复方甲氧那明平喘和抗炎作用

目的 :观察复方甲氧那明的支气管解痉和抗炎作用。方法 :比较复方甲氧那明及各单药对组胺诱发离体豚鼠气管条收缩的抑制作用 ;通过气管内注入脂多糖及熏香烟法建立慢性阻塞性肺病 (COPD)大鼠模型 ,给予 3个不同剂量 (3、9、2 7mg·d-1)的复方甲氧那明治疗 ,比较各组大鼠支气管肺泡灌洗液 (BALF)中的肿瘤坏死因子 α(TNF α)、白介素 1β(IL 1β)和白介素 6(IL 6 )的水平。结果 :复方甲氧那明对离体气管条收缩的抑制作用较各单药明显加强 ,对COPD大鼠BALF中的TNF α、IL 1β和IL 6具有抑制作用。结论 :复方甲氧那明具有良好的支气管解痉和抑制COPD大鼠模型气道炎症的作用     

甲氧那明复方药在大鼠慢性阻塞性肺部疾病模型中的抗炎作用

AIM: To evaluate the anti-inflammatory effect of methoxyphenamine compound (MC) on chronic obstructive pulmonary disease (COPD) in rats by measurement of proinflammatory cytokines, total and differential white cell counts (WCC) of bronchroalveolar lavage fluid (BALF). METHODS: Adult rat model of COPD (COPD group) was induced by intratracheal instillation of lipopolysaccharides and exposure to cigarette smoke. Treatment groups received different dosage of MC (3, 9, and 27 mg daily, MC group) or prednisone (0.25 mg daily, P group) respectively. Tumor necrosis factor alpha (TNF-alpha), interleukin 1beta (IL-1beta), interleukin-6 (IL-6), transforming growth factor beta (TGF-beta) of BALF were determined by ELISA. Total and differential WCC were performed after Giemsa staining. RESULTS: The levels of TNF-alpha, IL-1beta, IL-6, TGF-beta, total and differential WCC in BALF of MC groups were significantly decreased than that of COPD group (P<0.01), and there was no significant difference among MC groups. There was no significant decrease in the levels of TNF-alpha, IL-1beta and count of alveolar macrophages in P group compared to those of COPD group. More significant decrease in total WCC and neutrophils was found in P than in COPD group (P<0.01). CONCLUSION: MC has anti-inflammmatory effect in the rats with COPD.     

高血糖对慢性阻塞性肺疾病患者预后的影响

目的住院期间血糖升高对慢性阻塞性疾病急性发作期(COPD-AE)患者近期预后的影响。方法对131例COPD-AE患者入院3d内进行空腹血糖测定。根据空腹血糖把患者分为血糖异常组(空腹血糖≥6.1mmol/L),血糖正常组(空腹血糖<6.1mmol/L)。结果82例(62.6%)COPD-AE患者空腹血糖≥6.1mmol/L,其中确诊糖尿病患者36例(27.5%),血糖升高组多为高龄患者,住院期间病死率明显高于血糖正常组(P<0.05)。结论住院期间血糖升高是影响COPD-AE患者预后的一个重要的危险因素,对血糖升高的患者应给予积极的治疗。     

葆乐辉对慢性阻塞性肺疾病患者肺功能的疗效观察

目的　了解无水茶碱控释片 (葆乐辉 )对慢性阻塞性肺疾病 (COPD)的肺功能疗效。方法　采用随机公开分组对照法 ,前瞻性比较口服葆乐辉与不服用葆乐辉对慢性阻塞性肺疾病患者肺功能的疗效。将患者分为治疗组 ( 3 1例 )及对照组 ( 3 1例 )。治疗组采用葆乐辉 40 0mg d进行 2个月的连续口服治疗。对照组 3 1例不服该药。服药前及服药后第 2个月末 ,分别测定肺功能。结果　治疗组肺功能的主要指标FVC、FEV1 及FEV1 FVC %较服药前及对照组明显改善 ,差异有显著性。结论　使用无水茶碱控释片 (葆乐辉 )治疗慢性阻塞性肺疾病 ,对其肺功能改善有肯定疗效。说明即使对可逆性不大的气流阻塞的COPD患者 ,葆乐辉也有肯定疗效 ,且葆乐辉为控释制剂 ,患者的依从性明显优于普通氨茶碱     

慢性阻塞性肺疾病的肺康复研究进展

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)常见症状包括慢性咳嗽、咳痰、气短及呼吸困难等,其病死率较高。2017年欧洲呼吸学会和美国胸科协会明确提出COPD患者的肺康复治疗。肺康复治疗作为COPD的非药物治疗方法,可有效改善患者症状及预后。本文主要综述了肺康复的概念、肺康复所包含的具体内容及疗效评估的最新研究,同时分析其存在的不足以及发展前景。     

