王会仍教授自拟“王氏止咳方”治疗慢性咳嗽的临床疗效观察

目的:观察"王氏止咳方"治疗慢性咳嗽的临床效果。方法:在呼吸内科门诊选择124例诊断为慢性咳嗽的患者,随机分为对照组和观察组,每组62例。对照组用西药常规治疗,观察组口服"王氏止咳方"加减治疗,观察两组的临床疗效。结果:经治疗后对照组总有效率为70.97%,观察组总有效率为91.94%,观察组总有效率明显优于对照组(P0.05)。结论:"王氏止咳方"加减治疗慢性咳嗽疗效明显,且无不良反应,值得临床推广应用。     

孟鲁司特钠联合布地奈德混悬液雾化吸入治疗咳嗽变异型哮喘75例的临床研究

目的探讨孟鲁司特钠联合布地奈德混悬液雾化吸入治疗咳嗽变异型哮喘(CVA)的临床疗效。方法 75例CVA患者随机分为对照组和研究组。对照组36例,给予常规基础治疗和布地奈德混悬液雾化吸入;研究组39例,在对照组基础上给予孟鲁司特钠口服。观察治疗前、治疗10 d后临床疗效及肺活量(FVC)、最大呼气峰流速(PEF)及超敏C反应蛋白(hs CRP)、肿瘤坏死因子-α(TNF-α)和白介素-13(IL-13)水平变化。结果治疗前两组患者FVC、PEF及hs CRP、TNF-α和IL-13水平比较,差异无统计学意义(P>0.05)。治疗10 d后,研究组FVC、PEF升高幅度明显优于对照组(P<0.05),血清hs CRP、TNF-α、IL-13水平明显低于对照组(P<0.05),研究组治疗总有效率94.87%明显高于对照组总有效率77.78%(P<0.05)。结论孟鲁司特钠联合布地奈德混悬液雾化吸入治疗咳嗽变异型哮喘疗效显著、不良反应较少,明显改善哮喘、咳嗽等临床症状。     

布地奈德治疗儿童感染后咳嗽的临床疗效观察

目的观察雾化吸入布地奈德治疗儿童感染后咳嗽的临床疗效。方法收集2012年1月至2013年12月在我院诊断为感染后咳嗽的患儿的临床资料,对其进行回顾性分析。40例符合诊断标准的患儿分为治疗组22例,对照组18例。对照组给予常规治疗,开瑞坦5~10 m L/次,1次/d+易坦静口服液,5~10 m L/次,2次/d,对症止咳祛痰;治疗组在上述治疗的基础上,吸入布地奈德1 m L,2次/d。两组疗程均为2周,对两组的临床疗效进行评价。结果两组患儿咳嗽症状积分均明显下降,治疗组的有效率高于对照组,两组比较差异有统计学意义(P<0.01)。结论雾化吸入布地奈德在儿童感染后咳嗽治疗中具有较好的疗效,明显优于常规治疗方法。     

慢性咳嗽125例临床研究

目的探讨慢性咳嗽的病因及诊治现状。方法以2005年呼吸科诊治的125例慢性咳嗽患者进行研究。结果慢性咳嗽病因中的咳嗽变异性哮喘（CVA）及鼻后滴流综合征（PNDs）最多，52．8％的病例为呼吸系统以外的疾病引起的咳嗽，36．8％的病例由多种病因重叠引起的咳嗽。100％的病例均有被误诊，最长误诊时间达30个月，且并发症高达27．2％。确诊后治疗，90．3％的患者1～2周内咳嗽症状消失。结论慢性咳嗽病因复杂，误诊率高，并发症多，临床医师应重视慢性咳嗽的诊断和治疗。     

Cough threshold in reflux oesophagitis: influence of acid and of laryngeal and oesophageal damage

BACKGROUND: Gastro-oesophageal reflux is often associated with cough. Patients with reflux show an enhanced tussive response to bronchial irritants, even in the absence of respiratory symptoms. AIM: To investigate the effect of mucosal damage (either oesophageal or laryngeal) and of oesophageal acid flooding on cough threshold in reflux patients. PATIENTS: We studied 21 patients with reflux oesophagitis and digestive symptoms. Respiratory diseases, smoking, and use of drugs influencing cough were considered exclusion criteria. METHODS: Patients underwent pH monitoring, manometry, digestive endoscopy, laryngoscopy, and methacholine challenge. We evaluated the cough response to inhaled capsaicin (expressed as PD5, the dose producing five coughs) before therapy, after five days of omeprazole therapy, and when oesophageal and laryngeal damage had healed. RESULTS: In all patients spirometry and methacholine challenge were normal. Thirteen patients had posterior laryngitis and eight complained of coughing. Twenty patients showed an enhanced cough response (basal PD5 0.92 (0.47) nM; mean (SEM)) which improved after five and 60 days (2.87 (0.82) and 5.88 (0.85) nM; p<0.0001). The severity of oesophagitis did not influence PD5 variation. On the contrary, the response to treatment was significantly different in patients with and without laryngitis (p = 0.038). In patients with no laryngitis, the cough threshold improved after five days with no further change thereafter. In patients with laryngitis, the cough threshold improved after five days and improved further after 60 days. Proximal and distal oesophageal acid exposure did not influence PD5. Heartburn disappeared during the first five days but the decrease in cough and throat clearing were slower. CONCLUSIONS: Patients with reflux oesophagitis have a decreased cough threshold. This is related to both laryngeal inflammation and acid flooding of the oesophagus but not to the severity of oesophagitis. Omeprazole improves not only respiratory and gastro-oesophageal symptoms but also the cough threshold.     

