目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺...目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺功能检查的患者共101例,其中,存在F-V曲线下降支夹角的稳定期COPD患者(夹角组)33例,与夹角组第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second as a percentage of predicted value,FEV1%pred)匹配的无下降支夹角的稳定期COPD患者(无夹角组)38例,既往无心肺疾病,且肺功能检测正常的受试者(对照组)30例。收集并比较各组患者基本资料、临床症状评分[COPD自我评估测试(COPD assessment test,CAT)、改良版英国医学研究委员会呼吸困难问卷(modified medical research council dyspnoea scale,mMRC)]、肺功能参数和运动后指脉氧参数。采用多因素Logistic回归分析F-V曲线下降支夹角的相关因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析F-V曲线下降支夹角对COPD随访1年内急性加重的预测价值。结果:夹角组肺功能受损程度严重,第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)和用力肺活量(forced vital capacity,FVC)分别为0.91±0.24、2.11±0.63;夹角组CAT评分、mMRC评分、ΔSpO_(2)高于无夹角组及对照组,步行运动后SpO_(2)L低于无夹角组及对照组,差异有统计学意义(P<0.05);夹角组CAT评分≥12分、m MRC评分≥2分、ΔSpO_(2)≥13%是F-V曲线下降支更易出现夹角的主要相关因素;F-V曲线下降支夹角预测重度稳定期COPD急性加重的曲线下面积为0.777,当角度<129.1°时其预测灵敏度、特异度均为最佳,分别为72.73%、67.35%。结论:F-V曲线呈现下降支夹角的COPD患者其肺功能常严重受损,且更易发生活动后低氧血症和急性加重。因此,COPD肺功能报告中应关注F-V曲线下降支是否存�展开更多
目的探讨下腔静脉塌陷指数及右室长轴应变与肺动脉高压(PAH)的相关性。方法选取94例PAH患者(观察组)和35例健康体检者(对照组),其中观察组根据肺动脉收缩压进一步分为轻度组32例(30~49 mm Hg,1 mm Hg=0.133 kPa)、中度组32例(50~69 mm ...目的探讨下腔静脉塌陷指数及右室长轴应变与肺动脉高压(PAH)的相关性。方法选取94例PAH患者(观察组)和35例健康体检者(对照组),其中观察组根据肺动脉收缩压进一步分为轻度组32例(30~49 mm Hg,1 mm Hg=0.133 kPa)、中度组32例(50~69 mm Hg)、重度组30例(≥70 mm Hg),比较各组下腔静脉塌陷指数、右室长轴应变、三尖瓣反流压差、肺动脉平均压(mPAP)、肺毛细血管阻力(PVR)、肺毛细血管楔压(PCWP)的差异;分析下腔静脉塌陷指数、右室长轴应变、三尖瓣反流压差与肺动脉收缩压、mPAP、PVR、PCWP的相关性。结果观察组下腔静脉塌陷指数、右室长轴应变、PCWP均低于对照组,mPAP、PVR、三尖瓣反流压差均高于对照组,差异均有统计学意义(均P<0.05)。重度组下腔静脉塌陷指数、右室长轴应变、PCWP均低于轻、中度组,mPAP、PVR、三尖瓣反流压差均高于轻、中度组,中度组下腔静脉塌陷指数、右室长轴应变、PCWP均低于轻度组,mPAP、PVR、三尖瓣反流压差均高于轻度组,差异均有统计学意义(均P<0.05)。相关性分析显示,下腔静脉塌陷指数、右室长轴应变与肺动脉收缩压均呈负相关(r=-0.796、-0.895,均P<0.05);三尖瓣反流压差与肺动脉收缩压呈正相关(r=0.541,P<0.05);下腔静脉塌陷指数、右室长轴应变与PVR均呈负相关(r=-0.410、-0.454,均P<0.05),与PCWP均呈正相关(r=0.262、0.288,均P<0.05);三尖瓣反流压差与mPAP、PVR、PCWP均呈正相关(r=0.589、0.657、0.653,均P<0.05)。结论PAH患者下腔静脉塌陷指数和右室长轴应变均明显降低,两者均与肺动脉收缩压呈负相关。展开更多
