哮喘发作有24小时缓冲期 一般来说,哮喘并不是一个突然性发作后直接导致死亡的疾病.而造成死亡的哮喘,多数由于合并其他疾病所致.在正常情况下,哮喘发作后大约半小时或以上,憋气、喘息或呼吸困难的症状会自主缓解. 哮喘发作时,气管会出现痉挛,但气管中的软骨也能帮助人体保持呼吸,吸入氧气.因此,对于单纯性的哮喘,若急性发作后,患者仍有24小时的缓冲时间,可前往医院寻求帮助.若哮喘发作且身边没有急救药物,应该在病情稍作缓解后,马上前往医院就诊治疗.

目的 根据新型冠状病毒肺炎(COVID-19)病理特征,探讨“痰栓”的本质、黏液溶解剂治疗的可行性及其药物选择.方法 综述COVID-19病理特征等相关文献,结合笔者的工作体会,总结出COVID-19黏液溶解剂治疗方法.结果 “痰栓”并不是脓痰;“痰栓”中的黏液成分中,均含有大量的酸性黏蛋白.黏液溶解剂氨溴索盐酸盐与乙酰半胱氨酸对COVID-19具有重要的治疗作用.结论 对COVID-19病人应常规使用黏液溶解剂进行治疗.

Introduction: This study was to develop a simple model for predicting malignancy of peripheral pulmonary lesions (PPLs) based on endobronchial ultrasonography (EBUS) and clinical findings. Methods: Patients who had EBUS for PPLs were analyzed and compared on the EBUS imaging characteristics and clinical data. The malignancy prediction model was established by the logistic equation of probability of malignant PPL based on the data of 135 patients. The model was tested on an additional 50 patients for efficiency. Results: Among 135 prospectively enrolled patients, 77 (57%) patients had malignant and 58 (43%) had benign lesions with the size of 36.5 19.9 mm. Univariate analysis demonstrated a significant (P<0.05) difference in the serum CEA (borderline 15 mu g/mL) and smoking history between malignant and benign lesions but a non-significant (P>0.05) difference in age (50 years as the cutoff value) and history of extra-thoracic malignancies. Logistic analysis of multiple factors showed that smoking history, serum CEA, borderline, air bronchogram, heterogeneous echo, and anechoic areas were significant (P<0.02) risk factors for malignant lesions. The malignancy prediction model was established by the logistic equation of probability of malignant PPL (P) = 1/[1+e(-Z)], where Z=-2.986+1.993X(1)+2.293X(2)+1.552X(3)+1.616X(4)-2.011X(5)+1.718X(6), e is the base of the natural logarithm, X-1 is the smoking history, X-2 is the serum CEA, X-3 is the borderline, X-4 is the heterogenicity, X-5 is the air bronchogram, and X-6 is the anechoic area. The receiver operating characteristic curve had an area under the curve (AUC) of 0.926 (95% confidence interval: 0.883-0.969). The sensitivity, specificity, and accuracy were 88.2% (30/34), 75.0% (12/16), and 92.0% (46/50), respectively, for the logistic equation to predict the malignancy. Conclusion: Endobronchial ultrasonography is a safe and practical method, and the model combining EBUS and clinical data can accurately predict the malignancy of peripheral pulmonary lesions.

目的 希望临床医生根据COVID-19的病理生理学特点,针对性选用治疗药物.方法 综述COVID-19及SARS的相关文献,结合笔者的工作体会,总结出COVID的精准治疗方法.结果 发现氧化自由基是发病的重要机理之一,细胞免疫力下降体现在疾病的全过程,而且与疾病严重性成正比,炎性因子广泛增高,但有些是正向作用(如IL-6),而有些是负向作用(如IL-8),可能是机体复杂的调节结果.结论 COVID-19病人应常规抗氧化物治疗,常规使用提高细胞免疫力的药物,虽然有“炎性风暴”也不提倡应用糖皮质激素.

1Department of Respiratory and Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China; 2Department of Interventional Therapy, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China; 3Department of Respiratory Medicine, Zhongshan University Sixth Affiliated Hospital, Guangzhou, Guangdong, People’s Republic of China Introduction: This study was to develop a simple model for predicting malignancy of peripheral pulmonary lesions (PPLs) based on endobronchial ultrasonography (EBUS) and clinical findings. Methods: Patients who had EBUS for PPLs were analyzed and compared on the EBUS imaging characteristics and clinical data. The malignancy prediction model was established by the logistic equation of probability of malignant PPL based on the data of 135 patients. The model was tested on an additional 50 patients for efficiency. Results: Among 135 prospectively enrolled patients, 77 (57%) patients had malignant and 58 (43%) had benign lesions with the size of 36.5±19.9 mm. Univariate analysis demonstrated a significant (P<0.05) difference in the serum CEA (borderline 15 μg/mL) and smoking history between malignant and benign lesions but a non-significant (P>0.05) difference in age (50 years as the cutoff value) and history of extra-thoracic malignancies. Logistic analysis of multiple factors showed that smoking history, serum CEA, borderline, air bronchogram, heterogeneous echo, and anechoic areas were significant (P<0.02) risk factors for malignant lesions. The malignancy prediction model was established by the logistic equation of probability of malignant PPL (P) = l/[l+e], where Z=−2.986+1.993X1+2.293X2+l.552X3+1.616X4–2.011X5+1.718X6, e is the base of the natural logarithm, X1 is the smoking history, X2 is the serum CEA, X3 is the borderline, X4 is the heterogenicity, X5 is the air bronchogram, and X6 is the anechoic area. The receiver operating characteristic curve had an area under the curve (AUC) of 0.926 (95% confidence interval: 0.883–0.969). The sensitivity, specificity, and accuracy were 88.2% (30/34), 75.0% (12/16), and 92.0% (46/50), respectively, for the logistic equation to predict the malignancy. Conclusion: Endobronchial ultrasonography is a safe and practical method, and the model combining EBUS and clinical data can accurately predict the malignancy of peripheral pulmonary lesions.

