Do asthmatics suffer bronchoconstriction during rapid eye movement sleep?

Many patients with asthma are troubled by nocturnal wheeze. The cause of this symptom is unknown, but sleep is an important factor. A study was carried out to determine whether nocturnal bronchoconstriction is related to any specific stage of sleep. Eight asthmatics with nocturnal wheeze and eight control subjects performed forced expiratory manoeuvres immediately after being woken from rapid eye movement (REM) or non-REM sleep, wakings being timed to differentiate temporal effects from those related to the stage of sleep. The control subjects showed no significant temporal bronchoconstriction or bronchoconstriction related to the stage of sleep. All patients showed bronchoconstriction overnight, the mean peak expiratory flow rate falling from 410 (SEM 50) 1/min before sleep to 186 (49)1/min after sleep. After the patients had been woken from REM sleep the forced expiratory volume in one second was on average 300 ml lower (p less than 0.02) and peak expiratory flow rate 45 1/min lower (p less than 0.03) than after they had been woken from non-REM sleep. As wakenings from REM sleep were 21(8) minutes later in the night than those from non-REM sleep multivariate analysis was performed to differentiate temporal effects from those related to the stage of sleep. This showed that the overnight decreases in forced expiratory volume in one second and peak expiratory flow rate were significantly related both to time and to REM sleep. This study suggests that asthmatics may suffer bronchoconstriction during REM sleep.     

The effect of theophylline on sleep-disordered breathing in patients with stable chronic congestive heart failure

Objective To determine the prevalence of sleep-disordered breathing in patients with stable, optimally treated chronic congestive heart failure and the effect of short-term oral theophylline therapy on periodic breathing in these patients.Methods Patients with stable, optimally treated chronic congestive heart failure were monitored by polysomnography during nocturnal sleep. The effects of theophylline therapy on periodic breathing associated with stable heart failure were observed before and after treatment.Results Patients were divided into two groups. GroupⅠ(n=21) consisted of individuals with 15 episodes of apnea and hypopnea ［as determined by the apnea-hypopnea index (AHI)］ per hour or less; Group Ⅱ (n=15, 41.7%) individuals had an index of more than 15 episodes per hour. In group Ⅱ, the AHI varied from 16.8 to 78.8 (42.6±15.5) in which the obstructive AHI was 11.1±8.4 and the central AHI was 31.5±9.6. Group Ⅱ had significantly more arousals (36.8±21.3 compared with 19.4±11.2 in group Ⅰ) that were directly attributable to episodes of apnea and hypopnea, lower arterial oxyhemoglobin saturation (76.7%±4.6% compared with 86.5%±2.8%) and lower left ventricular ejection fraction (24.2%±8.8% compared with 31.5%±10.6%). Thirteen patients with compensated heart failure and periodic breathing received theophylline orally (at an average dose of 4.3 mg/kg) for five to seven days. After treatment, the mean plasma theophylline concentration was (11.3±2.5) μg/ml. Theophylline therapy resulted in significant decreases in the number of AHI (20.8±13.2 vs. 42.6±15.5; P<0.001) and the number of episodes of central apnea-hypopnea per hour (10.1±7.6 vs. 31.5±9.6; P<0.001). Furthermore, the percentage of total sleep time during which arterial oxyhemoglobin saturation (SaO2) was less than 90 percent (8.8%±8.6% vs. 23.4%±24.1%; P<0.05) and the arousals per hour (18.7±21.2 vs. 36.8±21.3; P<0.05) were also lower. There were no significant differences in the characteristics of sleep or obstructive AHI before and after theophylline treatment.Conclusions The prevalence of sleep-disordered breathing (mainly periodic respiration or cheyne-stokes respiration with central sleep apnea) is high in patients with stable chronic congestive heart failure. The sleep-disordered breathing episodes are associated with severe nocturnal arterial blood oxyhemoglobin desaturation and excessive arousals. In these patients, oral theophylline therapy may reduce the number of episodes of central apnea and hypopnea and the duration of arterial oxyhemoglobin desaturation during nocturnal sleep.     

