大株红景天注射液治疗AECOPD疗效观察

目的观察大株红景天注射液治疗AECOPD的临床疗效。方法 80例AECOPD患者,随机分为对照组和治疗组;对照组给基础治疗(吸氧、化痰、抗炎、解痉平喘、增强免疫力及必要时机械通气治疗),治疗组在对照组基础上加用大株红景天注射液。观察两组治疗前、后7天的动脉血气分析、临床症状;治疗前、后14天的肺功能、急性生理和慢性健康状态评价系统II评分(APACHEⅡ)、住院时间。结果治疗组比较对照组在:肺功能、血气分析结果、临床症状、APACHEⅡ评分方面恢复快;平均住院时间减少,P0.05。结论大株红景天注射液治疗AECOPD能明显改善病情,缩短住院时间。     

参芎葡萄糖注射液治疗老年性高血压肾病的疗效观察

目的：观察参芎葡萄糖注射液对老年性高血压。肾病的临床疗效。方法：60例老年性高血压肾病患者被随机分成治疗组（32例）和对照组（28例），对照组予以常规口服降压药控制血压，治疗组在对照组基础上给予参芎葡萄糖注射液200ml静脉滴注，每日1次，共4周。观察两组治疗前后及组间相关指标的变化。结果：治疗组患者24h尿蛋白（UP／24h）、尿β2-微球蛋白（β1-MG）、血尿素氮（BUN）、血肌酐（Ser）、血浆粘度（PV）、红细胞压积（HCT）、血浆凝血酶时间（TT）水平较治疗前明显下降（P〈0．01），且与对照组治疗后比较，亦有显著降低（P〈0．05～〈0．01），无不良反应发生。结论：参芎葡萄糖注射液治疗老年性高血压肾病，除了可以降低尿蛋白、尿素氮及肌酐水平外，还具有降低血液粘度、纠正血液高凝状态的作用，能有效保护肾功能及延缓肾功能恶化。     

参芎葡萄糖注射液治疗急性脑梗死的疗效观察

目的观察参芎葡萄糖注射液治疗急性脑梗死的临床疗效。方法选择我院2010—2012年收治的急性脑梗死患者64例,随机分为对照组和治疗组,每组32例。两组患者入院后均给予常规治疗,对照组患者在常规治疗基础上给予复方丹参注射液,治疗组患者在常规治疗基础上给予参芎葡萄糖注射液;两组患者均连续治疗21 d。观察两组患者临床疗效、治疗前后血液流变学指标及不良反应情况。结果治疗组患者总有效率为93.75%,高于对照组的78.12%(P0.05)。两组患者治疗前全血高切黏度、全血低切黏度、血细胞比容、血小板聚集率、纤维蛋白原比较,差异均无统计学意义(P0.05);治疗组患者治疗后全血高切黏度、全血低切黏度、血细胞比容、血小板聚集率、纤维蛋白原均低于对照组(P0.05)。两组患者治疗期间均未出现明显血压、血糖、血脂、血尿常规、肝肾功能异常。结论参芎葡萄糖注射液治疗急性脑梗死安全有效,可改善患者神经功能缺损情况及血液流变学指标,值得临床推广应用。     

参芎葡萄糖注射液治疗特发性肺间质纤维化的疗效观察

目的探讨参芎葡萄糖对特发性肺间质纤维化患者的疗效。方法采用随机对照研究特发性肺间质纤维化患者,参芎葡萄糖组使用参芎葡萄糖注射液,对照组使用葡萄糖注射液,总观察三个疗程,治疗前后观察临床表现,检查肺功能、肺CT。结果第一、二个疗程后,参芎葡萄糖组和对照组FEV1、FVC及DLco较治疗前无明显改善。第三个疗程后,参芎葡萄糖组FEV1、FVC平均分别增加了18 mL、40 mL,但差异不显著（P〉0.05）,DLco平均增加了20 mL/m in/mmHg,差异显著（P〈0.05）;对照组FEV1、FVC及DLco平均分别增加了2 mL、10 mL、1.1 mL/m in/mmHg,无显著差异（P〉0.05）。参芎葡萄糖组总有效率76.9%,而对照组5.6%,差异显著（P〈0.05）。肺CT改善率,参芎葡萄糖组总有效率66.7%,对照组为0,差异显著（P〈0.05）。结论参芎葡萄糖对特发性肺间质纤维化有较好的临床价值,可改善患者的临床表现及肺弥散功能,而对肺通气功能无显著影响。     

