目的:观察在急性期中重度慢性阻塞性肺疾病患者中应用肺康复治疗的临床效果.方法:择取2018年1月至2019年12月东莞市第五人民医院收治的50例急性期中重度慢性阻塞性肺疾病患者,按治疗方法将其分成三组,对照组10例患者行以常规对症支持治疗,观察1组20例患者基于常规对症支持治疗加行有氧呼吸训练,观察2组20例患者基于对症支持治疗加行有氧呼吸训练和上下肢训练等肺康复治疗,比较三组临床效果.结果:治疗前,三组中、重度患者的第1秒用力呼气容积(FEV1)预计值、改良呼吸困难指数(mMRC)以及6min步行距离比较,差异均无统计学意义(P＞0.05);治疗后,观察1组和观察2组患者的FEV1预计值、mMRC低于对照组,6 min步行距离多于对照组,且观察2组FEV1预计值以及6 min步行距离优于观察1组,差异均具有统计学意义(P＜0.05).结论:对于急性期中重度慢性阻塞性肺疾病患者来说,有氧呼吸训练、上下肢训练等肺康复治疗可以有效改善患者肺功能,同时也可以使患者呼吸困难得到改善.

目的:探讨无创通气治疗慢性阻塞性肺病急性加重疗效的影响因素.方法:2018年1月-2019年5月收治慢性阻塞性肺病处于急性加重期患者60例,分为两组,各30例.对照组接受常规治疗;研究组接受无创通气治疗.比较两组APACHEⅡ评分、GCS评分、PaO2、PaCO2.结果:研究组APACHEⅡ评分、GCS评分、PaCO2高于对照组,研究组PaO2低于对照组,差异均有统计学意义(P＜0.05).结论:对无创通气治疗慢性阻塞性肺病急性加重疗效的影响因素进行有效分析,并对其进行干预,可有效降低影响因素对患者疗效的影响,改善患者的各项指标.

目的 探讨细菌溶解产物对慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)患者免疫功能、临床疗效及肺功能的影响.方法 192例AECOPD患者随机分为观察组与对照组各96例,观察组在常规治疗的基础上给予细菌溶解产物胶囊(泛福舒胶囊)治疗.3个疗程结束后,对两组外周血T淋巴细胞亚群、免疫球蛋白(Ig)、补体、Th17细胞、Treg细胞比例进行检测分析,记录并比较两组治疗过程中急性发作次数、急性发作时间及发作期间抗生素应用时间;对比两组治疗后肺功能改善情况.结果 观察组治疗后CD3+细胞、CD4+细胞、CD4+/ CD8+细胞比例、免疫球蛋白(Ig)A、IgG、补体C3、C4水平均高于对照组,CD8+细胞低于对照组(P<0.05);观察组治疗后Th17细胞占CD4+T细胞比例高于对照组,Th17/Treg细胞比例高于对照组(P<0.05).观察组治疗后急性发作次数、急性发作时间及抗生素应用时间均少于对照组(P<0.05).观察组治疗12、24 w中发作及反复发作者比例低于对照组(P<0.05).观察组治疗后肺功能改变情况优于对照组(P<0.05).结论 细菌溶解产物能提高AECOPD患者的体液免疫及细胞免疫功能,增强机体的抗感染能力,降低COPD急性发作及反复发作次数,改善COPD患者的肺功能状态.

Objective To study and analyze the clinical effect of continuous positive airway pressure in treatment of sleep apnea syndrome and metabolic syndrome. Methods 100 patients with sleep apnea syndrome and metabolic syndrome cured in our hospital from June 2014 to May 2016 were divided into control group and research group with 50 cases in each.Patients in control group were treated with oropharynx orthotics,and patients in research group were treated with continuous positive airway pressure.Then the effects of two groups were compared. Results The total effective rate of research group was 90.00%,which was higher than that of control group with 62.00%(P < 0.05). The satisfaction degree of research group was 92.00%,which was higher than that of control group with 64.00% (P<0.05).After appropriate treatment,the average degree of blood oxygen saturation,average apnea time and respiratory disturbance index were significantly improved,compared with before the treatment(P < 0.05).The improvement of research group was better than that of control group(P<0.05). Conclusion The effect of continuous positive airway pressure treatment on sleep apnea syndrome and metabolic syndrome is obvious.It can improve sleep qualities and prognosis of the patients.

Objective To investigate the change of serum concentrations of IL‐17A and CXCL12 in patients with chronic ob‐structive pulmonary disease(COPD) and its correlation with illness severity and formation of lymph follicles .Methods Totally 88 cases of patients with COPD in acute phase in our hospital from 1 January 2014 to 1 January 2015 were selected as the research sub‐jects ,and were divided into mild group(n= 23) ,moderate group(n= 42) and severe group(n= 23) according to the severity of COPD ,and were divided into lymph follicles group(n=21) and non lymph follicles group(n=67) according to lymphoid follicles formation .Enzyme‐linked immunosorbent method was applied to detect the serum IL‐17A and CXCL12 concentrations of these groups in acute aggravating period and stability period ,and parameters of pulmonary function in the same period were also detected . The correlations of serum concentrations of IL‐17A and CXCL12 with illness severity ,formation of lymph follicles and lung function in patients with COPD were analysed .Results Compared with mild group ,serum concentrations of IL‐17A and CXCL12 of moder‐ate group and severe group in acute aggravating period and stable period were increased ,while FEV1 and FVC of medium group and severe group in the same period were decreased;compared with the moderate group ,serum concentrations of IL‐17A and CXCL12 of severe group in acute aggravating period and stable period were increased ,while FEV1 and FVC of severe group in the same period were decreased (P<0 .05) .Compared with non lymph follicles group ,serum concentrations of IL‐17A and CXCL12 of lymph folli‐cles group in acute aggravating period and stable period were increased ,while FEV1 and FVC of lymph follicles group in the same period were decreased (P<0 .05) .The results of correlation analysis showed that serum concentrations of IL‐17A and CXCL12 in patients with COPD were positively correlated to the illness severity and lymph follicle formation rate(IL‐17A :r=0 .728 ,0 .762 ;CXCL12 :r=0 .752 ,0 .776 ,P<0 .05) ,while were negatively correlated to FEV1 and FVC(IL‐17A :r= -0 .756 ,-0 .783 ;CXCL12 :r= -0 .743 ,-0 .767 ,P<0 .05) .Conclusion Serum concentrations of IL‐17A and CXCL12 in patients with COPD were associated with its illness severity ,pulmonary function and lymphoid follicles formation ,which may serve as a reference indexes for the assess‐ment of the illness severity ,pulmonary function and lymph follicle formation .

