布地奈德福莫特罗联合噻托溴铵对重度慢性阻塞性肺疾病稳定期患者的疗效分析

目的 探讨布地奈德福莫特罗（信必可都保）联合噻托溴铵（思力华）对重度慢性阻塞性肺疾病（COPD）稳定期患者的临床治疗效果.方法 选取重度COPD患者90例,随机分为试验组（45例）和对照组（45例）,两组均在常规治疗（常规吸氧、抗炎、解痉、平喘）的基础上,试验组使用布地奈德福莫特罗联合噻托溴铵吸入,对照组则以布地奈德福莫斯特罗单药治疗,治疗周期6个月;对两组患者的疗效进行对比分析.结果 经过6个月的治疗,两组患者的6 min步行距离、呼吸困难的症状均有改善,但试验组的效果更加明显（P＜0.05）;试验组患者的血气、肺功能指标均明显升高（P＜0.05）.结论 相比于使用布地奈德福莫特罗单药治疗,患者在血气分析、肺功能以及呼吸困难的改善上,噻托溴铵与布地奈德福莫特罗联合治疗重度COPD稳定期患者的疗效更好,具有在临床治疗中推广应用的价值.     

阿奇霉素联合布地奈德福莫特罗在支气管哮喘中的治疗作用

目的：探讨阿奇霉素联合布地奈德福莫特罗雾化吸入剂在支气管哮喘中的治疗作用。方法：选取2013年1月-2013年12月期间在我院接受支气管哮喘治疗的患者50例,分为实验组与对照组。实验组患者25人,采用阿奇霉素联合布地奈德福莫特罗雾化吸入剂2种药物进行双重药物治疗;对照组单独使用布地奈德福莫特罗雾化吸入剂进行治疗,对比2组患者支气管哮喘的治愈情况。结果：治疗前2组患者各项指标比较均无显著差异（P〉0．05）;治疗后治疗组和对照组FEV1、FEV1占FVC百分比、FEVl占预计值百分比和Pa02比较均有显著差异（P〈0．05）,其它指标差异无显著性（p〉0．05）。结论：阿奇霉素联合布地奈德福莫特罗雾化吸入剂在支气管哮喘的治疗中,效果显著,值得在临床上广泛推广。     

Budesonide/formoterol for the treatment of asthma

Budesonide/formoterol (Symbicort^®, AstraZeneca plc) is a novel treatment for asthma, combining an inhaled corticosteroid – budesonide, and a long-acting β₂-agonist – formoterol, in a single inhaler, the Turbuhaler^®. Randomised, clinical studies in patients with asthma have demonstrated that budesonide/formoterol is more effective than the inhaled corticosteroids, budes-onide and fluticasone alone, and at least as effective as both monocomponents in separate inhalers. Results from clinical studies suggest a synergistic effect when both drugs are administered via one inhaler, although the mechanisms for this are not fully understood. Budesonide/formoterol has a rapid onset of effect, apparent within 1 min of treatment, which is largely because of the properties of formoterol. Once- and twice-daily dosing with budesonide/formoterol are effective treatment options for patients with mild or moderate asthma. Studies have also shown that the beneficial safety profiles and dose relationships of both budesonide and formoterol allow dose adjustments of budesonide/formoterol in response to variations in the patient’s asthma. Findings from the budesonide/formoterol adjustable maintenance dosing programme, comparing fixed and adjustable, symptom-guided dosing regimens, demonstrate that patients achieve equally good asthma control with adjustable dosing (from one inhalation twice-daily to more than four inhalations twice-daily), but at a significantly lower overall drug load. Adverse events, mainly expected inhaled corticosteroid and long-acting β₂agonist class effects, have been few in number and mild in nature. In addition, there is growing evidence that budesonide/formoterol is also effective in patients with chronic obstructive pulmonary disease. The future for treatment with budesonide/formoterol may include as-needed administration in addition to maintenance therapy.     

噻托溴铵与布地奈德福莫特罗粉联合吸入在重度、极重度COPD稳定期中的疗效观察

目的观察噻托溴铵（思力华）与布地奈德福莫特罗粉联合吸入对重度、极重度（Ⅲ-Ⅳ级）慢性阻塞性肺疾病（COPD）稳定期患者的疗效。方法选取2011年9月至2012年9月于本院呼吸科门诊就诊的60例稳定期重度、极重度COPD患者,采用完全随机法分成3组（即思力华组、信必可都保组、思力华与信必可都保联合组）,共治疗6个月。分别于治疗前和治疗后测定患者肺功能（FEV1,FEV1/FVC%,FEV1占预计值%）、记录圣乔治呼吸问卷评分,统计半年总急性加重次数,采用分组对比治疗方法。结果思力华组、信必可都保组、联合组肺功能、圣乔治呼吸问卷评分均较治疗前改善（P〈0.05）,联合组各项指标改善更明显（P〈0.05）。联合组急性加重次数较其余两组明显减少（P〈0.05）。结论思力华吸入剂联合信必可都保吸入剂治疗稳定期重度、极重度COPD疗效肯定,优于单一种药物治疗,值得临床进一步推广应用。     