Comparison of the effect of oxitropium bromide and of slow-release theophylline on nocturnal asthma

The effects of a new inhaled antimuscarinic drug, oxitropium bromide, and of a slow-release theophylline preparation upon nocturnal asthma were compared in a placebo-controlled double-blind study. Two samples were studied: 12 patients received oxitropium at 600 micrograms (6 subjects) or at 400 micrograms t.i.d. (6 subjects) whereas 11 received theophylline at 300 mg b.i.d. Morning dipping, assessed by the fall in peak flow overnight, was significantly reduced in the periods when either active drug was taken, whereas no difference was noticed during the placebo administration. No significant difference was noticed between results obtained with either active drug, as well as with either dosage of oxitropium. No subject reported side effects of oxitropium, as compared to three subjects reporting nausea, vomiting and tremors after theophylline. Oxitropium proves to be a valuable alternative to theophylline in nocturnal asthma, since it is equally potent, safer and does not require the titration of dosage.     

Mechanism of bronchodilator effect in chronic airflow limitation.

OBJECTIVE: To examine the mechanisms through which two bronchodilators (theophylline and salbutamol) influence dyspnea during daily activities. METHODS: Twenty-four patients with chronic airflow limitation participated in a multiple crossover, randomized, placebo-controlled trial. The effect of theophylline and salbutamol, alone or combined, on pulmonary function and dyspnea during daily activities was examined. Correlations of changes in forced expiratory volume in 1 second (FEV1) and maximum expiratory pressures (MIPs) (independent variables) and changes in dyspnea score during daily activities (dependent variable) were also examined. RESULTS: The two drugs proved to be beneficial the effects in general were additive rather than synergistic. The drugs improved the FEV1; theophylline significantly improved the MIPs. The correlation between the changes in FEV1 and those in dyspnea score, after adjustment for the changes in MIPs, was 0.55 (p less than 0.001). The correlation between the changes in MIPs and those in dyspnea score, after adjustment for the changes in FEV1, was 0.39 (p less than 0.001). CONCLUSIONS: Changes in airway calibre and in respiratory muscle strength play an independent and important role in dyspnea during daily activities in patients with chronic airflow limitation. Changes in airway calibre may be of greater importance.     

慢性阻塞性肺疾病患者夜间低氧血症相关预测因素的分析

目的研究慢性阻塞性肺疾病(COPD)患者睡眠时低氧血症发生的可预测因素。方法分析和比较28例COPD患者与20例正常对照者的肺功能、白天动脉血气及夜间血氧水平。结果 COPD患者夜间平均血氧饱和度(MSaO2)、夜间最低血氧饱和度(LSaO2)较正常对照组明显下降(P<0.05)。COPD患者睡眠时动脉血氧饱和度(SaO2)<90%的时间占睡眠时间百分比(T90)亦显著高于正常对照(P<0.01)。日间SaO2、一秒钟用力呼气容积(FEV1)绝对值与夜间MSaO2相关(r值依次0.704、0.435,P<0.01)。建立了夜间血氧水平的预测公式:MSaO2(%)=0.536×日间SaO2(%)+2.35×FEV1绝对值(L)+38.805。日间SaO2、FEV1绝对值与夜间睡眠时血氧饱和度分布有关。结论 COPD患者睡眠时血氧饱和度较正常人出现明显下降,此时的血氧水平和分布可以通过日间SaO2、FEV1绝对值进行预测。     

Salivary theophylline estimation in the management of asthma in children.

