扶肺固肾饮对慢性阻塞性肺疾病稳定期患者BODE指数的影响

【目的】观察扶肺固肾饮对慢性阻塞性肺疾病(COPD)稳定期重度、极重度,且中医证型为肺肾两虚夹痰瘀证患者BODE指数(B为体质量指数,O为气流阻塞程度,D为呼吸困难,E为运动耐力)的影响。【方法】将80例患者随机分为治疗组和对照组各40例。对照组给予吸入沙美特罗替卡松粉吸入剂(舒利迭)治疗,治疗组在对照组基础上加用扶肺固肾饮口服治疗。2组疗程均为3个月。比较2组患者治疗前后体质量指数(BMI)、气流阻塞程度[第1秒用力呼气容积占预计值百分比(FEV1%)]、呼吸困难指数(MMRC)、运动耐力[6 min步行距离(6MWT)]指标的变化情况。【结果】(1)组内比较:治疗组重度、极重度患者FEV1%、MMRC、6MWT治疗后积分及BODE指数治疗后总分均较治疗前改善(P0.05),BMI无明显改善(P0.05);对照组重度、极重度患者MMRC、6MWT治疗后积分及BODE指数治疗后总分均较治疗前改善(P0.05),FEV1%、BMI无明显改善(P0.05)。(2)组间比较:除BMI外,治疗组FEV1%、MMRC、6MWT治疗后积分及BODE指数治疗后总分均较对照组治疗后明显改善(P0.05)。【结论】扶肺固肾饮联合舒利迭吸入能显著降低COPD稳定期患者的BODE指数积分,改善COPD稳定期患者的临床症状、肺功能和运动耐力,提高患者生活质量。     

布地奈德联合沙美特罗对儿童中重度哮喘的治疗作用

目的:观察布地奈德联合沙美特罗对儿童中重度哮喘的临床疗效.方法:对我院自2011年1月至2011年5月收治的50例儿童中重度哮喘患者的临床资料进行回顾性分析;按不同治疗方法分为观察组和对照组,对照组采用布地奈德治疗,观察组采用布地奈德联合沙美特罗治疗,比较两组的临床疗效.结果:观察组与对照组治疗后FEV1、PEF、白天症状评分和夜间症状评分较治疗前均有明显改善,观察组较对照组改善程度明显,具有统计学意义(P<0.05).结论:布地奈德联合沙美特罗治疗中重度患儿哮喘,效果良好,值得临床推广应用.     

舒利迭联合爱全乐治疗慢性支气管炎急性发作的临床分析

目的探讨舒利迭联合爱全乐治疗慢性支气管炎急性发作的临床疗效。方法选取2009～2011年笔者所在医院收治的160例慢性支气管炎急性发作患者的临床资料,采用随机、双盲、自愿的原则分为治疗组及对照组,各80例,对照组患者行常规治疗,治疗组加用舒利迭联合爱全乐,比较两组患者的临床症状及药物不良反应。结果治疗组患者临床症状改善优于对照组,两组患者比较差异有统计学意义(P<0.05)。结论舒利迭联合爱全乐治疗慢性支气管炎急性发作能明显改善患者临床症状,提高患者生活质量,值得临床推广。     

沙美特罗替卡松联合呼吸功能锻炼用于稳定期慢性阻塞性肺疾病患者的效果

目的探讨沙美特罗咎卡松联合呼吸功能锻炼用于稳定期慢性阻塞性肺疾病(COPD)患者的效果。方法选取2019年1月至2020年6月浙江省丽水市人民医院呼吸科门诊治疗的稳定期COPD患者72例,随机分为两组,每组各36例。单用组予沙美特罗菩卡松吸人,联合组在单用组基础上加呼吸功能锻炼,网组均治疗12周。观察两组治疗前和治疗12周后血清炎症因孔[超敏C-反应蛋白(ha-CRP)和肿瘤坏死因子-a(TNF-a).肺功能指标(FEV1.FVC和FEV/FVC比值)、临床症状指标(CAT评分)及运动和活动能力指标(6MWD)的变化,并评估其临床效果。结果治疗12周后,两组血清hs-CRP和TNF-a水平均较前明显下降(P<0.05或P<0.01),且联合组下降幅度较单用组更显著(PO0.0);两组肺功能指标FEV,.FVC和FEV/FVC比值均较前明显上升(P<0.05 或P<0.01),且联合组上升幅度较单用组更显著(P<0.05);两组CAT评分较前明显下降,6MWD均较前明显上升(P<0.05或P<0.01),且联合组变化幅度较单用组更显著(P<0.05);同时联合组临床总有效率为94.44% ,明显高于单用组的7.78%。差异有统计学意义(x-4.220,P<0.05)。结论 沙美特罗普卡松联合呼吸功能锻炼用于稳定期COPD患者的疗效确切,不仅能改善临床症状和肺功能,而且能提升患者运动和活动能力,其作用机制与其能降低血清has-CRP和TNF-a水平,抑制慢性炎症反应过程密切相关。     

Approaches to a long-acting,selectiveβ 2-adrenoceptor stimulant

Selectedβ ₂-stimulants were sought that would stick more firmly than salbutamol at their sites of action on theβ ₂-adrenoceptor protein in the cell membrane. Of the substance synthesized and tested it was concluded that salmeterol represented a new class ofβ ₂-stimulants that because of their exceptionally long duration of action have potential clinical advantages over current availableβ ₂-stimulants in the treatment of asthma.     

