郁自评量表 (Self -RatingDepressionScale ,SDS)对 10 2名COPD患者进行调查 ,同时选择 2 0 4人做 1:2配对分析。结果 :WHOQOL -BREF的总评价分、生理领域分、心理领域分、COPD生存质量评估表的总均分以及SDS的总标准分均明显下降 ,与对照组相比 ,差异有统计学意义 (P <0 .0 1)。结论 :COPD患者的生存质量明显下降     

冬虫夏草对慢性阻塞性肺疾病大鼠树突状细胞功能的影响

目的: 研究冬虫夏草对慢性阻塞性肺疾病(COPD)大鼠树突状细胞(DCs)功能的影响及其分子机制。方法: 将大鼠随机分为COPD模型组、冬虫夏草治疗组和正常对照组,观察各组大鼠气道病理改变,分离培养鼠DCs,ELISA法检测DCs培养上清液和DCs-T细胞共培养上清液中细胞因子含量。结果: 与正常对照组相比,COPD模型组和冬虫夏草治疗组的平均肺泡计数减少(P＜0.05),冬虫夏草治疗组高于COPD模型组,但差异无统计学意义(P>0.05)。冬虫夏草治疗组DCs-T细胞共培养后上清液中IFN-γ水平高于COPD模型组和正常对照组(P<0.05),IL-5水平各组无显著差异(P>0.05)。冬虫夏草治疗组DCs上清液中TNF-α和IL-12 p70水平高于COPD模型组和正常对照组(P<0.05)。结论: 冬虫夏草可促使COPD大鼠DCs产生Th1型细胞因子,机制可能与DCs产生的IL-12 p70促进T细胞产生IFN-γ有关。     

慢性阻塞性肺病及其相关非小细胞肺癌进程与EMT 的相关性研究

目的:通过对相关数据库数据分析,探究EMT 相关调节因子的异常表达与慢性阻塞性肺疾病及其相关非小细胞肺癌的相关性。方法:对NCBI 中GEO 数据库中的若干数据集数据进行表达量分析、生存分析和相关性分析。结果: 研究分析表明,Snai1 等EMT 相关调节因子在非小细胞肺癌患者中存在明显的高表达,而E-cadherin(CDH1)等则表现为明显的低表达。于对大量的COPD 病例样本进行分析,发现部分EMT 相关的分子在COPD 患者中也表现出明显的表达异常,且与非小细胞肺癌患者中的变化相一致。结论:EMT 指标和在COPD 患者中的表达相关性分析表明,EMT 调节因子的异常表达可能与COPD 患者的疾病发展存在一定的相关性。     

慢性阻塞性肺疾病患者的康复治疗

慢性阻塞性肺疾病（COPD）是呼吸系统常见病和多发病,因肺功能进行性减退,严重影响患者的劳动力和生活质量,随着人口老龄化,其患病率有逐年上升之势,对社会经济和人民健康都造成巨大的负担。近年来随着COPD研究的日益完善,在药物治疗的基础上进行康复锻炼及营养支持已成为治疗COPD的重要组成部分,合理的康复治疗可以减轻COPD患者的症状,提高生活质量。     

Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease

Introduction

The aim of this study was to assess the effects of preoperative pulmonary rehabilitation (PPR) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC), and net effects of PPR and cancer resection on residual pulmonary function and functional capacity.

Material and methods

This prospective single group study included 83 COPD patients (62 ±8 years, 85% males, FEV₁ = 1844 ±618 ml, Tiffeneau index = 54 ±9%) with NSCLC, on 2–4-week PPR, before resection. Pulmonary function, and functional and symptom status were evaluated by spirometry, 6-minute walking distance (6MWD) and Borg scale, on admission, after PPR and after surgery.

Results

Following PPR significant improvement was registered in the majority of spirometry parameters (FEV₁ by 374 ml, p < 0.001; VLC by 407 ml, p < 0.001; FEF₅₀ by 3%, p = 0.003), 6MWD (for 56 m, p < 0.001) and dyspnoeal symptoms (by 1.0 Borg unit, p < 0.001). A positive correlation was identified between preoperative increments of FEV₁ and 6MWD (r _s = 0.503, p = 0.001). Negative correlations were found between basal FEV₁ and its percentage increment (r _s = –0.479, p = 0.001) and between basal 6MWD and its percentage change (r _s = –0.603, p < 0.001) during PPR. Compared to basal values, after resection a significant reduction of most spirometry parameters and 6MWD were recorded, while Tiffeneau index, FEF₂₅ and dyspnoea severity remained stable (p = NS).

Conclusions

Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection. Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR. The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity.     

Effects of short-term pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease

Although the rehabilitation of patients with chronic obstructive pulmonary disease (COPD) improves both exercise capacity and quality of life, a standard protocol for COPD patients has not been established. To clarify whether physiologic and quality-of-life improvements can be achieved by an inpatient pulmonary rehabilitation program 5 days per week for 3 weeks, 18 patients with COPD were enrolled in a rehabilitation program. The physical exercise training regimen consisted of respiratory muscle stretch gymnastics and cycle ergometer exercise training. Pulmonary function tests, an incremental ergometer exercise test, a 6-min walking test, and a quality of life assessment by the Chronic Respiratory Questionnaire were administered before and after the program. The peak VO2, an indicator of maximal exercise capacity, did not increase, although the 6-min walking distance, an indicator of functional exercise capacity, increased significantly after rehabilitation. There was a significant improvement in the quality of life in terms of dyspnea, fatigue, and emotional state. These findings suggest that even a 3-week program may be beneficial for COPD patients. Increases in functional exercise capacity, even without an increase in maximal exercise capacity, are helpful for reducing dyspnea and improving quality of life parameters in patients with COPD.     