Simultaneous sampling was performed to determine whether saliva could replace plasma in the monitoring of theophylline dosages. Forty-eight children with moderate to severe asthma received oral theophylline preparation (usually sustained release) on a daily basis. They provided simultaneous saliva and plasma samples at routine out-patient visits. Saliva and plasma theophylline concentrations showed a wide variation between individuals, and their ratios also differed. Saliva theophylline concentrations below 7 micrograms/ml reflect plasma concentrations below 10 micrograms/ml, i.e. sub-therapeutic, while saliva concentrations above 7 micrograms/ml are consistent with therapeutic dosage. Estimation of saliva theophylline concentration on routine visits avoids the discomfort of blood sampling. It reflects whether daily oral theophylline dosage in childhood asthma is below or within the therapeutic range. The need for changes in dosage and the degree of patient-compliance with therapy can be usefully indicated.     

戒烟干预联合沙美特罗替卡松粉吸入剂对COPD患者的影响

目的：观察戒烟干预联合沙美特罗替卡松粉吸入剂对慢性阻塞性肺疾病（COPD）患者临床症状及肺功能的影响。方法将78例纳入研究的男性长期抽烟COPD患者进行随机分组,对照组40例,观察组38例。对照组予以茶碱缓释片、沙美特罗替卡松粉吸入剂;观察组在此基础上予以戒烟干预。观察两组患者戒烟率、症状、急性加重次数、生活评分及肺功能一秒用力呼气容积（FEV1）、用力呼气量占用力肺活量比值（FEV1／FVC）的改善情况;观察是否出现不良反应。结果两组患者症状均改善,但观察组更优,组间比较差异有统计学意义（P＜0．05）;患者FEV1、FEV1／FVC、急性加重次数、生活评分均较前改善,但观察组优于对照组（均 P＜0．05）;戒烟率观察组况优于对照组（P＜0．05）;未发现不良反应。结论戒烟干预联合沙美特罗替卡松粉吸入剂对COPD患者疗效显著,能改善患者肺功能及症状。     

茶碱对单个核细胞IL-12分泌的影响

目的 :了解茶碱在体外对人脐带血单个核细胞 (CBMC)分泌IL 12和IL 12p4 0的影响 ,以及健康人服用茶碱后全血中IL 12及IL 12p4 0水平的变化 ,了解茶碱是否可能在抗原呈递细胞水平上参与细胞免疫的调节。方法 :30份新生儿脐带血随机分为 3组 :对照组 ,IL 12抗体组 ,茶碱组 ,分离出单个核细胞体外培养。比较每组产生IL 12和IL 12p4 0量的差异。 12名健康人随机分为两组 ,一组不服药作对照 ,另一组口服舒弗美片 (2 0 0mg) ,取全血作体外培养 ,收集上清液测IL 12及IL 12p4 0的含量。结果 :加用无水茶碱组的脐带血单个核细胞产生IL 12及IL 12p4 0水平 [(2 8.36± 5 .86 )pg·ml- 1 ,(87.91± 33.84 )pg·ml- 1 ]比对照组 [(5 6 .86± 14 .2 2 )pg·ml- 1 ,(2 13.71± 81.78)pg·ml- 1 ]显著降低 (P <0 .0 1)。服用舒弗美片 (2 0 0mg)组IL 12及IL 12p4 0水平 [(19.34± 11.0 2 )pg·ml- 1 ,(92 .2 2± 12 .94 )pg·ml- 1 ]比对照组 [(32 .39± 15 .71)pg·ml- 1 ,(2 0 4 .5 3± 2 4 .70 )pg·ml- 1 ]显著降低 (P <0 .0 1)。结论 :茶碱对CBMC及健康人血液中IL 12的分泌有抑制作用 ,可能对原始CD4 + T细胞极化有潜在调控性作用     