信必可都保联合噻托溴铵治疗缓解期COPD的疗效分析

目的观察信必可都保(160/4.5ug)联合噻托溴铵治疗稳定期COPD的疗效。方法对本院收治的确诊60例中、重度COPD患者,随机分为对照组和治疗组。对照组给予噻托溴铵,每次18ug吸入,每日1次;治疗组在此基础上联合信必可都保(160/4.5ug),每次1吸,每日2次。观察2组患者治疗前后肺功能、血气分析及减少急性发作次数的情况。结果治疗组在肺功能、血氧饱和度及急性发作次数的指标上均明显优于对照组(P<0.05)。结论信必可都保(160/4.5ug)联合噻托溴铵能提高稳定期COPD患者的肺功能、血气分析及减少急性发作次数。     

LINX■ reflux management system to bridge the “treatment gap” in gastroesophageal reflux disease: A systematic review of 35 studies

BACKGROUND Gastroesophageal reflux disease(GERD) occurs when the reflux of stomach contents causes troublesome symptoms and/or complications. When medical therapy is insufficient, surgical therapy is indicated and, until now, Laparoscopic fundoplication(LF) constitutes the gold-standard method. However, magnetic sphincter augmentation(MSA) using the LINX^® Reflux Management System has recently emerged and disputes the standard therapeutic approach.AIM To investigate the device’s safety and efficacy in resolving GERD symptoms.METHODS This is a systematic review conducted in accordance to the PRISMA guidelines.We searched MEDLINE, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL databases from inception until September 2019.RESULTS Overall, 35 studies with a total number of 2511 MSA patients were included and analyzed. Post-operative proton-pump inhibitor(PPI) cessation rates reached 100%, with less bloating symptoms and a better ability to belch or vomit in comparison to LF. Special patient groups(e.g., bariatric or large hiatal-hernias)had promising results too. The most common postoperative complication was dysphagia ranging between 6% and 83%. Dilation due to dysphagia occurred in 8% of patients with typical inclusion criteria. Esophageal erosion may occur in up to 0.03% of patients. Furthermore, a recent trial indicated MSA as an efficient alternative to double-dose PPIs in moderate-to-severe GERD.CONCLUSION The findings of our review suggest that MSA has the potential to bridge the treatment gap between maxed-out medical treatment and LF. However, further studies with longer follow-up are needed for a better elucidation of these results.     

Pharmacokinetics of budesonide and formoterol administered via a series of single-drug and combination inhalers: four open-label, randomized, crossover studies in healthy adults

Objective: To investigate the pharmacokinetics of budesonide and formoterol administered concomitantly in healthy adults. Methods: Three single-dose, open-label crossover studies (n=28 each) were conducted (Study I: budesonide pMDI, formoterol DPI, budesonide pMDI+formoterol DPI; Study II: budesonide/formoterol pMDI, budesonide pMDI+formoterol DPI; Study III: budesonide/formoterol pMDI [three budesonide formulation strengths; constant formoterol]). Study IV (n=28) assessed steady state pharmacokinetics (budesonide/formoterol pMDI [two/four inhalations twice daily, 5-day treatment; four inhalations, single-dose]). Results: Study I: no pharmacokinetic interactions were observed between budesonide and formoterol. Study II: AUC ratios were 97.9% (budesonide) and 82.2% (formoterol) (budesonide/formoterol pMDI versus budesonide pMDI+formoterol DPI). Study III: formoterol AUC was comparable across budesonide/formoterol pMDI formulation strengths; budesonide AUC increased with formulation strength in proportion to fine particle dose. Study IV: dose proportionality was demonstrated for budesonide (AUC ratio, 104.3%) and suggested for formoterol (AUC ratio, 117.6%) with budesonide/formoterol pMDI (steady state); budesonide and formoterol AUC was higher with repeated versus single-dose budesonide/formoterol pMDI (four inhalations). Conclusions: No pharmacokinetic interactions were observed between budesonide and formoterol. Budesonide dose variation in budesonide/formoterol pMDI did not affect formoterol exposure. Steady state budesonide/formoterol pMDI dose-doubling yielded proportional increases in budesonide and formoterol exposure. Copyright © 2008 John Wiley & Sons, Ltd.     

吸入噻托溴铵联合信必可治疗稳定期中重度COPD的有效性与安全性

目的探讨吸入噻托溴铵联合信必可治疗稳定期中重度慢性阻塞性肺疾病(COPD)的有效性与安全性。方法将2015年1月~2017年1月在我院接受治疗的60例稳定期中重度COPD患者作为研究对象,并给予随机分组,对照组30例给予单纯信必可吸入治疗;干预组30例,在对照组基础上加用噻托溴铵治疗,对两组患者治疗前后的肺功能相关指标、临床症状评分、临床治疗效果以及不良反应发生情况进行综合评价。结果干预组患者治疗后的FEV1、FVC、FEV1/FVC等肺功能指标显著优于对照组,差异有统计学意义(P0.05);干预组治疗1个月、2个月后的临床症状评分与对照组比较有明显差异(P0.05);且干预组治疗后有28例患者显示有效,占93.3%,显著高于对照组的70.0%,差异有统计学意义(P0.05);干预组患者治疗后不良反应发生率仅为6.7%,显著低于对照组的23.3%,差异有统计学有意义(P0.05)。结论采用吸入噻托溴铵联合信必可治疗稳定期中重度COPD,能够促进患者临床症状缓解,改善肺功能,疗效优于单纯信必可治疗,值得推广应用。     

Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries

AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.