大株红景天注射液治疗 AECOPD 疗效观察简

目的 观察大株红景天注射液治疗AECOPD的临床疗效.方法 80例AECOPD患者,随机分为对照组和治疗组;对照组给基础治疗（吸氧、化痰、抗炎、解痉平喘、增强免疫力及必要时机械通气治疗）,治疗组在对照组基础上加用大株红景天注射液.观察两组治疗前、后7天的动脉血气分析、临床症状;治疗前、后14天的肺功能、急性生理和慢性健康状态评价系统II评分（APACHE Ⅱ）、住院时间.结果治疗组比较对照组在：肺功能、血气分析结果、临床症状、APACHE Ⅱ评分方面恢复快;平均住院时间减少,P〈 0.05.结论 大株红景天注射液治疗AECOPD能明显改善病情,缩短住院时间.     

参芎葡萄糖注射液治疗糖尿病冠心病50例疗效观察

选择100例患者,随机分为观察组与对照组,每组50例,观察组给予参芎葡萄糖注射液(贵州益佰注射剂有限公司)200ml静滴(每100ml加2u胰岛素),每天1次,硝酸甘油10mg静滴,1次/d;对照组以硝酸甘油10mg静滴,1次/d。两组均以15d为1个疗程,观察治疗前后心输出量(CO)、心脏指数(CI)、射血分数(EF)等数据的变化,ST段压低总次数、总时间的改变,心电图及血液流变学指标。结果 观察组CO、CI、EF等数据显著增加,ST段压低总次数、总时间均较治疗前显著减少,临床症状记分明显缩少,心电图改善,血液流变学明显改善。对照组无明显变化。两组比较差异显著P<0.05。结论 参芎葡萄糖注射液能改善糖尿病合并冠心病的血液流变学及心电图参数,从而对糖尿病合并冠心病有较好的预防治疗作用。     

乙酰半胱氨酸泡腾片治疗AECOPD的疗效观察

目的观察乙酰半胱氨酸泡腾片辅助治疗慢性阻塞性肺疾病急性加重期的疗效。方法将所选患者分为治疗组和对照组,治疗组46例,对照组44组。治疗组在常规治疗基础上加服乙酰半胱氨酸泡腾片,每次600 mg,每日两次,共十天。对照组给予抗感染应用β受体激动剂,糖皮质激素,茶碱类,甘草片等常规治疗。结果治疗组和对照组有效率分别为93.5%,77.3%。两组疗效差异有统计学意义(P<0.05)。结论乙酰半胱氨酸泡腾片能明显改善慢性阻塞性肺疾病急性加重期患者的临床症状,缩短疗程,改善预后。     

参芎葡萄糖注射液治疗椎-基底动脉供血不足疗效观察

目的观察参芎葡萄糖注射液治疗椎-基底动脉供血不足(VBI)性眩晕的疗效。方法选择VBI患者72例,按照随机数字表法分为试验组35例,对照组37例,试验组采用参芎葡萄糖注射液,对照组采用尼群地平。检测下列指标:(1)临床疗效改变和眩晕等主要临床症状和体征的变化;(2)血液流变学的全血黏度;(3)血浆黏度经颅多普勒(TCD)检测椎动脉和基底动脉的平均峰血流速度(Vm),动脉搏动指数(PI)等指标。结果治疗组临床治愈13例,有效10例,好转8例,无效4例,对照组治愈7例,有效7例,好转13例,无效10例,两组疗效有非常显著性差异(P<0.01)。TCD检测结果显示,治疗前两组Vm和PI均有提高,治疗组改善的程度比对照组明显(P<0.05)。结论参芎葡萄糖疗效确切,是一种治疗VBI性眩晕行之有效的治疗方法。     

分析前列地尔和参芎葡萄糖注射液治疗冠心病心力衰竭的临床疗效

目的探讨前列地尔和参芎葡萄糖注射液对冠心病心力衰竭患者的临床治疗效果,为冠心病心力衰竭患者的临床治疗提供参考。方法回顾性总结分析我院在2010年7月至2013年7月期间收治的360例冠心病心力衰竭患者的临床病例资料,将上述患者随机分为两组,观察组患者采用前列地尔和参芎葡萄糖注射液进行治疗,对照组患者采用硝酸甘油进行治疗,比较两组患者的临床治疗效果。结果观察组患者治疗前射血分数为(43.62±11.23)%,治疗后射血分数为(65.61±12.29)%;对照组患者治疗前射血分数为(44.69±10.73)%,治疗后射血分数为(56.72±10.27)%。两组患者治疗后射血分数显著高于治疗前,差异具有统计学意义(P0.05),观察组患者治疗后射血分数高于对照组,差异具有统计学意义(P0.05)。观察组患者治疗显效133例,有效47例,对照组患者治疗显效130例,有效50例,两组患者治疗有效率均为100%,差异无统计学意义(P0.05)。结论前列地尔联合参芎葡萄糖注射液能够避免硝酸甘油治疗对患者引起的心悸、头痛等不良反应,临床应用患者耐受性好,治疗效果确切,具有临床推广应用价值。     