目的 探讨多索茶碱对支气管炎治疗的临床效果.方法 选择2013年2月至2014年6月支气管炎患者64例,随机分为对照组观察组,每组32例,分别给予氨茶碱及多索茶碱治疗,比较两组疗效.结果 观察组总有效率为93.75％,对照组为65.63％,两组比较差异有统计学意义(P＜0.05).结论 多索茶碱治疗支气管炎临床效果显著,值得临床推广应用.

Objective To investigate the curative effect of cisplatin combined with gemcitabine and cisplatin plus pacli-taxel in the treatment of advanced non-small cell lung cancer. Methods All 100 patients with non-small cell lung can-cer in our hospital from January 2012 to January 2014 in our hospital, randomly divided into observation group (gemc-itabine+cisplatin, GP group) and control group (paclitaxel+cisplatin, TP group), each group had 50 cases, two groups of patients every 21 days for a cycle, observed curative effect after 2 cycles, toxic and adverse reaction were compared between the two groups. Results The effective rate of the observation group after treatment was 42.0%(21/50),was higher than that of the control group 40% (20/50), but there was no significant difference (P>0.05). Conclusion Cura-tive effect of cisplatin combined with gemcitabine and cisplatin plus paclitaxel in the treatment of advanced non-small cell lung cancer is similar, the poisonous side effect is different and can be tolerated, for the treatment of advanced non-small cell lung cancer treatment plan better.

Objective To investigate the clinical effect of Broncho-Vaxom combined with postural drainage in the treatment of bronchiectasis.Methods 78 cases of bronchiectasis whose acute phase condition was under control after treatment,were randomly double-blind divided into two groups.Control group received postural drainage,and treatment group received Broncho-Vaxom capsule combined with postural drainage.Compared immune indexes after 3 months and clinical symptoms including cough and expectoration,number of respiratory infection during 6 months between two groups.Results Cough and expectoration symptoms after treatment in treatment group were better than those in control group (P=0.046),the number of respiratory tract infection was lower (P=3.43× 1012).Expression levels of CD4+,CD4+/CD8+,NK after treatment improved significantly in treatment group (P＜0.01),expression level of CD8+ decreased (P＜0.01).Expression levels of CD4+,CD4+/CD8+,NK in control group before and after treatment did not change significantly.The levels of IgG and IgA after treatment in treatment group were significantly higher those in control group (P＜0.01).Conclusions Broncho-Vaxom combined with postural drainage can relieve cough and expectoration symptoms of bronchiectasis patients,reduce the incidence of respiratory tract infection,enhance body immunity.Broncho-Vaxom has a good drug tolerance,with slight side effect.

目的 探讨ADAM33基因外显子多态及其与吸烟的交互效应,并探讨其与我国人群慢性阻塞性肺疾病(COPD)和支气管哮喘(简称哮喘)发病的关系.方法 应用病例对照研究方法,采用Taqman技术检测300例COPD患者、220例哮喘患者和320例正常对照者6个常见外显子多态(rs3918392A>G、rs2271511C>T、rs3918396A>G、rs528557G>C、rs2280091A>G、rs2280090A>G)的基因型,应用logistic模型分析各多态位点及其与吸烟的交互效应,并分析其与COPD和哮喘发病风险的关系.结果 rs2280091A>G和rs2280090A>G 与COPD和哮喘发病皆有显著关联(P<0.05).合并两位点后,危险基因型个数与吸烟在增加COPD风险上有显著的交互效应(P=0.016),该交互效应在哮喘风险上接近统计学显著性水平(P=0.060).此外,未发现其余4个基因多态性与COPD和哮喘发病有显著关联.结论 ADAM33基因外显子多态rs2280091A>G和rs2280090A>G能增加我国人群COPD和哮喘的发病风险,是COPD和哮喘的共有遗传易感位点.

目的:探讨B超定位针刺胸膜活检在胸膜疾病诊断中的阳性率和安全性。方法:对近4年诊断为胸膜疾病并行针刺胸膜活检、胸水脱落细胞检查的68例患者的临床资料进行回顾性分析。结果:68例胸膜活检中提示结核性胸膜炎23例(33.8%)、慢性炎症13例(19.1%)、腺癌11例(16.1%)、鳞癌5例(7.0%)、小细胞癌3例(4.4%)、不明部位的转移癌3例(4.4%)、间皮瘤1例(1.4%),活检失败得到胸膜组织病理报告为骨胳肌组织和纤维脂肪组织9例(13.2%),胸膜活检恶性阳性率33.8%,胸水脱落细胞阳性率仅为29.4%,总病理确诊率为86.7%。术后并发症主要是气胸3例(4.4%),胸膜反应2例(2.9%),出血1例(1.4%)。结论:在胸膜疾病中,B超定位针刺胸膜活检是一种有效的诊断手段,阳性率高,致命并发症极少。