Effects of peripheral neuropathy on exercise capacity and quality of life in patients with chronic obstructive pulmonary diseases

Introduction

Chronic obstructive pulmonary diseases (COPD) have some systemic effects including systemic inflammation, nutritional abnormalities, skeletal muscle dysfunction, and cardiovascular, skeletal and neurological disorders. Some studies have reported the presence of peripheral neuropathy (PNP) at an incidence of 28-94% in patients with COPD. Our study aimed to identify whether PNP affects exercise performance and quality of life in COPD patients.

Material and methods

Thirty mild-very severe patients with COPD (male/female = 29/1, mean age = 64 ±10 years) and 14 normal subjects (male/female = 11/5, mean age = 61 ±8 years) were included in the present study. All subjects underwent pulmonary function testing (PFT), cardiopulmonary exercise testing, electroneuromyography and short form 36 (SF-36).

Results

Peak oxygen uptake (PeakVO₂) was lower in COPD patients (1.15 ±0.53 l/min) than healthy subjects (2.02 ±0.46 l/min) (p = 0.0001). There was no PNP in healthy subjects while 16 (53%) of the COPD patients had PNP. Forced expiratory volume in 1 s (FEV₁) and PeakVO₂ were significantly different between patients with PNP and those without (p = 0.009, p = 0.03 respectively). Quality of life of patients with PNP was lower than that of patients without PNP (p < 0.05).

Conclusions

The present study demonstrates the exercise limitation in COPD patients with PNP. Thus, presence of PNP has a poor effect on exercise capacity and quality of life in patients with COPD. Furthermore, treatment modalities for PNP can be recommended to these patients in order to improve exercise capacity and quality of life.     

慢性阻塞性肺疾病与肺癌在表观遗传学上的研究进展

肺癌与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是全球发病率与死亡率最高的疾病之一.COPD与肺癌存在共同的致病因素,包括环境因素与遗传因素,其中环境因素中由吸烟介导的氧化应激反应导致基因组发生表观遗传改变,较个体间的遗传易感性差异更受关注.表观遗传机制在许多复杂疾病中发挥巨大作用,并且表观遗传变化也是COPD与肺癌临床诊断上的重要生物标记物,主要包括DNA甲基化、组蛋白共价修饰和MicroRNAs.本文重点就DNA甲基化与组蛋白共价修饰在COPD与肺癌中的联系进行讨论.     

Self-efficacy and health-related quality of life in chronic obstructive pulmonary disease: A meta-analysis

ObjectiveTo determine the association between self-efficacy and health-related quality of life (HRQoL) in people with Chronic Obstructive Pulmonary Disease (COPD) and the moderating effect of self-efficacy type (exercise task, exercise barrier, COPD symptom, general) and HRQoL type (generic, COPD specific).MethodsDatabases were searched systematically from inception to January 2019. Methodological quality was assessed, and a meta-analysis was conducted following PRISMA guidelines (PROSPERO protocol: CRD42018114846).ResultsAcross 31 coefficients, there was a positive relationship between self-efficacy and HRQoL (r = 0.38, 95 %CI [0.32, 0.45]). Exercise barrier self-efficacy had the strongest relationship to HRQoL (r = 0.42, 95 % CI [0.30, 0.52]), followed by COPD symptoms (r = 0.41, 95 % CI [0.33, 0.49]), exercise tasks (r = 0.40, 95 % CI [0.29, 0.50]), and general self-efficacy (r = 0.21, 95 % CI [0.14, 0.28]). Generic HRQoL had a similar relationship to self-efficacy (r = 0.38, 95 % CI [0.28, 0.47]) as COPD specific HRQoL (r = 0.38, 95 % CI [0.30, 0.46]).ConclusionThere is a moderate positive relationship between self-efficacy and HRQoL in COPD, with the relationship stronger for exercise and COPD symptoms than general self-efficacy.     

Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression

The authors examined 179 veterans with chronic obstructive pulmonary disease (COPD) to determine the relative contribution of clinical depression and/or anxiety (Beck Depression and Beck Anxiety Inventories) to their quality of life (Chronic Respiratory Questionnaire and Medical Outcomes Survey Short Form). Multiple-regression procedures found that both depression and anxiety were significantly related to negative quality-of-life outcomes (anxiety with both mental and physical health quality-of-life outcomes, and depression primarily with mental health). When comorbid with COPD, mental health symptoms of depression and anxiety are some of the most salient factors associated with quality-of-life outcomes.     

Muscular pulmonary arteries in chronic obstructive lung disease

The small muscular pulmonary arteries are thought to be normal in obstructive pulmonary disease despite prolonged hypoxic stimulation to medial thickening. Because measurements on nondistended vessels have considerable variability, we reinvestigated the problem by studying the percentage of wall thickness of distended arteries in lungs taken post mortem from 5 asymptomatic emphysematous patients and 11 symptomatic patients with obstructive pulmonary disease. Vessels in the former patients had normal medial thicknesses. In contrast, we found an elevated mean percentage of wall thickness for vessels between 0.3 and 2.0 mm in diameter of 4.46% +/-1.44% (mean +/-SD) for patients with obstructive airways disease. Obstructive pulmonary disease, therefore, produced medial hypertrophy in small muscular arteries similar to that seen in other conditions associated with chronic hypoxia.