老年男性慢性阻塞性肺疾病与骨质疏松的关系

目的探索老年男性慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者骨密度(bone mineral density,BMD)水平及骨质疏松(osteoporosis,OP)发生率,进而探讨COPD与OP可能存在的联系。方法选取2013年1月至2017年9月期间入我院的60周岁以上共94名老年男性作为研究对象,并分为COPD组52名和对照组42名,利用双能X线骨密度仪测量不同部位的骨密度T值(腰椎TL2-4、股骨颈TNeck、髋部TTotal);肺通气功能仪测量肺通气指标值(FEV1%、FEV1/FVC%、VC%、MVV%)。计量资料采用独立样本t检验或曼-惠特尼U检验,计数资料采用χ2检验,多因素分析采用二分类Logistic回归分析。结果老年男性COPD患者的骨密度指标值(TNeck、TTotal)及肺通气各项指标值(FEV1%、FEV1/FVC%、VC%、MVV%)均显著低于对照组,差异具有统计学意义。老年男性COPD组与对照组的骨质疏松、骨量减少和骨量正常构成比分别为21.2%、55.8%、23.1%和9.5%、42.9%、47.6%,差异具有统计学意义。老年男性COPD的影响因素包括身高、体重、BMI指数、TNeck及FEV1/FVC%。结论老年男性COPD患者的股骨颈及髋部BMD显著低于对照组、骨质疏松的发生率显著高于对照组;老年男性患者股骨颈BMD值越高,COPD发生的风险越低。     

单双侧肺减容术后早期肺功能及肺血流动力学的变化

目的探讨单、双侧肺减容（LVRS）术后早期肺功能及肺血流动力学的不同变化。方法86例重度慢性阻塞性肺气肿患者（COPD）行LVRS手术,单侧61例、双侧25例,术前、术后3、6个月分别测量肺功能[第1秒用力呼气量（FEV1）、残气量（RV）、肺总量（TLC）]、动脉血气[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）]、心脏超声多普勒检查[心输出量（CO）、心脏指数（CI）、射血分数（EF）并计算肺动脉压（PAP）],并对其结果进行比较分析。结果80例患者痊愈出院,6例死亡;单侧LVRS术后3、6个月的FEV,较术前有明显提高（P〈0．05）,双侧LVRS术后各项指标改善较单侧更好（P=0．015）,RV、TLC较术前有明显降低（P〈0．05）;术后PaO2比术前提高（P〈0．05）,PaCO2较术前显著减低（P〈0．05）;肺血流动力学（CO、CI、EF、PAP）无明显变化（P〉0．05）。结论单、双侧LVRS治疗重度COPD患者是安全有效的,术后早期均可明显改善患者的肺功能,但双侧手术效果优于单侧;单、双侧LVRS对肺血流动力学无明显负影响,术前术后无明显改变。     

Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease

BACKGROUND: The aim of this study was to evaluate the influence of chronic obstructive pulmonary diseases (COPD) on postoperative pulmonary function and to elucidate the factors for decreasing the reduction of pulmonary function after lobectomy. METHODS: We conducted a retrospective chart review of 521 patients who had undergone lobectomy for lung cancer at Chiba University Hospital between 1990 and 2000. Forty-eight patients were categorized as COPD, defined as percentage of predicted forced expiratory volume at 1 second (FEV1) less than or equal to 70% and percentage of FEV1 to forced vital capacity less than or equal to 70%. The remaining 473 patients were categorized as non-COPD. RESULTS: Although all preoperative pulmonary function test data and arterial oxygen tension were significantly lower in the COPD group, postoperative arterial oxygen tension and FEV1 were equivalent between the two groups, and the ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the COPD group (p < 0.001). With multivariable analysis, COPD and pulmonary resection of the lower portion of the lung (lower or middle-lower lobectomies) were identified as independent factors for the minimal deterioration of FEV1. Actual postoperative FEV1 was 15% lower and higher than predicted, respectively, in the non-COPD patients with upper portion lobectomy and the COPD patients with lower portion lobectomy. Finally, we created a new equation for predicting postoperative FEV1, and it produced a higher coefficient of determination (R(2)) than the conventional one. CONCLUSIONS: The postoperative ventilatory function in patients with COPD who had lower or middle-lower lobectomies was better preserved than predicted.     