老年胃食管反流病患者夜间反流与睡眠障碍的关系分析

目的分析观察老年胃食管反流病(Gastroesophageal reflux disease,GERD)患者夜间反流与睡眠障碍的关系。方法选取我院2016年11月～2019年11月诊治的80例GERD患者,通过问卷调查的方式对患者的临床资料进行统计并分析。统计夜间GERD发生率以及睡眠障碍发生率、睡眠障碍患者的类型、老年GERD患者反流情况与睡眠障碍的关系以及老年GERD患者的药物使用情况。结果在GERD患者中,出现睡眠障碍主要类型为睡眠维持障碍与睡眠质量下降。患者出现夜间反流的发生与患者睡眠障碍有着直接的关系;在本次研究中,80例GERD患者中,有63例患者需要采用药物进行治疗,其中采用雷贝拉唑的患者27例(42.86%),口服艾司奥美拉唑的患者21例(33.33%),口服西咪替丁片患者8例(12.70%),口服安眠药的患者7例(11.11%)。结论通过对GERD患者进行分析,大部分患者因夜间烧心、反流等症状而导致夜间睡眠障碍,同时存在残留效应对患者日常生活造成严重影响。     

Influence of intrinsic sympathomimetic activity on respiratory function during chronic beta blockade: comparison of propranolol and pindolol

The long term effect of beta blockers and the influence of intrinsic sympathomimetic activity on respiratory function were assessed in patients with chronic stable angina pectoris randomised to receive treatment with propranolol (n = 21) or pindolol (n = 19) for one year. Forced expiratory volume in one second (FEV1) had fallen by a mean of 240 ml after one year (p less than 0.001) in those treated with propranolol compared with 120 ml in those treated with pindolol (p less than 0.05). The difference between the groups was significant (p less than 0.01). Vital capacity fell significantly only in those treated with propranolol (p less than 0.05 at one year). In those in whom the basal ratio of FEV1 to forced vital capacity was low (less than 70%) propranolol, but not pindolol, caused a significant (p less than 0.05) fall in FEV1 throughout treatment. Long term administration of pindolol has a less adverse effect on respiratory function than propranolol, which results in a progressive deterioration in respiratory function over one year.     

重叠综合征患者夜间缺氧与生活质量评分的相关性研究

目的探讨慢性阻塞性肺病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS),即重叠综合征(OS)患者的夜间缺氧与生活质量的相关性。方法观察对象105例,其中COPD组30例,OSAHS组30例,OS组25例,正常对照组20例,所有患者均行肺功能测定和多导睡眠呼吸监测(PSG),填写生活质量呼吸问卷和贝克抑郁量表(BDI),并对各组数据做统计学单因素方差分析,同时对生活质量评分和贝克抑郁评分的相关因素做相关分析和多元回归分析。结果在比较COPD组和OS组第1秒钟用力呼气容积占预计值的百分比(FEV1占预计值%)、第1秒钟用力呼气容积占用力肺活量的百分比(FEV1/FVC)差异无显著性的情况下,OS组的Epworth评分、浅睡眠所占百分率(S1+S2)%、微觉醒指数、呼吸暂停低通气指数(AHI)、血氧饱和度<90%的时间占总监测时间的百分比(TS90%)、氧减指数(ODI)、氧减事件时间/小时、均明显高于COPD组(P均<0.05)。OS组的最长呼吸暂停时间(LAT)、生活质量评分、BDI评分均明显高于其他3组(P均<0.05),而最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)则明显低于其他3组(P均<0.05)。OS组生活质量评分与TS90%、ODI、氧减事件时间/小时具有很好的相关性(相关系数分别为0.543、0.651、0.769,P<0.05);而且这3种缺氧指标和BDI同样具有很好的相关性(相关系数分别为0.490、0.568、0.622,P均<0.05)。多元回归分析显示,OS组患者生活质量评分与氧减事件时间/小时正相关(P<0.05),AHI、微觉醒指数、BMI、睡眠效率等未进入回归方程,而BDI评分则与氧减事件时间/小时和微觉醒指数正相关(P<0.05)。结论重叠综合征患者与单纯的COPD患者和OSAHS患者相比,睡眠相关的缺氧程度更严重,因夜间缺氧而引起健康等相关生活质量情况更差,抑郁程度更重。     