Pharmacoeconomics of the management of acute exacerbations of chronic obstructive pulmonary disease

Acute exacerbations of chronic obstructive pulmonary disease (COPD) impose a significant burden on society in terms of morbidity, mortality, reduced quality of life and healthcare expenditure. New generations of antibiotics are used to treat exacerbations, and other modes of delivery involving home support are being implemented. The optimal strategy to manage exacerbations on pharmacoeconomic grounds depends on issues such as diagnosis of an exacerbation and safety, effectiveness and costs of available alternatives. This review outlines the state of the art of pharmacoeconomic knowledge of the management of acute COPD exacerbations. It presents estimates of the level and distribution of costs associated with exacerbations and reports on the cost-effectiveness or cost-utility of antimicrobial therapy and other approaches to the management of exacerbations.     

慢性阻塞性肺疾病急性加重期大鼠模型构建方法的比较

慢性阻塞性肺疾病的治疗是目前医学界的难题之一,其困难之处在于致病因素的多样性及发病机制的不确定性.为寻求更好的治疗方案.多年来,国内外学者致力于通过建立急性期（AECOPD）模型,来揭开其发病机制,达到降低病死率的目的,但由于其病因太多,发病机制十分复杂,至今进展仍然缓慢.笔者复习有关文献,对COPD和AECOPD大鼠模型构造进行总结,旨在为COPD的发病机制研究提供帮助.     

The economic impact of chronic obstructive pulmonary disease

The cost burden associated with chronic bronchitis and emphysema, collectively known as chronic obstructive pulmonary disease (COPD), is large. The disease impacts not only on patients but caregivers and society as well. An estimated 16 million people in the US are currently diagnosed with COPD, the majority having chronic bronchitis. Mortality associated with this disease is on the upswing, as is its prevalence in the female population and the elderly. It is currently the fourth most common cause of death both in the US and worldwide. To date, the only proven cost-effective therapies for the disease are the cessation or prevention of smoking, which is the single most common cause of COPD, and vaccination to prevent influenza and pneumococcal infection. Hospitalisation and associated costs represent the greatest healthcare expenditures for people with the disease. Long-term oxygen therapy is also among the most costly interventions in terms of total money spent on direct medical costs for COPD treatment, although it is probably cost-effective because of its positive impact on rates of mortality. In fact, oxygen therapy is the only intervention to date that has been shown to decrease death rates due to COPD. Appropriate treatment with medication has the potential to decrease resource utilisation but does not appear to affect death rates. Similarly, pulmonary rehabilitation programs appear to benefit patients in terms of quality of life; however, long-term cost-effectiveness and effects on mortality have yet to be elucidated. Indirect costs also contribute a substantial part of the economic burden of the disease but are significantly harder to quantify.     

慢性阻塞性肺疾病的药物治疗进展

慢性阻塞性肺疾病作为全球第四大死因,给公众的健康带来了严重威胁。适宜的慢性阻塞性肺疾病药物治疗能够预防和控制症状,减少急性加重的频率和严重程度,提高运动耐力和生活质量。合理使用作用机制不同、作用持续时间不同的药物,是当前慢性阻塞性肺疾病治疗的研究热点。本文综述近年来慢性阻塞性肺疾病的药物治疗进展及其治疗策略。     

布地奈德雾化吸入治疗慢性阻塞性肺疾病急性发作期的护理效果

目的：探讨布地奈德雾化吸入治疗慢性阻塞性肺疾病急性发作期的护理效果。方法：选取2013年8月—2015年8月收治的慢性阻塞性肺疾病急性发作期患者96例,按照入院顺序随机分为研究组和对照组各48例,对照组采取常规护理。在对照组基础上,研究组进行相关疾病的健康教育、心理护理等。观察患者干预后疾病知识掌握情况、护理满意情况、疗效、体温、痰量、痰颜色、肺部啰音恢复时间。结果：研究组患者疾病知识掌握度高于对照组（95.83%比7.08%, P＜0.05）,护理满意度高于对照组（95.83%比81.25%,P＜0.05）,总有效率高于对照组（97.92%比75.00%,P＜0.05）。研究组患者体温、痰量、痰颜色、肺部啰音恢复时间低于对照组,组差异有统计学意义（P＜0.05）。结论：对布地奈德雾化吸入治疗慢性阻塞性肺疾病急性发作期进行护理,效果较好,应用价值较高。     