口服罗红霉素对慢性阻塞性肺疾病患者肺功能的影响

目的探讨口服罗红霉素对慢性阻塞性肺疾病（COPD）患者肺功能的影响,并分析其可能的机制。方法将50例COPD患者采用随机、单盲方法分成治疗组25例与对照组25例,其中对照组采用常规基础治疗,治疗组在常规基础治疗基础上口服罗红霉素0．15g,2次／d,并持续1年。观察两组患者治疗前后外周血中性粒细胞计数及肺功能的变化,统计分析两组患者发生病情急性加重及因此而需住院的次数。结果治疗组患者治疗前后外周血中性粒细胞计数差异有统计学意义（P〈0．05）;治疗组第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1％预计值）、最大通气量、清晨最大呼气流量治疗前后改变不明显（P〉0．05）,对照组却有明显下降（P〈0．05）,两组患者治疗前后肺功能的变化差异有统计学意义（P〈0.05）;治疗组急性加重10例次（40％）,对照组19例次（76％）;治疗组需住院6例次（24％）,对照组13例次（52％）,两组急性加重率及需住院率比较差异均有统计学意义（P〈0．05）。结论口服罗红霉素对COPD患者肺功能具有保护作用,其可能的机制与罗红霉素对中性粒细胞的抑制作用有关。     

Postoperative exacerbation of chronic obstructive pulmonary disease. Does it exist?

BACKGROUND: One of the characteristics of chronic obstructive pulmonary disease (COPD) is the tendency to develop acute exacerbation, defined by the presence of different clinical findings as worsening dyspnea, increase in sputum purulence and volume. This study was designed to verify if definition of acute COPD exacerbation is applicable to patients who underwent pulmonary surgery, and if it has any impact on postoperative morbidity and mortality. METHODS: This study was designed to prospectively enrol 1000 patients undergoing pulmonary resection for lung cancer from five different centres. Postoperative exacerbation of COPD was defined by the concomitant presence of three of the following five signs: deteriorating dyspnea, purulent sputum, bronchial secretion volume >10 ml/24 h, fever without apparent cause, and wheezing. The presence of concomitant pulmonary complications excluded the diagnosis of exacerbation, as they may present one or more of these signs. RESULTS: In the absence of respiratory complications, postoperative stay in exacerbated patients was significantly longer as compared to patients without exacerbation (6.3+/-1.3 vs 8.3+/-1.1, p=0.001). A postoperative exacerbation of COPD was recorded in 276 patients and 152 of them (55%) subsequently developed respiratory complications. Multivariate analysis established that risk factors for postoperative exacerbation are sex (female OR 0.54, CI 0.2-0.8), COPD class (OR 1.5, CI 1.1-8.1), and the postoperative prolonged use of antibiotics (OR 0.6, CI 0.2-0.9). CONCLUSIONS: Postoperative exacerbation of COPD is an existing, frequent clinical entity after lung resection and, when present, it increases the risk of pulmonary complications. The existing guidelines for the treatment of acute exacerbation should be adapted for the management of patients after lung resection in order to test the hypothesis that they could reduce respiratory morbidity.     