联合吸入噻托溴铵和沙美特罗/氟替卡松治疗慢性阻塞性肺疾病的疗效分析

目的探析噻托溴铵粉吸入剂联合美沙特罗/氟替卡松雾化吸入治疗慢性阻塞性肺疾病(COPD)的临床疗效。方法采用前瞻性平行试验法收集2011年6月至2013年6月期间接受雾化吸入治疗150例COPD患者,采用随机抽签法将其分为两组,每组75例。对照组雾化吸入沙美特罗替卡松粉吸入剂(50μg沙美特罗/250μg丙酸氟替卡松),试验组雾化吸入沙美特罗替卡松粉吸入剂+噻托溴铵粉吸入剂。对比分析两组患者肺功能、临床症状、临床疗效及预后。结果疗程结束后,试验组肺功能改善情况明显优于对照组(P0.05),临床症状改善情况明显优于对照组(P0.05),明显改善患者的身体状况(P0.05);试验组治疗总有效率明显高于对照组(P0.05),无严重不良反应发生,随访期间,试验组急性发作率低于对照组(P0.05)。结论联合吸入噻托溴铵和沙美特罗/氟替卡松治疗能改善COPD患者临床症状和体征,促进肺功能的恢复,降低对生活的影响程度,减少急性加重发作次数,疗效显著且安全性高,可作为临床治疗COPD的首选方案。     

吸入型沙美特罗/丙酸氟替卡松与异丙托溴铵/沙丁胺醇治疗慢性阻塞性肺疾病患者的疗效及安全性的比较研究

目的比较沙美特罗/丙酸氟替卡松与异丙托溴铵/沙丁胺醇治疗稳定期中重度慢性阻塞性肺疾病(chronic obstruchive pulmonary disease,COPD)患者的疗效及安全性。方法 21例确诊为中、重度COPD患者随机分为:①沙美特罗/丙酸氟替卡松组(10例):予50/500μg,1吸/次,2次/d;②异丙托溴铵/沙丁胺醇组(11例):20/120μg,2吸/次,4次/d;共用12周。测定治疗前后4周、12周的临床症状变化、英国医学研究委员会(modified medical research council,MMRC)呼吸困难评分、多因素分级系统(body mass,airflow obstruction,dyspnea,and exercise cqpacity,BODE)指数评分、圣乔治医院呼吸问题调查问卷(St.George's Hospital respiratory questionaire,SGRQ)得分、肺功能相关指标[使用支气管扩张剂后的第一秒用力呼气容积(forced expiratory vohime in one second,FEV1)、FEV1占预计值百分比(FEV1%)、FEV1/FVC%、最大呼气峰流速值(peak expiratory flow,PEF)及PEF占预计值百分比(PEF%)],记录药物不良反应及患者急性加重的发生率。结果治疗12周后两组患者肺功能有所改善,其中FEV1沙美特罗/丙酸氟替卡松组治疗后与治疗前行配对t检验的P=0.03,异丙托溴铵/沙丁胺醇组治疗后与治疗前行配对t检验的P=0.09,两组间配对t检验4周时P=0.04,12周时P0.05。各项评分包括MMRC、BODE、SGRQ等两组治疗前后相比较无明显差异(P0.05)。结论沙美特罗/丙酸氟替卡松和异丙托溴铵/沙丁胺醇治疗稳定期中重度COPD患者12周后在疗效上无显著差异。可能仍需更多大规模、随访时间长的临床实验加以验证。     

Adjustable maintenance dosing with budesonide/formoterol compared with fixed-dose salmeterol/fluticasone in moderate to severe asthma

SUMMARY

Background: Current asthma guidelines recommend that patients are educated to adjust their medication according to their asthma severity using physician-guided self-management plans. However, many patients take a fixed dose of their controller medication and adjust their reliever medication according to asthma symptoms.

Objectives: This study examined whether asthma control improved if patients adjusted the maintenance dose of budesonide/formoterol (Symbicort Turbuhaler 160/4.5 |ig) according to asthma severity compared with traditional fixed dosing (FD) regimens.