In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new mo...In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.展开更多
目的探讨流速-容积曲线中典型凹陷型图形在慢性阻塞性肺疾病诊断中的价值。方法回顾分析2021年10月—2022年3月以“咳嗽、咳痰、呼吸困难”为主诉且行支气管舒张试验检查的患者资料85份,患者行支气管舒张试验检查时用最强的呼气爆发力...目的探讨流速-容积曲线中典型凹陷型图形在慢性阻塞性肺疾病诊断中的价值。方法回顾分析2021年10月—2022年3月以“咳嗽、咳痰、呼吸困难”为主诉且行支气管舒张试验检查的患者资料85份,患者行支气管舒张试验检查时用最强的呼气爆发力完成流速-容积曲线。分别用慢性阻塞性肺疾病诊断标准和典型凹陷型图形对其进行回顾性分析。被诊断为慢性阻塞性肺疾病的患者有54例(定义为阳性),没有被诊断为慢性阻塞性肺疾病的患者有31例(定义为阴性)。流速-容积曲线中有典型凹陷型图形的患者有52例(定义为阳性),没有典型凹陷型图形的患者有33例(定义为阴性)。绘制配对四格表资料,用McNemar检验计算其P值,并对典型凹陷型图形作为慢性阻塞性肺疾病的诊断依据进行评价。用多元线性回归分析检验慢性阻塞性肺疾病气道阻塞程度指标第一秒用力呼气容积占预计值百分比(the ratio of foced expiratory volume in one second to predicted value,FEV_(1)占预计值%)、气道限闭程度指标深吸气量占预计值百分比(the ratio of inspiratory capacity to predicted value,IC占预计值%)对典型凹陷型图形角度α大小影响的效能。结果85例符合质控要求的参与者包括67例男性和18例女性。2种检查方法在对该组研究对象诊断的阳性率差异无统计学意义(63.53%vs.61.18%,χ^(2)=82.012,P=0.625>0.05)。该图形诊断慢性阻塞性肺疾病的灵敏度为94.4%,特异度为96.8%,约登指数为91.2%。气道阻塞程度FEV_(1)占预计值%决定着典型凹陷型图形角度α的大小(VIF=1.0,标准系数=0.585)。结论用最强的呼气爆发力完成的流速-容积曲线图形中的“典型凹陷型图形”在慢性阻塞性肺疾病的诊断上与其诊断标准具有相同的价值,然而典型凹陷型图形角度α的大小却取决于气道阻塞程度(FEV_(1)占预计值%)而不是气道限闭程度(IC占预计值%)。展开更多
[目的]观察辨证分型血府逐瘀汤+二陈汤苓+桂术甘汤联合西药治疗肺栓塞(痰瘀互结、水饮凌心)随机平行对照研究疗效。[方法]将48例住院患者按数字表法随机分治疗组和对照组各24例;低氧血症氧疗;合并下肢深静脉栓塞卧床休息。对照组予以低...[目的]观察辨证分型血府逐瘀汤+二陈汤苓+桂术甘汤联合西药治疗肺栓塞(痰瘀互结、水饮凌心)随机平行对照研究疗效。[方法]将48例住院患者按数字表法随机分治疗组和对照组各24例;低氧血症氧疗;合并下肢深静脉栓塞卧床休息。对照组予以低分子肝素、尿激酶溶栓、华法林。治疗组,辨证分型,痰瘀互结:血府逐瘀汤+二陈汤;水饮凌心,血府逐瘀汤+苓桂术甘汤;1剂/d,水煎300 m L,早晚口服;西药治疗同对照组。连续治疗10d为1疗程。观测临床表现、PCO2、PO2、心率、呼吸频率、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组显效20例,有效3例,无效1例,总有效率98.80%;对照组显效16例,有效5例,无效3例,总有效率87.50%;两组间无明显差异(P>0.05)。呼吸频率两组均有改善(P<0.05,P<0.01),PCO2、Pa O2、心率治疗组明显改善(P <0.05,P<0.01),对照组无明显变化(P>0.05)。[结论]辨证分型血府逐瘀汤+二陈汤苓+桂术甘汤联合西药治疗肺栓塞(痰瘀互结、水饮凌心),疗效满意,无严重不良反应,值得推广。展开更多
