Bronchoconstriction of the asthmatic airway by inhaled and ingested propranolol

Summary Responsiveness to inhaled histamine and DL propranolol hydrochloride was measured in 31 adult asthmatics and compared with bronchoconstriction provoked by acute oral propranolol dosing (max 160 mg).Twelve asthmatics developed 15% reduction in the forced expired volume in 1 s (FEV₁), 2 h after 100 mg oral propranolol; cardiac -adrenoceptor blockade was confirmed by cycle exercise tests in the 19 without airway response. The provocative inhaled dose of each aerosol causing a 20% fall in FEV₁ (PC₂₀) was lower, histamine 0.43 mg·ml^–1, propranolol 3.12 mg·ml^–1, in the 12 with a positive oral test compared with the 19 with a negative test, PC₂₀ histamine 1.65 mg·ml^–1, PC₂₀ propranolol 16.2 mg·ml^–1 (P < 0.001 for both aerosols). A correlation was demonstrated between the PC₂₀ values for asthmatics with a negative oral test (r=0.72, P < 0.001, n=19) but not for the remainder (r=0.14, P > 0.05, n=12).Plasma propranolol concentrations (CL, ng·ml^–1) after the final oral dose did not correlate with the % FEV₁(26.3) (r=-0.28) when an airway response was provoked or with the reduction in exercise tachycardia (25.9%) (r=0.31) when no bronchoconstriction occurred. CL exceeded the limit of detection after the final inhaled propranolol dose (7.5 ng·ml^–1) and was weakly related to the PC₂₀ propranolol value (r=0.53, P=0.01, n=27). The prevalence of a positive oral challenge was low in this group (39%). APC₂₀ propranolol value which was 100% sensitive as a predictor of a positive oral test had low specificity (58%) and a low predictive value (60%).This study has not found that nonspecific bronchial responsiveness to histamine or specific responsiveness to inhaled propranolol can be employed to predict bronchoconstriction in asthmatics following acute oral propranolol dosing.     

尼卡地平预防双腔支气管导管插管反应的观察

目的　观察应用尼卡地平预防双腔支气管导管插管心血管反应的效果。　方法　肺、食道择期手术病人 40例 ,随机分为 2组 ,每组 2 0例。咪唑安定 0 .0 4mg/kg、异丙酚 1.5mg/kg、芬太尼 4μg/kg、维库溴铵 0 .12mg/kg静脉诱导后 ,甲组给予尼卡地平 4μg/kg ,乙组给予生理盐水 3ml作为对照。分别于诱导前、后 ,插管后即刻及 1、3、5min监测收缩压 (SBP)、舒张压 (DBP)、心率 (HR) ,并计算心率收缩压乘积 (RPP)。　结果　A组插管后血压无明显升高 ,心率较诱导前无明显增快 ,B组插管后血压明显升高。　结论　尼卡地平可抑制双腔支气管导管插管时的心血管副反应。     

变应性鼻炎与气道高反应的关系

目的 :探讨变应性鼻炎与气道高反应性的相关性。方法 :用 1∶ 1 0 0 ( w/v)蒿属花粉对 50例变应性鼻炎和 2 0例正常者做支气管激发试验 ,分别测定两组第 1秒用力呼气量 ( FEV1) ;测血清中嗜酸性粒细胞阳离子蛋白 ( ECP)。结果 :支气管激发试验前 ,两组支气管均无症状 ,鼻炎组FEV1为 ( 70± 2 0 ) % ,对照组为 ( 85.6± 8.9) % ,两组有显著性差异 ( P <0 .0 1 ) ;支气管激发后 ,鼻炎组中 2 3例胸部有紧迫感 ,1 0例有哮鸣 ,5例有喘息 ,1 2例无症状 ,激发阳性率为 76%。对照组均无支气管症状。激发后鼻炎组 FEV1为 ( 60± 2 0 ) % ,对照组为 ( 85.6± 8.9) % ,两组有显著性差异 ( P <0 .0 5)。鼻炎组 ECP为 ( 30 .37± 1 8.92 ) μg/L,对照组为 ( 5.2 4± 3.2 3) μg/L,两组有显著性差异 ( P <0 .0 5)。结论 :变应性鼻炎不仅鼻粘膜有变态反应所致的慢性炎症 ,而且大部分气道也有慢性炎症反应而导致气道高反应性。     

肺癌患者血清与支气管肺泡灌洗液四项放免肿瘤指标同步检测的结果分析

对３８例肺癌患者的血清和支气管肺泡灌洗液（ＢＡＬＦ）同步进行ＣＥＡ、ＣＡ－５０、ＡＦＰ、ＳＦ的检测。结果显示：肺癌ＢＡＬＦ的ＣＥＡ浓度测值７３％明显高于血清中ＣＥＡ浓度;ＣＡ－５０浓度测值６８％高于血清;ＳＦ９２％明显低于血清中测值;而ＡＦＰ在肺癌患者无论血清及灌洗液中,阳性率均低于７％,但仍是ＢＡＬＦ的浓度测值敏感于血清。提示支气管肺泡灌洗液的ＣＥＡ、ＣＡ－５０与血清的同步检测是目前肺癌早期诊断的主要优选方法之一。     

Allergen tachyphylaxis of guinea pigs in vivo: A prostaglandin E mediated phenomenon?