β2肾上腺素受体多肽16位基因型与夜间哮喘表现型的关系

目的探讨β2肾上腺素受体(β2AR)16、27位基因多态性与夜间哮喘表现型的关系.方法以最大呼气流速(PEFR)为标准,将49例哮喘患者分为夜间哮喘组(25例)和非夜间哮喘组(24例).用PCR产物直接测序确定β2AR 16、27位基因型分布,以及分析两个位点各种基因型与两组病例PEFR、第一秒用力呼气量(FEV1)以及用药情况之间的关系.结果以PEFR为标准,夜间哮喘组PEFR在夜间平均下降33.6%,非夜间哮喘组下降7.0%,二者差异显著(P<0.001).夜间哮喘组和非夜间哮喘组(白天)基础FEV1分别为73.7 %和85.8 %,也具有显著性差异(P<0.001).Gly16的等位基因频率在夜间哮喘组56.0%明显较非夜间哮喘组22.9%高(P<0.05),Gly16集中分布于夜间哮喘组.27位点的多态性在两组间无显著性差异.结论β2 AR Gly16基因型与夜间哮喘可能有关系.     

双水平气道正压通气对重叠综合征患者心肺功能及睡眠质量的影响

目的探讨双水平气道正压通气对重叠综合征患者心肺功能以及睡眠质量的影响。方法选择32例患者（观察组）使用双水平气道正压通气（BiPAP）治疗,并与31例（对照组）使用持续正压通气（CPAP）治疗的患者比较,观察治疗后患者心肺功能、血气分析的变化,并评价患者睡眠质量的改善情况,探讨两种治疗方法对患者的影响。结果治疗后观察组FEV1、FEV1／FVC以及FVC均显著较高于对照组（P〈0．05）;观察组脑钠肽水平恢复正常。且显著低于对照组（P〈0．05）;观察组pH、PaO2、PaCO2以及Sp02值均基本恢复正常,且治疗效果显著优于对照组（P〈0．05）;观察组的最长呼吸暂停时间显著短于对照组（P〈0．05）,且睡眠紊乱指数和呼吸暂停指数均恢复正常,显著优于对照组（P〈0．05）。结论BiPAP能有效改善患者的心肺功能和睡眠质量,是治疗重叠综合征的首选无创呼吸机治疗方法。     

硫酸沙丁胺醇气雾剂吸入与茶碱控释片治疗急性老年哮喘的疗效对比分析

目的：探究硫酸沙丁胺醇气雾剂吸入与茶碱控释片治疗急性老年哮喘的疗效对比。方法方便选取该院2013年1月—2016年1月收治患急性老年哮喘患者78例作为研究对象,随机分为吸入组和口服组,每组39例。吸入组给予硫酸沙丁胺醇气雾剂吸入治疗,联合组给予硫酸沙丁胺醇气雾剂联合茶碱控释片治疗,观察两组患者治疗后肺功能水平、动脉血气分析、不良反应及治疗效果。结果联合组FEV1/FVC、FEV1%、Pa2O2、PaCO2均优于吸入组,联合组总有效率为94.87%明显高于吸入组82.05%,证明联合组较吸入组治疗显著,组间对比显示P<0.05。结论硫酸沙丁胺醇气雾剂联合茶碱控释片可有效缓解老年急性哮喘的动脉血气及肺部功能,降低老年患者呼吸困难所感到的痛苦感,提升自身生活质量,并提升临床治疗效果,值得广大呼吸科医师积极推广应用。     