慢性阻塞性肺疾病急性加重和疾病进展的关系

目的研究肺功能、血气分析、圣乔治呼吸调查问卷（SGRQ）评分、全身营养状况等临床指标在评价慢性阻塞性肺疾病（COPD）的疾病进展中的作用。方法观察因急性加重而住院的中重度COPD患者的肺功能、血气分析、SGRQ评分、全身营养状况等临床指标与前一次急性加重时的变化趋势。结果中度COPD患者第1秒用力呼气容积占预计值百分比（FEV1％pred）和氧合指数随病情的进展呈现明显下降趋势[住院1、2．3、4次分别为（68．43±3．09）％、（61．27±3．38）％、（42．05±4．16）％、（33．64±3．34）％和435．55±10．23、404．35±11．56、358．38±13．21、321．29±11．78]（P〈0．05）,PaCO2则呈现明显上升趋势[住院1、2、3、4次分别为（36．23±3．62）、（45．44±4．67）、（57．82±4．12）、（78．28±5．21）mmHg（1mmHg=0．133kPa）]（P〈0．05）,重度COPD患者氧合指数呈明显下降趋势。SGRQ评分在中重度患者中均有明显下降趋势（P〈0．05）,血红蛋白、白蛋白、体重指数则无明显变化趋势。结论急性加重对COPD患者的肺功能和生活质量影响甚大,肺功能检查、血气分析指标和SGRQ评分可以反映COPD的疾病进展。     

慢性阻塞性肺疾病急性加重期患者肺康复的研究进展

介绍慢性阻塞性肺疾病急性加重期患者的主要肺康复形式如气道廓清技术、神经肌肉电刺激、运动训练、呼吸肌训练、营养支持等,对患者开展肺康复治疗的有效性、安全性、可行性,目前实施肺康复干预的场所、开始时机进行总结阐述,以期提高医护人员对慢性阻塞性肺病急性加重期患者行肺康复的认识,为临床实践提供指导,推动慢病全程化管理水平的提升...     

Effect of lung transplantation on diaphragmatic function in patients with chronic obstructive pulmonary disease.

BACKGROUND--To date there are no data on the effects of lung transplantation on diaphragmatic function in patients with end stage chronic obstructive pulmonary disease (COPD). It is not known whether the relation between the transdiaphragmatic pressure (PDI) and lung volume is altered in recipients after transplantation as a result of changes in diaphragmatic structure caused by chronic hyperinflation. The effect of lung transplantation on diaphragmatic strength was determined in patients with COPD and the relation between postoperative PDI and lung volume analysed. METHODS--Diaphragmatic strength was assessed in eight double lung transplant recipients, six single lung transplant recipients, and in 14 patients with COPD whose lung function was similar to those of the transplant recipients preoperatively. PDI obtained during unilateral and bilateral phrenic nerve stimulation at 1 Hz (twitch PDI) at functional residual capacity (FRC) and during maximal sniff manoeuvres (sniff PDI) at various levels of inspiratory vital capacity (VCin) served as parameters for diaphragmatic strength. Sniff PDI assessed at the various VCin levels were used to analyse the PDI/lung volume relation. RESULTS--Lung transplantation caused a reduction in lung volume, especially in the double lung transplant recipients. As a consequence sniff PDI was higher in the double lung transplant recipients than in the patients with COPD at all levels of VCin analysed. However, sniff PDI values analysed at comparable intrathoracic gas volumes were not reduced in the patients with COPD when compared with those who underwent lung transplantation. Bilateral twitch PDI values were similar in the patients with COPD and in the lung transplant recipients. In the single lung transplant recipients unilateral twitch PDI values were similar on the transplanted and the non-transplanted side. The relation between PDI and lung volume was similar in the patients with COPD and in the lung transplant recipients. CONCLUSIONS--In patients with COPD lung transplantation leads to an increase the maximal sniff induced PDI values by placing the diaphragm in a more favourable position for pressure generation. Since patients with COPD and postoperative lung transplant recipients showed similar PDI/lung volume relations, this suggests that chronic pulmonary hyperinflation does not cause major functional alterations of the diaphragm.     

