肺切除及肺减容术治疗肺癌合并中、重度COPD的肺功能变化与处理

1998年1月至2004年3月，我们对22例肺癌合并中、重度慢性阻塞性肺疾病(COPD)患者进行了肺切除及肺减容术，围术期施行了全面监护和治疗，着重于观察肺功能变化并作相应处理。现报告如下。     

肺减容术治疗肺气肿患者的围手术期护理

肺气肿是慢性阻塞性肺疾病 (COPD)晚期最常见 ,最严重的并发症之一 ,既往的治疗方法主要是内科平喘和吸氧等治疗 ,但疗效欠佳 [1 ] 。肺减容术 (L VRS)是通过切除被破坏的肺组织 ,减少生理无效腔和肺动静脉分流 ,减少肺残气量 ,减轻肺阻力 ,改善肺通气和血流 ,增加肺的弹性回缩力 ,从而增加气体流动和减少肺过度膨胀 [2 ] ,以改善临床症状 ,提高生活质量。 1999年来我院先后施行 12例肺减容术治疗慢性阻塞性肺气肿 ,现将其围手术期护理报告如下 :1　临床资料本组 12例均为男性 ,年龄 6 5 - 72岁 ,术前诊断为慢性支气管炎并慢性阻塞性肺…     

老年人COPD合并自发性气胸81例临床分析

本文回顾1980年1月～1999年1月门诊和住院病人的自发性气胸(简称气胸)250例临床资料进行分析。为探讨老年人慢性阻塞性肺部疾病(Chro-nic obstructive pulmonary disease,COPD)并发气胸的特点,对其中老年人COPD与同期125例非老年组气胸患者的诊治情况进行分析对比如下。 临床资料 一、一般资料:205例患者中,男176例,女30例,年龄16岁～82岁。闭合性气胸80例,张力性气胸56例,交通性气胸70例。单侧气胸195例,双侧气胸11例。其中老年组81例,男65例,女16例,年龄60岁～81岁,平均67.6岁。非老年组125例,男     

单侧肺减容术治疗慢性阻塞性肺疾病的疗效评价

目的　评价单侧肺减容术 (LVRS)治疗慢性阻塞性肺疾病 (COPD)的疗效、手术适应证和禁忌证 ,总结手术操作要点。方法　回顾性分析中日友好医院胸外科在 1998年 1月～ 2 0 0 2年 12月间进行单侧LVRS的COPD患者 (2 5例 )的随访资料。术前利用CT和核素肺通气灌注扫描确定“靶区”。 2 5例患者中 4例行标准后外侧切口手术 ,2 1例行胸腔镜或胸腔镜辅助小切口手术 ;直线切割缝合器 (Linerstapler)或胸腔镜专用缝切器 (EndoGIA)加牛心包垫切除过度充气破坏的肺组织。比较术前、术后 1年、术后 2年的呼吸困难程度、肺功能及生活质量等指标的变化 ,以评价单侧LVRS的有效性。结果　单侧LVRS后一秒钟用力呼气容积 (FEV1)平均提高 (35± 9) % ;6分钟步行距离(6MWD)平均提高 (88± 2 2 ) % ;呼吸困难指数再分级 ,16例术前Ⅳ级中 4例转为Ⅰ级 ,12例转为Ⅱ级 ;9例术前Ⅴ级中 1例转为Ⅰ级 ,1例转为Ⅱ级 ,4例转为Ⅲ级 ,3例转为Ⅳ级。Karnofsky评分平均提高 (4 4± 10 )分。本组 1年、2年生存率分别为 96 %、92 % ,无手术死亡 ,术后并发症发生率为 32 %。结论　单侧LVRS可以改善具备手术指征的COPD患者的临床症状 ,且手术病死率低。尽量切除术侧无功能肺组织 ,防止肺漏气为手术要点 ,术前、术后呼吸功能锻炼有助于患者术后     

肺移植术后移植肺自发性气胸1例

2004年7月26日，我们为1例终末期肺气肿患者成功实施了右单肺移植，同期左肺减容术，取得了满意的效果，术后14月移植肺合并自发性气胸，现报道如下。     

肺减容术的临床应用及进展

肺减容术 (ｌｕｎｇｖｏｌｕｍｅｒｅｄｕｃｔｉｏｎｓｕｒｇｅｒｙ ,ＬＶＲＳ)是治疗内科疗效不佳的部分重度肺气肿的有效方法。多年前 ,在病例选择、术后肺功能改善的机理及手术技术等方面存在不少问题。现在 ,这些问题大多已解决 ,对手术适应证、禁忌证、手术方法及并发症预防等已有较一致的看法 ,主要未解决的问题是手术后功能改善的效果能持续多久 ?本文就以上问题综合文献作一介绍。一、病例选择[1]ＬＶＲＳ手术适应证 :(1)诊断为重度肺气肿 ,经积极内科治疗 ,症状进行性加重 ;(2 )气急指数 (ｄｙｓｐｎｅａｉｎｄｅｘ) 3～ 4级 ;(3)…     