醒脑开窍针法结合项八针对脑卒中后睡眠倒错患者夜间睡眠的影响

目的 观察醒脑开窍针法结合项八针对卒中后睡眠倒错患者夜间睡眠情况的改善,以评价其临床疗效。方法选取我院2017年9月至2019年12月门诊及住院的120例卒中后睡眠倒错患者,采用随机数字表法分为治疗组和对照组,每组各60例。治疗组采用单纯醒脑开窍针法结合项八针治疗,对照组采用单纯口服艾司唑仑片治疗。两组患者治疗前后均予匹兹堡睡眠质量指数(PSQI)评估,行多导睡眠图(PSG)监测,对患者治疗前后的睡眠结构及睡眠进程进行评估。结果 ①两组治疗后的PSQI评分低于治疗前,差异有统计学意义(P0.05);治疗组治疗后PSQI评分低于对照组,差异有统计学意义(P0.05)。②两组治疗后的S1%低于治疗前,S3%+S4%和REM%高于治疗前,差异有统计学意义(P0.05),治疗组治疗后S1%低于对照组,S3%+S4%和REM%高于对照组,差异有统计学意义(P0.05)。③两组治疗后的总睡眠时间长于治疗前,睡眠潜伏期短于治疗前,觉醒次数少于治疗前,睡眠效率高于治疗前,差异有统计学意义(P0.05);两组治疗后以上指标比较,差异无统计学意义(P0.05)。结论 醒脑开窍针法结合项八针治疗卒中后睡眠倒错,在改善患者夜间睡眠情况方面优于口服艾司唑仑治疗,该疗法的优势可能在于通过降低患者的浅睡眠比,提高深睡眠比,从而起到改善患者整体睡眠质量的作用。     

Nocturnal negative pressure ventilation

In this study, 25 patients between the ages of 12 and 24 years who had neuromuscular diseases, a vital capacity less than 50 percent of predicted, and a history suggestive of nocturnal hypoventilation were observed with overnight monitoring of end-tidal CO2 (EtCO2) and O2 saturation (SaO2). Those patients with a strong clinical history and evidence of nocturnal hypoventilation (increased EtCO2 of 50 to 70 torr and decreased SaO2 [less than 90 percent]) (10 patients) were placed on nocturnal negative pressure ventilation (NNPV). Admission, treatment, and posttreatment arterial blood gases were analyzed by paired statistical "t" tests. Comparison of mean PaO2 values obtained on admission with those obtained during treatment revealed a greater than 97.5 percent confidence (p = 0.025; n = 7). Mean PaO2 values obtained after treatment (off negative pressure ventilation [NPV], awake during daytime) were 65.9 +/- 18.2 mmHg and 79.0 + 14.5 mmHg, respectively (p = 0.005; n = 6). Comparison of post-treatment PaO2 values as a percentage of admission (pretest) values showed a significant change at the 0.5 percent level with an applied Wilcoxan Signed-ranks Matched-pairs Test. The mean PaCO2 values obtained upon admission and those obtained during treatment were 53.7 +/- 15.1 mmHg and 48.1 +/- 14.2 mmHg, respectively (p = 0.05; n = 7), and comparison mean PaCO2 values obtained upon admission and after treatment were 57.9 +/- 16.0 mmHg and 51.2 +/- 7.0 mmHg, respectively (p = 0.1; n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)     

Bronchoalveolar mast cells in extrinsic asthma: a mechanism for the initiation of antigen specific bronchoconstriction

Bronchoalveolar lavage performed in 10 patients with extrinsic asthma and 14 controls yielded similar recoveries of fluid and cells. Mast cells and eosinophils, however, formed a greater proportion of the cells recovered from the asthmatic subjects (p less than 0.001 for mast cells; p less than 0.01 for eosinophils), the histamine content of the lavage cells being correspondingly increased (p less than 0.01). Both the percentage of mast cells and the histamine content of lavage cells were significantly inversely correlated with the forced expiratory volume in one second (FEV1; expressed as percentage of predicted) and with the ratio of FEV1 to forced vital capacity before lavage. There was also a significant inverse correlation between the concentration of histamine required to produce a 20% fall in FEV1 and the percentage of mast cells recovered (p less than 0.05). When incubated with antihuman IgE bronchoalveolar mast cells from asthmatic subjects released a significantly increased proportion of total cellular histamine than cells from control subjects at all effective doses of anti-IgE. By contrast, dose response curves for IgE dependent histamine release from peripheral blood leucocytes were similar in asthmatics and controls. Specific antigen led to release of histamine from bronchoalveolar cells and peripheral blood leucocytes of asthmatic subjects but not controls. Lying superficially within the airways, bronchoalveolar mast cells would be readily exposed to inhaled antigen and would release mediators directly on to the airway surface. Their immunological response suggests that they are likely to be important in the pathogenesis of airflow obstruction in asthma.     