Ovalbumin (OA) sensitized guinea pigs were repeatedly challenged with 1% OA in saline nebulized ultrasonically at the 0, 10, 20, 60 and 70th min. The intensity of bronchial obstruction was measured by body plethysmography. The first three challenges (0, 10, 20 min) caused strong asthmatic reactions in all animals, the last two (60, 70 min) only mild ones in 10 out of 15 animals. The development of this tachyphylaxis was markedly reduced by pretreatment of the animals with cyclooxygenase inhibitors (indomethacin 10 mg/kg intraperitoneally resp. acetylsalicylic acid 10 mg/kg orally 2h before test). The effect of both inhibitors (i.e. inhibition of tachyphylaxis) was abolished by supplementing prostaglandin E₂ as aerosol simultaneously to the allergen (100–200 ng per inhalation). The results suggest that allergen tachyphylaxis we have observed in vivo might be due to synthesis of cyclooxygenase products, e.g. prostaglandin E.Supported by Deutsche Forschungsgemeinschaft (grant Do 240) in part presented at the 17th workshop on pediatric research [Göttingen 1981, Eur. J. Pediatr. 135: 336 (1981)]     

Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.     

Tetralogy of Fallot with Absent Pulmonary Valve and Bronchial Compression: Treatment with Endobronchial Stents

Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac lesion. The lesion includes ventricular septal defect, overriding aorta, and absence of the pulmonary valve, with resultant pulmonary incompetence. It has been suggested that the pulmonary incompetence induces intrauterine dilatation of the pulmonary artery, which leads to tracheobronchial compression. One of the presenting features in infants with APVS is severe airway obstruction, which may be difficult to manage. We report an infant who benefited from bilateral endobronchial endoscopic stent placement.     

吸入沙美特罗替卡松联合特异性脱敏防治支气管哮喘的研究

目的观察吸入沙美特罗替卡松联合特异性脱敏防治支气管哮喘的疗效。方法常见变应原皮内试验,根据试验结果,行特异性脱敏,阶梯式吸入沙美特罗替卡松干粉剂,峰速仪监测PEFam值,疗程1年。结果临床控制率80% ,显效率88% ,总有效率100%。结论特异性脱敏联合吸入沙美特罗替卡松可有效的防治支气管哮喘。     

隐孔菌发酵物对脾虚证哮喘小鼠气道高反应性及炎症的影响

目的建立脾虚证哮喘小鼠模型,观察隐孔菌发酵物(CVFS)对脾虚证哮喘小鼠气道高反应性及炎症的影响。方法以卵白蛋白(OVA)致敏 饮食不节 劳倦过度伤脾法建立脾虚证哮喘小鼠模型;测定小鼠的肺阻力(RL)和支气管-肺泡灌洗液(BALF)中的炎症细胞,观察肺组织和免疫器官脾脏的病理变化。结果脾虚证哮喘小鼠的气道高反应性、BALF中的嗜酸性粒细胞数目,肺组织嗜酸性粒细胞炎性病理变化以及脾脏指数与单纯哮喘小鼠比较有明显差异(P<0.05)。CVFS能明显改善单纯哮喘小鼠和脾虚证哮喘小鼠由乙酰甲胆碱(MCH)诱导的气道高反应性,减少BALF中的嗜酸性粒细胞数目,以及改善肺组织嗜酸性粒细胞炎性病理变化,而对脾虚证哮喘小鼠作用更为明显。CVFS能明显增加脾虚证哮喘小鼠脾脏指数,而对单纯哮喘小鼠的脾脏指数无明显影响。结论OVA致敏 饮食不节 劳倦过度伤脾法可建立脾虚证哮喘小鼠模型;CVFS可明显改善脾虚症状,抑制脾虚证哮喘小鼠的气道高反应性和炎症反应,提示CVFS可用于临床脾虚证哮喘的治疗。     

经支气管动脉介入治疗肺癌58例疗效分析

目的探讨支气管动脉化疗栓塞术治疗肺癌的临床疗效及应用价值。方法对58例肺癌患者行支气管动脉造影明确其分支及肿瘤血管情况,超选择性插管至肿瘤供血动脉,先行局部化疗药物(含顺铂、丝裂霉素及5-FU)灌注,后以碘化油加顺铂混合乳剂进行栓塞。结果58例大多血供丰富,二次介入治疗者肿瘤血管减少。完全缓解5例,部分缓解43例,稳定10例。有效率82.8%。症状总缓解率55.7%。结论支气管动脉化疗栓塞术治疗肺癌近期疗效较好,可以明显缓解症状,提高患者的生存质量。