参芎葡萄糖注射液对急性冠脉综合征疗效及炎症反应的影响

近年来,我们采用参芎葡萄糖注射液治疗急性冠脉综合征(ACS),并观察了其临床疗效和对炎症反应的影响.现报告如下. 临床资料:选择2007年8～12月收入我科住院的68例ACS患者,符合美国心脏病学会ACS诊断标准.排除以下疾病患者:未控制的高血压、糖尿病,感染性疾病,甲状腺疾病,风湿性疾病,严重心功能不全,肝肾疾病,恶性肿瘤.     

Efficacy of Low Molecular Weight Heparin in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Receiving Ventilatory Support

Introduction: Severe and acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with a high mortality. Since COPD is an airway inflammatory disease, and heparin has shown anti-inflammatory effects in previous studies, we evaluated the clinical effect of low molecular weight heparin (LMWH; nadroparin) in COPD patients admitted into the hospital due to acute exacerbations. Methods: Sixty-six patients admitted to the intensive care unit (ICU) were randomly divided into control group (n = 33) and LMWH group (n = 33). The control group received conventional treatment, including oxygen therapy (non-invasive or conventional mechanical ventilation), anti-infection, atomization expectorant, spasmolysis, anti-asthmatics, and nutritional support. The LMWH group received the same treatment plus LMWH for 1 week. The levels of plasma C-reactive protein, interleukin-6, and fibrinogen were measured. The main outcomes were duration of mechanical ventilation, length of ICU stay, and hospital stay. Results: There were no significant differences between the groups with respect to demographics, severity of illness, and gas exchange variables. The levels of plasma C-reactive protein, interleukin-6, and fibrinogen were significantly decreased in the LMWH group. LMWH significantly reduced the mean duration of mechanical ventilation (6.6 days vs. 3.8 days; p < 0.01), the length of ICU stay (8.5 days vs. 5.6 days; p < 0.01) and hospital stay (14.3 days vs. 11.3 days; p < 0.01). Conclusions: The addition of LMWH to standard therapy benefits COPD patients with acute exacerbation.     

强化血糖控制对慢性阻塞性肺疾病急性加重期合并高血糖肺功能的影响

目的：观察强化血糖控制对慢性阻塞性肺疾病急性加重期合并高血糖肺功能的影响,为慢性阻塞性肺疾病急性加重期合并高血糖的治疗提供理论依据和实践指导。方法：采用同期、平行、随机对照试验的方法对研究对象的肺功能进行分析。结果：治疗后两组的肺功能均有明显改善,第14d后实验组FEV1／FVC及FEV1实测／预计值较对照组比较有统计学差异,P〈0．05。结论：强化血糖控制利于患者肺功能恢复,改善患者生活质量。     

Factors Associated with Frequency of Emergency Department Visits for Chronic Obstructive Pulmonary Disease Exacerbation

Background Little is known about the factors associated with frequency of emergency department visits (FEDV) in chronic obstructive pulmonary disease (COPD) patients with recurrent exacerbations. Objective To characterize the use of emergency department (ED) services in patients with COPD exacerbation and identify factors associated with FEDV. Design A prospective, multicenter cohort study. Patients Three hundred eighty-eight patients were included. Fifty-two percent were women and the median age was 69 years (interquartile range 62–76). Measurements Using a standard questionnaire, consecutive ED patients with COPD exacerbation were interviewed. The number of ED visits in the previous year was retrospectively collected. Results Over the past year, this cohort reported a total of 1,090 ED visits because of COPD exacerbation. Thirteen percent of COPD patients had 6 or more ED visits, accounting for 57% of the total ED visits in the past year. Multivariate analysis showed that patients with an increased FEDV were more likely to be Hispanic (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.16–3.33), to have more severe COPD as determined by previous hospitalizations (IRR 2.06, 95% CI 1.51–2.82), prior intubations (IRR 1.49, 95% CI 1.02–2.18), prior use of systemic corticosteroids (IRR 1.57, 95% CI 1.16–2.13) and methylxanthine (IRR 1.48, 95% CI 1.04–2.12), and less likely to have a primary care provider (IRR 0.51, 95% CI 0.31–0.82). Conclusions Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation. Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations.     