The effect of desmopressin on nocturnal polyuria, overnight weight loss, and morning postural hypotension in patients with autonomic failure

Day and night urine volume, morning and evening body weight, and supine and sitting blood pressure were measured in five patients with chronic autonomic failure who were not receiving treatment with drugs. All had nocturnal polyuria, overnight weight loss, and a pronounced postural fall in blood pressure, with lowest levels in the morning. Desmopressin (2-4 micrograms given intramuscularly at 8 pm) reduced nocturnal polyuria, diminished overnight weight loss, raised supine blood pressure, and reduced the postural fall, especially in the morning, when patients were often at their worst. Desmopressin may be a useful alternative to, or may supplement, other forms of treatment in some patients with autonomic failure.     

高原地区茶碱联合舒利迭在COPD中的应用研究

目的：观察沙美特罗/丙酸氟替卡松（舒利迭）联合茶碱治疗高海拔地区（平均海拔2 295m）慢性阻塞性肺疾病（COPD）的临床疗效。方法：选取80例COPD患者作为研究对象,随机分成对照组和研究组各40例,两组患者口服茶碱缓释胶囊0.2 g,2次/日。研究组加用舒利迭（沙美特罗替卡松50mg/250mg）,2次/日,治疗前后分别对两组进行肺功能、血气分析、呼吸困难评分进行分析。结果：经过12周治疗后,研究组血气中PaO2含量明显高于对照组,血气中PaCO2明显低于对照组,血气中SaO2高于对照组,差异均有统计学意义（P〈0.05）。研究组肺功能指标FVC、FEV1、FEV1/FVC%均高于对照组,研究组的呼吸困难评分下降值是（0.73±0.58）分,对照组是（0.35±0.62）分,差异有统计学意义（P〈0.05）。结论：沙美特罗/丙酸氟替卡松联合茶碱缓释胶囊治疗COPD能有效减轻患者的临床症状,改善血气及肺功能,安全可靠,具有重要的临床应用价值。     

Correlation between manifestations of digoxin toxicity and serum digoxin, calcium, potassium, and magnesium concentrations and arterial pH

In 18 patients with gastrointestinal manifestations of digoxin toxicity the mean serum digoxin concentration (+/- SEM) was 3.16 micrograms/l (+/- 0.25), the calcium to potassium ratio 0.31 (+/- 0.01), and the mean arterial pH 7.406 (+/- 0.017). In contrast 19 patients with digoxin induced automaticity had a mean serum digoxin concentration of 1.24 micrograms/l (+/- 0.15; p less than 0.001), a calcium to potassium ratio of 0.38 (+/- 0.01; p less than 0.01), and an arterial pH of 7.498 (+/- 0.008; p less than 0.001). Eight out of 13 patients with digoxin induced cardiotoxicity had serum concentrations of the drug within the therapeutic range (0.8-2.0 micrograms/l). The calcium to potassium ratio, however, was lower than in the patients with automaticity (0.31 +/- 0.02; p less than 0.01) and the arterial pH was 7.370 (+/- 0.033; p less than 0.05). Serum magnesium concentrations were similar in all groups. In this study patients with digoxin induced gastrointestinal symptoms had high serum concentrations of the drug, whereas those with drug induced automaticity had therapeutic concentrations. This second group, however, was identified by their higher calcium to potassium ratios and higher pH values.