目的:评价足量布地奈德溶液雾化治疗重度慢性阻塞性肺疾病急性加重期患者的临床应用价值。方法: 90例30%≤FEV1lt;50%的重度COPD急性加重期患者随机分为3组: 布地奈德组给予布地奈德溶液雾化吸入2mg/次,每8小时1次;甲泼尼龙组给予口服甲泼尼龙片24mg /次,1/日;对照组不使用任何糖皮质激素。疗程10d,观察3组患者治疗后肺功能,动脉血气和呼吸困难评分变化,以及糖皮质激素主要不良反应。结果: 与对照组相比,吸入布地奈德组和口服甲泼尼龙组在FEV1,PaO2,PaCO2和呼吸困难评分改善值方面,有显著差异性(Plt;005);吸入布地奈德组和口服甲泼尼龙组两组各项指标改善程度相似(Pgt;005);吸入布地奈德组和对照组的不良反应少于口服甲泼尼龙组 (Plt;005)。〖HTH〗结论:〖HTSS〗足量布地奈德溶液雾化治疗与口服糖皮质激素疗效相近,全身副作用小,安全性好,是重度COPD急性加重期糖皮质激素的有效选择。
Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IPA) in both animal studies and clinical researches. Methods MEDLINE, ISI, EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4. 22 sofeware was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio ( OR) and 95% confidence interval ( CI) . Results Five animal studies with a total of 626 animals were included. The overall survival rate of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was increased ( 38.3% vs. 9.7% , OR=13.93, 95% CI 7.46 ～26.01, Plt;0. 000 01) . Six clinical trials including 1354 patients were considered. Our meta-analysis showed that inhaled AmB could significantly reduce the incidence rate of IPA ( 2.6% vs. 9.2% , OR=0.27, 95% CI 0.16 ～0.46, P lt;0. 000 01) , but had no definite benefit on mortality. Four studies evaluated the potential side effects of nebulized AmB and showed that there were no significant adverse events. Conclusions Empirical inhaled AmB is associated with a lower rate of IPA but no significant
ObjectiveTo evaluate the clinical effects of nebulized lidocaine anesthesia and anesthesia with lidocaine and midazolam in patients with preoperative bronchoscopy. MethodsTotally, 136 inpatients between May 2002 and June 2013 with preoperative bronchoscopy were included in the study. The patients were randomly assigned to experimental group and control group with 68 patients in each. For patients in the experimental group, 8 mL of 2% lidocaine was administered through inhalation anesthesia, followed by 2-3 mg bolus of midazolam, and subsequently 0.5 mg of midazolam was administered every 2 minutes depending on patients' awareness. Patients in the control group accepted lidocaine alone for anesthesia. The clinical efficacy and adverse effects of both the two ways of anesthesia were observed. ResultsThe time of sustained and effective anesthesia was (24.5±2.8) minutes in the experimental group, as compared with (16.8±2.1) minutes in the control group (P<0.01). The average amount of consumption of lidocaine was (12.4±1.3) mL in the experimental group, as compared with (16.8±1.5) mL in the control group (P<0.01). The heart rate at 5 min after operation was (81.5±19.5) beats/min in the experimental group, as compared with (94.6±34.6) beats/min in the control group (P<0.01). The mean pulse oxygen saturation at 5 min after operation was (93.5±3.6)% in the experimental group, as compared with (88.2±13.3)% in the control group (P<0.01). ConclusionCombined application of lidocaine and midazolam before bronchoscopy is simple and feasible for anesthesia, which has higher success rate, lesser side effects and other reactions such as body movement and coughing.
ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.
ObjectiveTo observe the clinical efficacy of triple aerosol inhalation of pulmicort respules,ipratropine and ventolin in treatment of severe acute asthma exacerbations in adults. Methods46 cases of severe asthmatic patients with acute exacerbations admitted between May 2011 and May 2013 were recruited in the study.They were randomly divided into a treatment group and a control group,23 cases in each group.The control group received aminophylline and methylprednisolone intravenously,while the treatment group received triple aerosol inhalation of pulmicort respules,ipratropine and ventolin on the basic treatment of the control group.The clinical efficacy,the score of asthma symptom of the day and night,the time of disappearance of symptoms and wheezing sound,the glucocorticoid dosage and the incidence of adverse reactions of each group were compared. ResultsComparison of clinical efficacy of two groups drew significant differences (P<0.05) after 7 days.The score of asthma symptom of the day and night in the treatment group was lower than that of the control group (P<0.05).Except cough,the duration of wheezing,breathlessness,chest distress and extinction time of wheezing sound in the treatment group were shorter than those in the control group (P<0.05).The triple inhalation therapy can reduce the dosage and shorten the period of intravenous glucocorticoid treatment with slight adverse reactions (P<0.05). ConclusionIn the treatment of severe asthmatic patients with acute exacerbations,the clinical efficacy of triple aerosol inhalation of pulmicort respules,ipratropine and ventolin on the base of intravenous treatment is satisfactory with rapid onset,which can also reduce the glucocorticoid dosage and the incidence of adverse reactions.So the combination therapy is worthy of clinical use.