Methods: Symptomatic patients with asthma (n?=?658, mean symptom score 1.5, mean inhaled corticosteroids 735|ig/day, mean forced expiratory volume in 1?second [FEV1] 84% predicted) were randomised after 2 weeks' run-in to either: budesonide/formoterol adjustable maintenance dosing (AMD), budesonide/formoterol FD or salmeterol/fluticasone (Seretide Diskust 50/250 |ig) FD. In a 4-week double-blind period, both budesonide/formoterol AMD and FD groups received two inhalations twice daily (bid) and salmeterol/fluticasone FD patients received one inhalation bid. In the following 6-month open extension, both FD groups continued with the same treatment. Patients in the AMD group with well-controlled asthma stepped down to one inhalation bid; others continued with two inhalations bid. All AMD patients could increase to four inhalations bid for 7-14 days if symptoms worsened. All patients used terbutaline or salbutamol for symptom relief throughout. The primary variable was the odds of achieving a well-controlled asthma week (WCAW).

Results: The odds ratio for achieving a WCAW did not differ between the FD regimens; however, during the open period, budesonide/formoterol AMD increased the odds of achieving a WCAW vs. budesonide/formoterol FD (odds ratio 1.335; 95% CI: 1.001,1.783; p?=?0.049) despite a 15% reduction in average study drug use. Budesonide/formoterol AMD patients had a lower exacerbation rate over the study: 40% lower vs. salmeterol/fluticasone FD (p?=?0.018); 32% lower vs. budesonide/formoterol FD (NS). During the double-blind period, there were no clinically relevant differences between the budesonide/formoterol FD and salmeterol/fluticasone FD groups. Budesonide/formoterol AMD patients used less reliever medication in the open extension: 0.58 vs. 0.92 occasions/day for budesonide/formoterol FD (p?=?0.001) and 0.80 occasions/day for salmeterol/fluticasone FD (p?=?0.011).

Conclusions: Adjustable maintenance dosing with budesonide/formoterol provides more effective asthma control by reducing exacerbations and reliever medication usage compared with fixed-dose salmeterol/fluticasone.     

MORA生物共振治疗仪联合辅舒良治疗常年性变应性鼻炎的临床观察

目的使用MORA生物治疗仪联合辅舒良治疗常年变应性鼻炎,观察其疗效及治疗前后症状和体征评分变化。方法选择150例变应性鼻炎患者随机分为A、B、C3组,分别使用辅舒良鼻喷剂治疗、MORA生物共振治疗仪进行脱敏治疗,辅舒良鼻喷剂联合MORA治疗仪脱敏治疗,疗程均为4周。结果①治疗1周后,C组治疗前后症状改善比较差异有统计学意义。②A、B、C3组治疗4周后患者症状改善且3组间有效率比较,差异无统计学意义。③B组无任何不良反应、A组和C组部分患者出现鼻腔干燥,鼻出血。结论辅舒良喷鼻联合MORA脱敏治疗能较早的控制常年性过敏性鼻炎的症状,减轻患者的痛苦,有效减轻或抑制过敏反应;在后期治疗中,可选择停用辅舒良喷鼻,采用MORA脱敏治疗,能有效脱敏治疗并减少治疗过程中的不良反应。     

吸入沙美特罗/氟替卡松联合噻托溴铵对稳定期慢性阻塞性肺疾病患者的疗效观察

目的 观察长期吸入沙美特罗/氟替卡松及噻托溴铵治疗稳定期慢性阻塞性肺疾病(COPD)患者的疗效.方法 将95例稳定期COPD患者随机分为三组:A组吸入沙美特罗/氟替卡松和噻托溴铵;B组吸入沙美特罗/氟替卡松;C组吸入噻托溴铵.治疗半年,评估肺功能1秒钟用力呼气容积(FEV1)、FEV1与用力肺活量的比值与治疗满意度.疗效比较采用优势检验.结果 全部病例完成半年随访,吸入沙美特罗/氟替卡松和噻托溴铵可明显减缓肺功能的恶化,同时发现吸入沙美特罗/氟替卡松和噻托溴铵组有着明显的治疗满意度.结论 吸入沙美特罗/氟替卡松和噻托溴铵在改善症状方面优于噻托溴铵,具有较好的依从性. Abstract： Objective To observe therapeutic effects of inhaling salmeterol/fluticasone and tiotropium bromide for stable COPD patients. Methods Ninety-five cases of stable COPD patients were divided randomly into three groups, group A inhaling salmeterol/fluticasone and tiotropium bromide, group B inhaling salmeterol/fluticasone, group C inhaling tiotropium bromide. All were for half a year. Lung function(FEV1,FEV1/FVC) and AECOPD manifestations and therapeutic satisfaction were evaluated. Therapeutic effects were compared with advantage test. Results All follow-ups of half a year were completed. It was found that inhaling salmeterol/fluticasone and tiotropium bromide could decrease obviously worsening of lung function. And meanwhile there was more satisfactory therapy than another two groups.Conclusions Inhaling salmeterol/fluticasone is better than inhaling tiotropium bromide in improving symptoms and with better compliance.