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。     

盐酸班布特罗口服液治疗支气管哮喘的评价

目的：评价新型长效β２激动剂——盐酸班布特罗口服液治疗支气管哮喘的疗效和安全性。方法：采用随机单盲对照和开放试验,对１０１例哮喘患者进行为期４周、口服盐酸班布特罗口服液、１０～２０ｍｇ每晚一次的疗效观察,并进行剂量滴定。结果：治疗组（５０例）和开放组（５１例）临床控制率分别为５４．０％和６２．５％,有效率分别为８８．０％和９２．７％。治疗２周,肺功能即显著改善。剂量滴定试验提示部分患者的合适剂量为每日２０ｍｇ。不良反应发生率为７．９％。主要表现为手抖、心悸和头晕,不影响治疗。１例出现一过性血清丙氨酸转氨酶（ＡＬＴ）轻度升高。结论：盐酸班布特罗口服液是安全而有效的,是一种长效支气管扩张药物。     

低剂量丙酸倍氯松吸入对轻度哮喘儿童气道高反应性的影响

为探讨低剂量丙酸倍氯松吸入对轻度哮喘儿童肺功能及气道高反应性的影响,将 ３０例轻度哮喘患儿（年龄 ５～ １４岁,男２１例,女 ９例）随机分为 ３组（每组 １０例）,分别吸入安慰剂,ＢＤＰ２００或４００μｇ／日,结果：患儿吸入２００或４００μｇ／日的ＢＤＰ后,哮喘症状明显改善, ＦＥＶＩ及 ＰＥＦ明显升高。且Ｌｏｇ［ＰＤ２０ＦＥＶ１（μｇ）］显著增加即 ＢＨＲ显著下降。其下降程度随吸药时间的延长而增加,而对照组的各项指标均无明显变化。２００μｇ组及４００μｇ组间有关临床症状改善,各项肺功能指标及 ＢＨＲ的变化,不存在显著差异（Ｐ均＜０．０５）。结论：吸入２００μｇ／日的ＢＤＰ即能有效地控制轻度儿童哮喘患者的临床症状,改善其肺功能并降低ＢＨＲ,将剂量增力。至４００μｇ／日并不能明显增力。疗效。建议临床上使用ＢＤＰ吸入疗法治疗轻度儿童哮喘时,宜采用２００μｇ／日为常规剂量。     

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)]     

紧急动脉栓塞治疗大咯血

目的评价介入栓塞治疗大咯血的疗效。方法16例大咯血患者行介入栓塞治疗,肺结核10例,支气管扩张6例;栓塞支气管动脉24支,肋间动脉6支,右乳内动脉1支。结果即刻止血13例,咯血明显减少2例,失败1例;随访3～48个月,3例复发,2例再次栓塞治疗咯血停止,1例内科保守治疗成功。本组未发生脊髓损伤及异位栓塞综合征。结论大咯血患者行介入栓塞治疗止血快,疗效显著,安全可靠。     

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。