男性慢性阻塞性肺病患者骨密度对照分析

目的探讨慢性阻塞性肺病（COPD）与骨质疏松的关系。方法39例男性COPD患者（COPD组），应用双能X线吸收仪测定其股骨颈（Neck），股骨三角（Ward’s），股骨大转子（Troch）的骨密度（BMD），设健康对照组。结果COPD组BMD明显比对照组低（P〈0．05）。讨论COPD患者是骨质疏松的重点预防对象，应注意检测骨密度。     

慢性阻塞性肺疾病患者自我感受负担与家庭关怀度的相关性

目的探讨慢性阻塞性肺疾病(COPD)患者自我感受负担及其与家庭关怀度的关系。方法采用自我感受负担量表、家庭关怀度量表对143例稳定期COPD患者进行调查。结果 COPD患者自我感受负担总分为(31.51±5.87)分,家庭关怀度总分为(5.02±1.63)分,两者总分及各维度之间呈负相关(均P0.05)。结论 COPD患者自我感受负担与家庭关怀度均处于中等水平,且两者显著相关。护理人员应重点关注患者家庭的关怀支持,降低患者自我感受负担,提高患者生活质量。     

Pulmonary vascular structure and function in chronic obstructive pulmonary disease.

Cardiac catheterization data from eight patients with severe chronic obstructive lung disease and pulmonary hypertension at rest (greater than 25 mm Hg) were compared with those obtained from 14 patients with mild to moderate disease whose pulmonary artery pressure was within the normal range at rest (mean 15 (SEM 1) mm Hg), but increased with exercise (30 (2) mm Hg). We obtained lung sections from necropsy material from the group with severe disease, and from surgical specimens in the group with mild to moderate disease, and compared the structure of the vasculature in these groups with that obtained from surgical specimens in a non-smoking control group of seven patients. Oxygen administration either at rest or during exercise did not greatly affect the pulmonary arterial pressures. When cardiac index was plotted against pulmonary artery pressure at rest and during exercise and extrapolated to the axis there was no evidence for a critical closing pressure in either group. The vessels in the groups with mild to moderate and severe chronic obstructive lung disease showed intimal thickening (each 19% (SD 0.5%)) by comparison with the non-smoking group (16% (0.5%]. The group with severe disease, in addition, had medial hypertrophy (27% (0.5%) versus 24% (SD 1%) in the non-smoking group). These data are consistent with the idea that the diseased vessels are distorted and rigid. The lack of effect of breathing oxygen on the vascular response at rest and during exercise suggests that hypoxic vasoconstriction has a minimal role in the pulmonary hypertension of chronic obstructive lung disease. The data suggest that the intimal changes could narrow the vessel calibre in those patients with mild to moderate disease, and that the thickened media present in the vessels from patients with severe disease may act in concert with the enlarged intima to produce more severe vascular obstruction.     

Frequency of venous thrombosis in patients with an exacerbation of chronic obstructive lung disease

The presence or absence of venous thrombosis was determined in 29 patients with an acute exacerbation of chronic obstructive lung disease by the technique of autologous platelet labelling with indium-111. Deep venous thrombosis was diagnosed in 13 patients and in nine of these patients thrombosis was located proximal to the knee--that is, in areas associated with an appreciable risk of pulmonary embolism. One patient died; pulmonary emboli were found at postmortem examination. The incidence of venous thrombosis seen in this study is high enough to suggest that these patients may benefit from prophylactic antithrombotic treatment.     

慢性阻塞性肺疾病急性加重期胰岛素强化治疗的临床研究

目的:观察胰岛素强化治疗在慢性阻塞性肺疾病(COPD)急性加重期的治疗作用及预后.方法:106例COPD急性发作期患者随机分为常规治疗组(CT组)及胰岛素强化治疗组(IT组),每4 h监测1次床旁血糖.当CT组血糖>11.1 mmol/L时,皮下注射中性可溶性胰岛素控制血糖在11.1 mmo l/L以下;当IT组血糖>6.1 mmol/L时,皮下注射胰岛素控制血糖在4.4～6.1mmo l/L.观察两组肝肾功能异常、有创通气患者例敷及死亡例教.并用酶联免疫吸附试验(ELISA)检测两组治疗前、1、3、7天血清C反应蛋白(CRP)值.结果:强化组肝肾功能异常例数显著少于常规组(P<0.05),两组死亡例数差异无显著(P>0.05).强化组治疗7天后血清CRP含量较常规组显著降低(P<0.05或0.01).结论:胰岛素强化治疗在COPD急性加重期伴有应激性高血糖患者中有较好应用价值.