终末肺气肿同期行单肺移植和对侧肺减容术的围术期护理

对肺移植患者围手术期实施全程、系统的护理。认为良好的围手术期护理是肺移植成功的关键因素之一。通过该例肺移植术积累了该类手术的护理经验,为进一步开展肺移植工作打下基础。     

肺减容术37例临床分析

目的对临床肺减容术效果进行探究。方法针对在我院肺减容术37例患者的预后研究分析。结果本组37例患者均治愈出院,无一例死亡。术后所有患者呼吸困难的症状得到明显改善,FEV1和动脉血氧饱和度均有所增加,高碳酸血症也有明显的改善。术后15例患者出现肺漏气,占40.5%;3例发生对侧气胸,占8%,经胸腔闭式引流后痊愈;7例肺部感染,占18.9%,经大量抗生素治疗后痊愈。结论 LRVS有良好的近期疗效,能明显改善患者的呼吸功能和生活质量,为广大重症COPD带来了福音。     

老年COPD患者并发自发性气胸89例临床分析

目的探讨老年慢性阻塞性肺疾病(COPD)并发自发性气胸的特点及诊疗方法。方法对2000年至2004年我科收治的继发于老年COPD的自发性气胸89例临床资料进行分析对照。结果治愈80例(89.9%),死亡4例(4.5%)。结论老年慢性阻塞性肺疾病(COPD)并发自发性气胸起病隐匿,病情进展快,常常会导致严重的心肺功能衰竭,危及生命,尽早的诊断和及时的治疗,可以大大降低死亡率。     

肺减容术治疗肺气肿

肺气肿是一种慢性进行性加重、难以根治且严重影响人们生活质量的疾病。肺气肿若导致气流受限即为慢性阻塞性肺疾病（ＣＯＰＤ）。１９９１年调查统计,美国患ＣＯＰＤ者达１６００万人,其病死率上升为第４位［’１。一旦ｎｙ。降低至预计值的３０％,５年生存率降为６０％。尽管用支气管扩张药治疗、疫苗接种和肺修复等有助于缓解症状,预防并发症,但它不能阻止病程的进展。肺移植可给予那些比较年轻的病人带来了希望,但不为大部分年老患者所选择,而肺减容术则为近年来颇受重视的治疗方法。概述１９５７年由Ｄｒ．ＯｔｔｏＢｒ。ｔｉｇ…     

电视胸腔镜手术对合并慢性阻塞性肺病的老年自发性气胸的疗效观察

目的探讨电视胸腔镜手术（VATS）及与常规开胸手术（TH）治疗合并慢性阻塞性肺病的老年自发性气胸的疗效。方法 50例老年自发性气胸患者分别采用VATS手术和常规开胸手术治疗,比较其治疗效果及肺功能变化。结果本组无死亡病例,均治愈出院。VATS组胸引管留置时间、术中出血量、出院时间优于较常规开胸组（P〈0.05）,VATS组患者术后2周肺功能恢复较常规开胸组快（P〈0.05）。结论 VATS治疗合并慢性阻塞性肺病的老年自发性气胸手术风险低、创伤小、恢复快、疗效满意。     

Perioperative Short-term Pulmonary Rehabilitation for Patients Undergoing Lung Volume Reduction Surgery

Although pulmonary rehabilitation is recommended for patients undergoing lung volume reduction surgery, the optimal method of pulmonary rehabilitation is unclear. The aim of this study was to determine the feasibility and safety of perioperative short-term pulmonary rehabilitation. We enrolled candidates for lung volume reduction surgery from 1999 to 2006 and retrospectively evaluated the feasibility and safety of perioperative short-term pulmonary rehabilitation for these patients. The program included the progressive exercise training on a treadmill for approximately 3 weeks. Two primary endpoints, feasibility and safety, were determined by the adherence rates of the program session and the adverse events. Pulmonary function and exercise capacity were evaluated at baseline and the termination of pre- and postoperative short-term pulmonary rehabilitation. Twenty-two patients were enrolled in this study. All patients completed our program without any serious adverse events. The mean values of adherence rates of the preoperative, postoperative, and overall period were, 89.1%, 95.1%, and 92.1%, respectively. All values of pulmonary function tests, except for forced vital capacity, significantly improved at the termination of postoperative short-term pulmonary rehabilitation in comparison to those at the termination of preoperative short-term pulmonary rehabilitation. The values of the 6-minute walk distance, total exercise time, and maximal workload on incremental exercise test were significantly improved by preoperative short-term pulmonary rehabilitation, and their values were maintained until the termination of postoperative short-term pulmonary rehabilitation. The results indicated that it is both feasible and safe to perform perioperative short-term pulmonary rehabilitation.     