Influence of Left Ventricular Hypertrophy on In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Left ventricular hypertrophy (LVH) is associated with worse outcomes in chronic obstructive pulmonary disease (COPD); however, its role in an acute exacerbation of COPD (AECOPD) has not been reported. This was a retrospective cohort study during 2008–2012 at an academic medical center. AECOPD patients >18 years with available echocardiographic data were included. LVH was defined as LV mass index (LVMI) >95 g/m² (women) and >115g/m² (men). Relative wall thickness was used to classify LVH as concentric (>0.42) or eccentric (<0.42). Outcomes included need for and duration of non-invasive ventilation (NIV) and mechanical ventilation (MV), NIV failure, intensive care unit (ICU) and total length of stay (LOS), and in-hospital mortality. Two-tailed p < 0.05 was considered statistically significant. Of 802 patients with AECOPD, 615 patients with 264 (42.9%) having LVH were included. The LVH cohort had higher LVMI (141.1 ± 39.4 g/m² vs. 79.7 ± 19.1 g/m²; p < 0.001) and lower LV ejection fraction (44.5±21.9% vs. 50.0±21.6%; p ≤ 0.001). The LVH cohort had statistically non-significant longer ICU LOS, and higher NIV and MV use and duration. Of the 264 LVH patients, concentric LVH (198; 75.0%) was predictive of greater NIV use [82 (41.4%) vs. 16 (24.2%), p = 0.01] and duration (1.0 ± 1.9 vs. 0.6 ± 1.4 days, p = 0.01) compared to eccentric LVH. Concentric LVH remained independently associated with NIV use and duration. In-hospital outcomes in patients with AECOPD were comparable in patients with and without LVH. Patients with concentric LVH had higher NIV need and duration in comparison to eccentric LVH.     

背部腧穴药物注射治疗慢性阻塞性肺疾病急性加重期患者的临床疗效研究

目的探讨背部腧穴药物注射治疗慢性阻塞性肺疾病急性加重期患者的临床疗效。方法选取我院2008—2012年收治的慢性阻塞性肺疾病急性加重期患者360例,随机分为A、B、C 3组,每组120例。3组患者入院后均进行常规治疗,A组患者给予决明茶碱、薯芋皂甙、莨菪碱溶液2 ml背部腧穴注射,B组患者给予决明茶碱、薯芋皂甙、莨菪碱溶液2 ml肌肉注射,C组患者给予二丙茶碱0.5 g+甲泼尼龙40 mg+0.9%氯化钠溶液250 ml静脉滴注。观察3组患者起效时间、临床疗效、治疗前及治疗30 min后肺功能。结果 A组患者起效时间为5~15 min,B组为30~45 min,C组为20~30 min。A组患者总有效率为97.5%,B组为56.7%,C组为93.3%,A、C组患者总有效率均高于B组(P0.05),而A组与C组总有效率比较,差异无统计学意义(P0.05)。3组患者治疗前用力肺活量(FVC)、用力呼气量(FEV)及最大呼气中期流量(MMEF)比较,差异均无统计学意义(P0.05);治疗后,A组患者FVC、FEV、MMEF大于B组(P0.05),而A组与C组、B组与C组FVC、FEV、MMEF比较,差异均无统计学意义(P0.05)。结论背部腧穴药物注射治疗慢性阻塞性肺疾病急性加重期患者起效快,作用迅速,可有效改善其肺功能,缓解其临床症状,临床疗效较好,安全性较高。     

Predictors of Outcome After Exacerbation of Chronic Obstructive Pulmonary Disease

BACKGROUND  The outcome after hospitalization for an exacerbation of chronic obstructive pulmonary disease (COPD) is unfavorable and uncertainty exists about factors predicting short and long-term prognosis. OBJECTIVE  To identify clinical predictors of length of hospital stay (LOS) and three-year mortality after COPD exacerbations requiring hospitalization. DESIGN  Retrospective analysis of prospectively collected data. PARTICIPANTS AND METHODS  All consecutive patients hospitalized with COPD exacerbation were enrolled. Disease severity was estimated by FEV_1, body mass index (BMI), Medical Research Council (MRC) chronic dyspnoea scale, previous hospitalizations, need for long-term oxygen treatment (LTOT), arterial oxygen and carbon dioxide partial pressures (PaO₂ and PaCO₂), pH and respiratory rate. Outcome was assessed by LOS and three-year mortality. MAIN RESULTS  Out of 81 patients enrolled, three-year mortality data were available for 61. LOS was related to BMI, MRC scale and respiratory rate. Three-year mortality was related to FEV₁, BMI, MRC scale, LTOT, and PaCO₂. Multiple logistic regression analysis demonstrated that MRC scale was the only independent determinant of LOS, [p = 0.001, odds ratio (OR) 7.67 (95% CI 2.50–23.41)], whereas MRC scale and BMI predicted three-year mortality, [p = 0.001, OR 8.28 (95% CI 2.25–30.47) and p = 0.006, OR 6.91 (95% CI 1.74–27.48), respectively]. Cox regression analysis demonstrated identical results. Using receiver-operator-optimized thresholds for these variables (MRC > 2 and BMI < 25 kg/m²), we propose a prediction model that accurately determines three-year mortality risk. CONCLUSIONS  In this study, MRC scale and BMI predicted outcome after COPD hospitalization. Pending further validation, this predictive model may contribute to identify patients with poor outcome even when spirometric data are unavailable.     