Objective To investigate the expression of stromal cell derived factor-1 ( SDF-1) and the effects of budesonide suspension for inhalation ( Pulmicort Respules) in mice with asthma. Methods Thirty Kunming female mice were randomly divided into three groups, ie. a control group, an asthma group, and a pulmicort treatment group. The asthma group and the pulmicort treatment group were sensitized with ovalbumin ( OVA) by a combination of intraperitoneal injection and repeated OVA intranasal challenges to establish mouse asthma model. The pulmicort treatment group received 100μL pulmicort by intranasal administration before OVA challenge. The immunohistochemistry was used to estimate the expression of SDF-1 in lung tissues. HE staining and Wright-Giemsa staining method were used to assess inflammatory infiltration in the airway and bronchoalveolar lavage fluid ( BALF) respectively. Results The expression of SDF-1 in the asthma group increased significantly compared with the control group ( 0.48 ±0.03 vs. 0.21 ± 0.02, Plt;0.05) , and significantly decreased after the intervention with pulmicort ( 0.29 ±0.01 vs. 0.48 ± 0.03, Plt; 0.05 ) . Compared with control group, the infiltration of inflammatory cells in airway was significantly enhanced in the asthma group, and attenuated in the pulmicort treatment group. The total number of inflammatory cells and eosinophil, lymphocyte, neutrophil counts in BALF increased significantly in the asthma group compared with the control group, and decreased significantly after pulmicort intervention. Conclusion SDF-1 may play an important role in the recruitment of inflammatory cells in asthmatic airway and pulmicort may relieve airway inflammation by decreasing the expression of SDF-1.
Objective To assess the clinical efficacy of ultrasonic atomization of penicillin combined with erythromycin in children with acute suppurative tonsillitis. Methods From July 2007 to December 2007, 70 children with a confirmed diagnosis of acute suppurative tonsillitis were randomized into two groups. Thirty-one patients in the control group received continuous 5-day treatment of routine intravenous drip of penicillin (200000units/ (kg?d)), twice a day, while 39patients in the trial group received, in addition to the routine treatment, another 5-day treatment of ultrasonic atomization of 0.1 g erythromycin and 10ml saline diluted by 10ml sterile water, 15min for each treatment, twice a day. Observation of the clinical efficacy of the two groups and statistical analyses were conducted. Results The cure rate and total effective rate of the trial group were 61.54% and 97.44%, and those of the control group were 35.48% and 77.42%, respectively. The pyretolysis rates at 48 h and 72 h in the trial group were 75.36% and 89.74%, and those in the control group were 45.16% and 61.29%, respectively. The improvement rates of pharyngodynia at 48 h and 72 h in the trial group were 76.92% and 92.31%, and those in the control group were 48.39% and 70.97%, respectively. The results of both rank sum test and chi-square test revealed significant differences between the trial group and the control groups (Plt;0.05), which indicated that the trial group was superior to the control group in terms of cure rate, total effectiveness rate, pyretolysis rate and improvement of pharyngodynia. During ultrasonic atomization, 3 patients experienced mild nausea and vomiting, all of which disappeared after rest. No other adverse reactions were recorded. Conclusions Ultrasonic atomization of penicillin combined with erythromycin for children with acute suppurative tonsillitis is worthy of clinical application due to its better efficacy and safety profile.
Objective To evaluate the effects of midazolam intravenous drip combined with lidocaine via nebulization on patients during mechanical ventilation in intensive care unit ( ICU) . Methods 60 thoracic patients required postoperative mechanical ventilation in ICUwere randomized into 2 groups. The patients in therapeutic group received lidocaine 1 mg/kg via nebulization and midazolam intravenous drip 0. 1 mg·kg- 1·h- 1 . The patients in control group received 0. 9% NaCl 1 mg/kg via nebulization andmidazolam0. 1 mg·kg- 1 ·h- 1 . According to the scale of Ramsay, the additional midazolam and fentanyl were injected to maintain sedation and inhibit cough in both groups. During ventilation, calm score, the number and the severity of cough, the mean arterial pressure ( MAP) , heart rate ( HR) , and the consumption of midazolam and fentanyl were record. Results The number and severity of cough, the scale of MAP and HR in the therapeutic group were all significant lower than those in the control group ( P lt; 0. 05) . Theconsumption of midazolam and fentanyl in the therapeutic group were also significantly lower than that in the control group ( P lt; 0. 05) .Conclusion Midazolam intravenous drip combined with lidocaine via nebulization can reduce the side effects and requirement of sedative and opioids drug in ICU patients undergoing mechanical ventilation.
ObjectiveTo explore the effect of respiratory support in Community Respiratory Support Center on patients with chronic obstructive pulmonary disease (COPD) in stable phase. MethodsSixty-four GOLD gradeⅢpatients with stable COPD over age of 55 years were randomly divided into two groups.A respiratory support group received respiratory support in Community Respiratory Support Center, including health education, long-term oxygen therapy (LTOT), long-term ambroxol for atomization, long-term budesonide and formoterol for inhalation.A control group were prescribed budesonide and formoterol for inhalation when recruited, informed LTOT and long-term ambroxol for atomization at home, and follow-up visits to clinic every month. ResultsAfter 24 months of treatment in the respiratory support group, SpO2, PaO2, FEV1%pred, 6MWD, BMI, and ALB increased, mMRC, CAT, Hb, PaCO2 decreased (P < 0.05).While in the control group, FEV1%pred decreased, mMRC and CAT increased (P < 0.05), other indexes did not change significantly (P > 0.05).The times of acute exacerbation and hospitalization of the respiratory support group was less than that in the control group(P < 0.05). ConclusionsEstablishing Community Respiratory Support Center will benefit patients with stable COPD correct hypoxemia, slow the deterioration of lung function, improve the nutritional status of patients, and can also increase patients compliance to treatment.