银杏达莫治疗AECOPD合并肺心病的疗效观察

目的：研究银杏达莫治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并肺源性心脏病（肺心病）的疗效。方法：将56例AECOPD合并肺源性心脏病的患者随机分为治疗组和对照组,每组28例,均给予低流量吸氧、抗感染、解痉祛痰、强心利尿等常规治疗,治疗组在常规治疗基础上加用银杏达莫静脉滴注,对照组仅给予常规治疗,疗程均为15d。结果：治疗组总有效率为100．0％,对照组总有效率为96．4％．两组差异无统计学意义（P〉0．05）;但治疗组在临床症状体征改善方面明显快于对照组（P〈0．05）;在感染控制快慢方面,两组差异无统计学意义（P〉0．05）;两组凝血系统及血小板计数在治疗前后无明显变化。结论：银杏达莫注射液治疗AECOPD合并肺源性心脏病是安全有效的。     

前列腺素E1对慢性阻塞性肺疾病的疗效

目的：观察前列腺素Ｅ１（ＰＧＥ１）对慢性阻塞性肺疾病（ＣＯＰＤ）急性加重期患者的疗效。方法：对２５例ＣＯＰＤ的患者在常规治疗的基础上加用ＰＧＥ１ １００￣２００μｇ／ｄ,对照组仅接受常规治疗。结果：ＰＧＥ１治疗组患者临床症状和体征改善的有效率明显高于对照组;治疗组治疗后肺功能（ＦＥＶ１．０）有明显改善（Ｐ〈０．０１）,但对照组改善不明显（Ｐ〉０．０５）;２组患者治疗后血气分析各项指标（ｐＨ,ＰａＯ     

噻托溴铵对中重度慢性阻塞性肺病的治疗效果

目的探讨吸入噻托溴铵治疗中重度慢性阻塞性肺病的疗效和安全性。方法观察2010年6月～2011年11月门诊或住院使用噻托溴铵干粉剂(思力华,18μg,1次/d)的慢性阻塞性肺病患者35例。比较患者治疗前及治疗3个月后肺功能、平均每日使用β受体激动剂次数及心肺功能不全患者外周血浆脑纳肽水平(BNP),记录患者治疗前3个月及治疗后3个月因病情加重入院治疗的次数,同时观察不良反应。结果吸入噻托溴铵后肺功能明显好转,每日使用β受体激动剂次数减少,BNP水平有明显下降,急性加重发作的次数减少,无严重不良反应发生。结论噻托溴铵对于中重度慢性阻塞性肺病患者疗效显著且安全可靠。     

三伏天穴位贴对慢性阻塞性肺疾病患者的影响及护理

目的 探讨三伏天穴位贴敷对慢性阻塞性肺疾病的影响及护理方法.方法 将256例呼吸内科住院治疗的慢性阻塞性肺疾病患者纳为研究对象,每年夏季三伏天给予穴位贴敷,每伏1次,连续3年为1个疗程.1个疗程结束后对患者的疾病急性加重次数、肺功能及血气分析指标进行比较.结果 1个疗程结束后,患者的疾病急性加重次数、肺功能及动脉血气分析指标较治疗前有明显改善,差异有统计学意义（P〈0.05）.结论 三伏天穴位贴敷对改善慢性阻塞性肺疾病患者的肺功能及动脉血气疗效显著,且操作简单,经济安全,值得临床推广.     

帕罗西汀辅助治疗慢性阻塞性肺疾病合并抑郁症的临床疗效观察

目的：研究帕罗西汀辅助治疗COPD合并抑郁症的疗效。方法选取110例COPD合并抑郁症患者,按照随机数字表法将患者分为观察组和对照组,每组55例。对照组给予心理疏导,观察组在对照组的基础上给予帕罗西汀。比较两组临床疗效、动脉氧分压（ PaO2）、动脉二氧化碳分压（ PaCO2）、第1秒用力呼气容积（FEV1）、Hamilton抑郁量表（HAMD）以及不良反应。结果观察组总有效率92．7％,显著高于对照组67．3％（χ2＝13．152,P＝0．013）;观察组治疗后PaO2、PaCO2以及FEV1分别为（84．8±0．3） mmHg、（38．3±0.7）mmHg、（1．7±0．2）L均较治疗前的（67．9±0．9）mmHg、（64．9±0．4）mmHg、（1．5±0．3）L显著改善（t＝9．798、10．132、9．693,P＝0．029、0．018、0．026）,与对照组治疗后比较差异亦均有统计学意义（t＝10．021、11.021、10．751,P＝0．026、0．018、0．023）;观察组HAMD评分为（11．2±0．4）分,显著低于治疗前（17．8±0.3）分（t＝9．915,P＝0．032）,与对照组治疗后比较差异亦有统计学意义（t＝11．723,P＝0．031）;两组不良反应比较差异无统计学意义（χ2＝5．152,P＝0．073）。结论应用帕罗西汀辅助治疗COPD合并抑郁症具有较好的临床疗效,能显著改善患者的临床症状,且无严重不良反应。     

Inhaled corticosteroids for chronic obstructive pulmonary disease

Introduction: Current guidelines recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICSs) and their combinations for maintenance treatment of moderate-to-severe chronic obstructive pulmonary disease (COPD); however, it is questionable whether all COPD patients should be treated, as the long-term use of ICSs is accompanied by side effects.