Acute and chronic cough

Individuals are generally content to self-medicate for acute cough. It is only when the cough becomes persistent that they seek medical assistance. It is not known why patients cough in association with an acute upper respiratory tract infection (URTI), although interest has focused on how viruses may influence airway sensory nerve function and contribute to heightened cough reflex sensitivity. Why some patients develop a persistent cough following a viral URTI is also unclear. Much more is known about the causes and aggravants of chronic cough although there is no broad agreement as to the best way to manage such patients. Asthma, upper gastrointestinal dysfunction and rhinitis are frequently associated with chronic cough, although the impact of cough in suppurative lung disease and interstitial lung fibrosis is rarely considered. The development of effective treatments for cough remains a challenge and will require co-operation between clinicians, scientists and the pharmaceutical industry.     

A marked decrease in l‐selectin expression by leucocytes in infants with Bordetella pertussis infection: leucocytosis explained?

OBJECTIVE: Infants with Bordetella pertussis infection (whooping cough) have an unexplained lymphocytosis and leucocytosis characterized by an increase in small lymphocytes with convoluted and cleaved nuclei. To characterize these cells immunophenotyping using multiparameter flow cytometry was performed on leucocytes from a group of 11 infants aged 3-6 months with proven pertussis and from uninfected control subjects. METHODOLOGY: The panel of monoclonal antibodies used to elucidate leucocyte subtypes included activation, adhesion, costimulatory, memory, T-helper (Th) 1 and Th2 markers. RESULTS: Patients with pertussis showed an increase in absolute numbers of neutrophils, monocytes, T lymphocytes (both CD4 and CD8), B lymphocytes (including CD10+/CD19+ haematogones) and natural killer (NK) cells. All leucocyte subgroups showed a marked decrease in L-selectin (CD62L) expression. The expression of other adhesion molecules CD11a, CD44 and CD54 on all leucocyte subgroups was unchanged. Expression of costimulatory molecules, CD49D and CD28 on T cells and CD80 and CD86 on monocytes, was unchanged. Lymphocyte activation markers CD69, CD25 and HLA-DR were unchanged. There was an increase in CD45RA+/CD45RO+/CD4+ cells (activated) and CD62L-/CD45RO+/CD4+ cells (Th1-like) but no increase in CD7-/CD4+ T cells (Th2-like). CONCLUSIONS: L-Selectin expression mediates extravasation of leucocytes into tissues and is important for homing of peripheral blood lymphocytes to lymph nodes. The significant down-regulation of L-selectin on leucocytes in pertussis infection may prevent leucocyte migration to areas of infection and homing and adhesion of T and B cells to peripheral lymphoid tissues. The increase in lymphocytes with Th1 phenotype may be required for effective immune response to the infective organism. These data provide a possible explanation for the absolute leucocytosis observed in this disease.     

三拗片联合特布他林治疗咳嗽变异性哮喘的临床研究

目的探讨三拗片联合特布他林治疗咳嗽变异性哮喘的临床研究。方法选取2019年8月—2020年4月在青岛西海岸新区中医医院门诊急诊治疗的咳嗽变异性哮喘患者90例,随机分为对照组(n=45)和治疗组(n=45)。对照组经雾化器吸入硫酸特布他林雾化液,2.5mg/次,3次/d;治疗组在对照组治疗的基础上口服三拗片,2片/次,3次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组咳嗽症状的缓解和消失时间。比较两组嗜酸性粒细胞和肺功能的变化情况。结果治疗后,治疗组的总有效率95.56%,显著高于对照组的73.33%(P0.05)。治疗后,治疗组咳嗽缓解时间和咳嗽消失时间明显短于对照组(P0.05)。治疗后,两组患者血清中嗜酸性粒细胞水平明显低于治疗前水平(P0.05);治疗组治疗后血清中嗜酸性粒细胞水平显著低于对照组(P0.05)。治疗后,两组患者肺活量(FVC)、第1秒用力呼气量(FEV1)和最大呼气流量(PEF)明显高于治疗前(P0.05);治疗组治疗后FVC、FEV1和PEF显著高于对照组(P0.05)。结论三拗片联合特布他林治疗咳嗽变异性哮喘具有较好的临床疗效,能降低嗜酸性粒细胞水平,有效改善临床症状和肺功能指标,具有一定的临床推广应用价值。