文摘目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺功能检查的患者共101例,其中,存在F-V曲线下降支夹角的稳定期COPD患者(夹角组)33例,与夹角组第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second as a percentage of predicted value,FEV1%pred)匹配的无下降支夹角的稳定期COPD患者(无夹角组)38例,既往无心肺疾病,且肺功能检测正常的受试者(对照组)30例。收集并比较各组患者基本资料、临床症状评分[COPD自我评估测试(COPD assessment test,CAT)、改良版英国医学研究委员会呼吸困难问卷(modified medical research council dyspnoea scale,mMRC)]、肺功能参数和运动后指脉氧参数。采用多因素Logistic回归分析F-V曲线下降支夹角的相关因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析F-V曲线下降支夹角对COPD随访1年内急性加重的预测价值。结果:夹角组肺功能受损程度严重,第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)和用力肺活量(forced vital capacity,FVC)分别为0.91±0.24、2.11±0.63;夹角组CAT评分、mMRC评分、ΔSpO_(2)高于无夹角组及对照组,步行运动后SpO_(2)L低于无夹角组及对照组,差异有统计学意义(P<0.05);夹角组CAT评分≥12分、m MRC评分≥2分、ΔSpO_(2)≥13%是F-V曲线下降支更易出现夹角的主要相关因素;F-V曲线下降支夹角预测重度稳定期COPD急性加重的曲线下面积为0.777,当角度<129.1°时其预测灵敏度、特异度均为最佳,分别为72.73%、67.35%。结论:F-V曲线呈现下降支夹角的COPD患者其肺功能常严重受损,且更易发生活动后低氧血症和急性加重。因此,COPD肺功能报告中应关注F-V曲线下降支是否存�
文摘目的探讨下腔静脉塌陷指数及右室长轴应变与肺动脉高压(PAH)的相关性。方法选取94例PAH患者(观察组)和35例健康体检者(对照组),其中观察组根据肺动脉收缩压进一步分为轻度组32例(30~49 mm Hg,1 mm Hg=0.133 kPa)、中度组32例(50~69 mm Hg)、重度组30例(≥70 mm Hg),比较各组下腔静脉塌陷指数、右室长轴应变、三尖瓣反流压差、肺动脉平均压(mPAP)、肺毛细血管阻力(PVR)、肺毛细血管楔压(PCWP)的差异;分析下腔静脉塌陷指数、右室长轴应变、三尖瓣反流压差与肺动脉收缩压、mPAP、PVR、PCWP的相关性。结果观察组下腔静脉塌陷指数、右室长轴应变、PCWP均低于对照组,mPAP、PVR、三尖瓣反流压差均高于对照组,差异均有统计学意义(均P<0.05)。重度组下腔静脉塌陷指数、右室长轴应变、PCWP均低于轻、中度组,mPAP、PVR、三尖瓣反流压差均高于轻、中度组,中度组下腔静脉塌陷指数、右室长轴应变、PCWP均低于轻度组,mPAP、PVR、三尖瓣反流压差均高于轻度组,差异均有统计学意义(均P<0.05)。相关性分析显示,下腔静脉塌陷指数、右室长轴应变与肺动脉收缩压均呈负相关(r=-0.796、-0.895,均P<0.05);三尖瓣反流压差与肺动脉收缩压呈正相关(r=0.541,P<0.05);下腔静脉塌陷指数、右室长轴应变与PVR均呈负相关(r=-0.410、-0.454,均P<0.05),与PCWP均呈正相关(r=0.262、0.288,均P<0.05);三尖瓣反流压差与mPAP、PVR、PCWP均呈正相关(r=0.589、0.657、0.653,均P<0.05)。结论PAH患者下腔静脉塌陷指数和右室长轴应变均明显降低,两者均与肺动脉收缩压呈负相关。
文摘In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.