Areas covered: This article reviews the evidence about the effects of ICSs in the treatment of COPD. It mainly focuses on meta-analyses of published data and pooled analyses of primary data. It also offers an overview of pipeline developments.

Expert opinion: There is now more evidence that there are subsets of patients (mainly, frequent exacerbators with predominant chronic bronchitis and those with overlap between COPD and asthma) with a favorable response to treatment with ICSs (i.e., reduced progression of lung function loss, reduced exacerbation rate and improved health-related quality of life). Therefore, nowadays, the right question is not whether ICSs should not be used at all unless patients have concomitant asthma, but, instead, which COPD patient can benefit from a therapy with ICSs. Unfortunately, however, the number of studies that have investigated the clinical features that might predict corticosteroid response in COPD is still inadequate.     

Treatment of Chlamydia pneumoniae infection and chronic obstructive pulmonary disease

Chronic obstructive lung disease (COPD) is a general term for chronic, irreversible lung disease that combines qualities of emphysema and chronic bronchitis. The standard definition of chronic bronchitis is a productive cough for three months per year (for at least two consecutive years) without an underlying aetiology. Acute exacerbation of chronic bronchitis (AECB) represents a common complaint that leads patients to seek medical attention. COPD and AECB are directly responsible for the overuse of antibiotics in the developed world. Fifty per cent of exacerbations have either viral or non-infectious origin. For this reason, antibiotic use remains controversial. Among other bacteria, Chlamydia pneumoniae is responsible for 4 – 16% of AECB in hospitalised or out-patients, although among smokers and people using steroids, the incidence is 34%. C. pneumoniae may either be the sole causative agent or a co-agent in AECB. This paper reviews the management of COPD/AECB with respect to antibiotic use. Diagnosis and antimicrobial therapy relevant to Chlamydia in the management of AECB are also evaluated in this review.     

贝羚胶囊与复方鲜竹沥液治疗慢性阻塞性肺疾病急性加重期的疗效比较

目的：比较贝羚胶囊与复方鲜竹沥液治疗老年人慢性阻塞性肺疾病急性加重期（AECOPD）的疗效.方法：选择AECOPD患者64例,其中33例（治疗组）采用贝羚胶囊治疗,31例患者（对照组）采用复方鲜竹沥液治疗,疗程均为7天,比较两者的疗效.结果：治疗组总有效率90.9%,对照组总有效率71.0%,两组比较差异有统计学意义.结论：贝羚胶囊治疗AECOPD疗效显著,优于复方鲜竹沥液.     

胸腺肽α1对老年慢性阻塞性肺病急性发作期免疫功能的影响

目的：探讨胸腺肽α1对老年慢性阻塞性肺病（COPD）免疫功能的影响.方法：108例老年COPD急性期住院患者随机分为2组,均按常规治疗,治疗组同时给予胸腺肽α1 1.6 mg皮下注射,隔日1次（qod）,疗程2周.观察2组免疫功能、有效率、平均住院天数、二重感染数及不良反应.结果：免疫功能：治疗组TLC、CD4^＋、CD8^＋、CD4^＋/CD8^＋明显改善,作用优于对照组（P＜0.05或P＜0.01）;同时与对照组相比临床有效率提高、住院时间缩短,二重感染机率低（P＜0.05）;而且无明显不良反应.结论：胸腺肽α1能改善老年COPD患者的免疫功能,是老年COPD获得理想治疗效果的重要手段之一.     

补肺化纤汤对吸烟致大鼠COPD的治疗作用

目的通过观察补肺化纤汤治疗慢性阻塞性肺疾病大鼠的肺功能、TGF-β1及胶原蛋白Ⅲ含量变化,探讨慢性阻塞性肺疾病的发病机制,为补肺化纤汤的治疗作用提供理论依据。方法雄性SD大鼠随机分成正常对照组（A组）、补肺化纤汤治疗组（B组）、N-乙酰半胱氨酸组（C组）,B组按25g/kg予补肺化纤汤,C组按80mg/kg予N-乙酰半胱氨酸灌胃。结果 B组较C组肺功能有改善（P〈0.05）。C组肺组织胶原蛋白Ⅲ含量高于B组（P〈0.01）。血清中,B组和C组TGF-β1含量均高于正常对照组,但差异无统计学意义（P〉0.05）。结论补肺化纤汤具有抗氧化性损伤作用,可以改善已损伤的肺功能。