老年AECOPD患者合并急性心肌梗死临床观察

目的 探讨老年慢性阻塞性肺病急性加重期（AECOPD）合并急性心肌梗死（AMI）的临床特点,以减少误诊及漏诊.方法对老年AECOPD合并AMI（A组）22例患者的临床表现、实验室检查、心电图进行回顾性分析,与同期收治的单纯老年AECOPD（B组）164例患者进行比较.结果 两组均有咳嗽、咳痰、气喘;A组突然出现胸闷、呼吸困难加重的发生率显著高于B组（100%比3.7%,P〈0.01）,多伴有冷汗（81.8%比0,P〈0.01）、晕厥（22.7%比0,P〈0.01）、消化道症状（36.4%比10.4%,P〈0.01）和低血压（18.2%比3.7%,P〈0.05）;A组动脉氧分压/氧浓度（PaO2/FiO2）显著低于B组（313.52±126.68比361.86±120.82,P〈0.05）.结论老年AECOPD患者突然出现胸闷和呼吸困难加重、冷汗、晕厥、低血压,应警惕合并AMI,追踪心电图及心肌酶谱动态变化有助诊断.     

布地奈德联合特布他林雾化吸入治疗慢性阻塞性肺疾病急性加重期的疗效研究

目的探讨布地奈德(普米克令舒)联合特布他林(博利康尼)雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效。方法选取我院2010年1月—2013年6月住院的AECOPD患者60例,将其随机分为观察组和对照组,各30例。在常规治疗基础上观察组用普米克令舒+博利康尼混合后雾化吸入,对照组用0.9%氯化钠溶液+庆大霉素注射液+α-糜蛋白酶+地塞米松雾化吸入,均治疗10 d。治疗前后对两组患者进行肺功能检查及动脉血气分析。结果治疗后,观察组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC均高于对照组(P0.05);喘息缓解时间、咳嗽消失时间及哮鸣音基本消失时间均短于对照组(P0.05);PaO2高于对照组,PaCO2低于对照组(P0.05)。结论普米克令舒与博利康尼联合使用能明显改善AECOPD患者肺功能、血气指标及临床症状,且安全性高,可作为AECOPD的常规治疗方法。     

Streptococcus Pneumoniae Urinary Antigen Test and Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract

Background : Streptococcus pneumoniae is one of the most common bacteria identified in sputum obtained from subjects with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Purpose : To examine the urinary pneumococcal antigen test in subjects admitted with AECOPD and subjects with COPD, and to evaluate its relationship with AECOPD. Methods: Urine samples from 82 subjects with AECOPD involved in 122 consecutive hospitalizations were tested. Additionally, 196 consecutive subjects with stable COPD were tested a total of 607 times at intervals greater than 6 months. Results: Pneumococcal antigen was positive in 14 (17.1%) out of all 82 subjects first hospitalized with AECOPD. It was positive in 7 (20.6%) out of the 34 subjects with pneumonic exacerbations of COPD, and in 7 (14.6%) out of the 48 subjects with non-pneumonic exacerbations of COPD. Two subjects with non-pneumonic S. pneumoniae-related AECOPD were identified, and they both tested positive. A total of 607 urinary antigen tests were performed on stable COPD subjects, and 16 (2.6%) specimens were positive. Colonization by S. pneumoniae was found in the sputum of only 25% of the COPD subjects with positive urinary pneumococcal antigen test results. Conclusion: The results of the pneumococcal urinary antigen test were similar for AECOPD subjects with and without pneumonia. This test may be a useful method for preventing the under-diagnosis of S. pneumoniae-related exacerbations of COPD. The detection of pneumococcal antigen in the urine is not related to the persistent colonization of the respiratory mucosa by S. pneumoniae.