文摘目的探讨流速-容积曲线中典型凹陷型图形在慢性阻塞性肺疾病诊断中的价值。方法回顾分析2021年10月—2022年3月以“咳嗽、咳痰、呼吸困难”为主诉且行支气管舒张试验检查的患者资料85份,患者行支气管舒张试验检查时用最强的呼气爆发力完成流速-容积曲线。分别用慢性阻塞性肺疾病诊断标准和典型凹陷型图形对其进行回顾性分析。被诊断为慢性阻塞性肺疾病的患者有54例(定义为阳性),没有被诊断为慢性阻塞性肺疾病的患者有31例(定义为阴性)。流速-容积曲线中有典型凹陷型图形的患者有52例(定义为阳性),没有典型凹陷型图形的患者有33例(定义为阴性)。绘制配对四格表资料,用McNemar检验计算其P值,并对典型凹陷型图形作为慢性阻塞性肺疾病的诊断依据进行评价。用多元线性回归分析检验慢性阻塞性肺疾病气道阻塞程度指标第一秒用力呼气容积占预计值百分比(the ratio of foced expiratory volume in one second to predicted value,FEV_(1)占预计值%)、气道限闭程度指标深吸气量占预计值百分比(the ratio of inspiratory capacity to predicted value,IC占预计值%)对典型凹陷型图形角度α大小影响的效能。结果85例符合质控要求的参与者包括67例男性和18例女性。2种检查方法在对该组研究对象诊断的阳性率差异无统计学意义(63.53%vs.61.18%,χ^(2)=82.012,P=0.625>0.05)。该图形诊断慢性阻塞性肺疾病的灵敏度为94.4%,特异度为96.8%,约登指数为91.2%。气道阻塞程度FEV_(1)占预计值%决定着典型凹陷型图形角度α的大小(VIF=1.0,标准系数=0.585)。结论用最强的呼气爆发力完成的流速-容积曲线图形中的“典型凹陷型图形”在慢性阻塞性肺疾病的诊断上与其诊断标准具有相同的价值,然而典型凹陷型图形角度α的大小却取决于气道阻塞程度(FEV_(1)占预计值%)而不是气道限闭程度(IC占预计值%)。
文摘[目的]观察辨证分型血府逐瘀汤+二陈汤苓+桂术甘汤联合西药治疗肺栓塞(痰瘀互结、水饮凌心)随机平行对照研究疗效。[方法]将48例住院患者按数字表法随机分治疗组和对照组各24例;低氧血症氧疗;合并下肢深静脉栓塞卧床休息。对照组予以低分子肝素、尿激酶溶栓、华法林。治疗组,辨证分型,痰瘀互结:血府逐瘀汤+二陈汤;水饮凌心,血府逐瘀汤+苓桂术甘汤;1剂/d,水煎300 m L,早晚口服;西药治疗同对照组。连续治疗10d为1疗程。观测临床表现、PCO2、PO2、心率、呼吸频率、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组显效20例,有效3例,无效1例,总有效率98.80%;对照组显效16例,有效5例,无效3例,总有效率87.50%;两组间无明显差异(P>0.05)。呼吸频率两组均有改善(P<0.05,P<0.01),PCO2、Pa O2、心率治疗组明显改善(P <0.05,P<0.01),对照组无明显变化(P>0.05)。[结论]辨证分型血府逐瘀汤+二陈汤苓+桂术甘汤联合西药治疗肺栓塞(痰瘀互结、水饮凌心),疗效满意,无严重不良反应,值得推广。