肺减容术治疗重度肺气肿及围术期处理

目的总结肺减容术(LVRS)治疗重度肺气肿的手术操作要点及围术期处理经验。方法回顾性分析2005年1月—2011年12月在我院施行LVRS治疗的112例不均质型重度肺气肿患者的临床资料,并比较分析患者术前、术后活动能力及肺功能指标的变化。结果手术均顺利完成,手术时间(109.6±21.4)min,术后胸腔引留管留置时间(6.2±4.6)d,术后住院时间(8.7±5.3)d。术后14例患者发生并发症(12.5%),3例死亡(2.7%)。随访76例(69.7%),随访时间1～68个月,平均(18.4±9.5)个月。患者术后的第1秒用力呼气量、肺总量、残气量、氧分压、二氧化碳分压、6min步行距离均明显改善,与术前比较差异有统计学意义(P<0.05)。结论对重度肺气肿患者,正确地施行LVRS和有效的围术期处理,可以降低手术并发症,明显改善患者肺功能,提高生活质量。     

Global Strategy for the Diagnosis,Management and Prevention of Chronic Obstructive Lung Disease 2017 Report

This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de‐escalation of therapy is introduced in the treatment assessment scheme; (iv)non‐pharmacological therapies are comprehensively presented and (v) the importance of co‐morbid conditions in managing COPD is reviewed.     

慢性阻塞性肺疾病并发自发性气胸的诊治分析

目的 探讨并分析慢性阻塞性肺疾病并发自发性气胸的临床诊断和治疗的方法.方法 回顾性分析2006年9月-2011年11月于我院就诊的140例慢性阻塞性肺疾病并发自发性气胸患者的临床资料,随机分为试验组80例和对照组60例,试验组采用水封瓶闭式引流或者抽气减压方法进行治疗,对照组采取卧床休息和吸氧等方式进行治疗.结果 试验组治疗总有效率为95.0%,对照组总有效率为85.0%,两组比较差异有统计学意义(P＜0.05).结论 慢性阻塞性肺疾病并发自发性气胸的病情较为严重,且误诊率和死亡率都较高,及时的诊断和治疗可以有效的降低死亡率.     

Prevalence and Risk Factors for Depressive Symptoms in Persons with Chronic Obstructive Pulmonary Disease

Background  Although depression is a risk factor for adverse outcomes in chronic illness, little is known about the prevalence or risk factors for depressive symptoms in chronic obstructive pulmonary disease (COPD). Objective  To determine the prevalence of depressive symptoms in COPD as compared to other chronic illnesses and to identify risk factors for depressive symptoms in COPD. Design and Patients  Cross-sectional study of 18,588 persons (1,736 subjects with self-reported COPD), representing a sample of the US population aged ≥50 years who participated in the 2004 Health and Retirement Survey. Measurements  Presence of COPD and other chronic conditions was defined by self-report. Presence of depressive symptoms was assessed using the CES-D8 scale. Participants with a score ≥3 on CES-D8 were classified as having clinically significant depressive symptoms. Main Results  Of 1,736 participants with COPD, 40% had ≥3 depressive symptoms. Depressive symptoms were more common in COPD than in coronary heart disease, stroke, diabetes, arthritis, hypertension, and cancer. Risk factors for ≥3 depressive symptoms in COPD: younger age (OR 1.02/per year younger, 95% CI [1.02–1.03]), female gender (1.2 [1.1–1.3]), current smoking (1.5 [1.3–1.7]), marital status [divorced/separated (1.8 [1.6–2.1]), widowed (1.8 [1.6–2]), never married (1.4 [1.1–1.8]), ≤high school degree (1.6 [1.5–1.8]), dyspnea (2.3 [2.1–2.6]), difficulty walking (2.8 [2.5–3.2]), and co-morbid diabetes (1.2 [1.1–1.4]), arthritis (1.3 [1.2–1.5]) or cancer (1.2 [1.1–1.4]). Conclusions  Depressive symptoms are common in COPD and are more likely to occur in COPD than in other common chronic illnesses. The risk factors identified may be used for targeted depression screening in COPD patients. An erratum to this article can be found at