许多慢阻肺患者一感觉自己呼吸困难的症状有所缓解,就认为已经痊愈.实际上,慢阻肺的病程分为“稳定期”和“急性加重期”.在夏季,很多患者处于稳定期,此时虽咳喘减轻,但尚未痊愈,得坚持治疗.稳定期坚持治疗的主要目的在于预防慢阻肺急性加重,改善日常活动能力,尽可能恢复受损的心肺功能,防止或减缓心肺功能继续减退及各种并发症的发生.

目的 探讨肺泡灌洗联合局部用药治疗呼吸道重症感染的效果及肺泡灌洗液(BALF)和血清炎症因子水平对其转归的预测意义.方法 纳入呼吸道重症感染患者125例,入院后均完善相关检查,给予对症治疗,常规静脉应用抗生素联合肺泡灌洗及局部用药治疗.采用酶联免疫吸附试验(ELISA)检测灌洗前和灌洗后1d血清炎症因子[包括白细胞介素(IL)-6、IL-8、C反应蛋白(CRP)和降钙素原(PCT)]水平及灌洗后BALF中上述炎症因子水平.根据临床转归将患者分为有效组105例和无效组20例,比较两组患者灌洗前和灌洗后1d血清炎症因子水平及灌洗后BALF炎症因子水平.采用Pearson相关分析评估两组患者灌洗前后血清与灌洗后BALF炎症因子水平的相关性.结果 两组患者BALF细菌培养总阳性率及菌群分布构成比比较差异均无统计学意义(x2 =0.163,P=0.687;x2=0.956,P=0.916).两组患者灌洗前血清炎症因子水平比较,差异均无统计学意义(P＞0.05).有效组灌洗后血清炎症因子水平明显低于灌洗前(P＜0.05),而无效组灌洗前后血清炎症因子水平比较,差异均无统计学意义(P＞0.05).有效组灌洗后血清和BALF炎症因子水平均低于无效组同一时间同一部位(P＜0.05).Peanon相关分析结果显示,有效组患者灌洗前血清与灌洗后BALF IL-6、IL-8、CRP及PCT水平均呈正相关(P＜0.05),而有效组患者灌洗后血清与灌洗后BALF及无效组灌洗前血清与灌洗后BALF、灌洗前血清与灌洗后BALF IL-6、IL-8、CRP及PCT水平均无相关性(P＞0.05).结论 肺泡灌洗联合局部用药治疗呼吸道重症感染具有较高的安全性和有效性,检测BALF和血清炎症因子水平对其转归具有重要的预测意义.

目的 制备西罗莫司涂层支架及探讨药物涂层支架的体外药物释放过程.方法 配制不同浓度比例的西罗莫司/聚乳酸-羟基乙酸共聚物(PLGA),制成浸涂液,将清洗过的裸镍钛合金支架置人浸涂液中;通过扫描电镜观察支架表面的形态、结构和覆膜厚度;用酶放大免疫法测定支架的药物释放量.结果 西罗莫司可顺利、均匀地附着于支架表面;西罗莫司/PLGA质量比为1∶10的支架上携带的药物量最多,支架涂层的载药量存在饱和效应.气管涂层支架平均载药量为(80.07±2.26) μg.连续6周的体外药物浓度测定发现,西罗莫司气管支架的药物释放在前10天内呈快速释放过程,此后紧跟一个缓慢释放过程.结论 西罗奠司涂层支架具有良好的表面形态学特征,并具有持续有效的药物释放特性,值得进一步研发应用.

目的 探讨白细胞介素(IL)-17及转化生长因子( TGF)-β1在老年支气管哮喘患者诱导痰中的变化及临床意义.方法 收集门诊及中山大学附属第六医院呼吸内科门诊及住院的60例老年支气管哮喘患者作为观察组(包括中重度32例、轻度患者28例);另外选取同期老年健康志愿者26例作为对照组,通过人工诱导的方法获得痰液,酶联免疫吸附试验法( ELISA)检测IL-17及TGF-β1水平,测定第1秒用力呼气容积占预计值百分比(FEV1% ).观察组患者给予吸氧、静脉滴注氨茶碱、雾化、止咳、化痰等常规治疗.比较观察组治疗前与对照组以及哮喘轻度组与哮喘中重度组诱导痰中IL-17、TGF-β1、FEV1%水平,比较观察组治疗前后诱导痰中IL-17、TGF-β1、FEV1%水平,分析观察组诱导痰中IL-17与TGF-β1及FEV1%水平的相关性.结果 观察组诱导痰中IL-17、TGF-β1水平明显高于对照组,FEV1%明显低于对照组(P<0. 05);哮喘中重度组诱导痰中IL-17、TGF-β1水平明显高于哮喘轻度组,FEV1%明显低于哮喘轻度组(P<0. 05);治疗后观察组诱导痰中IL-17、TGF-β1水平明显低于治疗前,FEV1%明显高于治疗前,差异有统计学意义(P<0. 05).直线相关分析显示,老年支气管哮喘患者诱导痰中IL-17与TGF-β1水平呈正相关( P<0. 05),IL-17与FEV1%呈负相关(P<0. 05).结论 IL-17及TGF-β1参与了老年支气管哮喘相关的细胞免疫反应及气道炎症,IL-17及TGF-β1可以作为支气管哮喘患者临床病情判定和疗效观察的参考指标.

目的 探讨强化排痰方案辅助BAL对行机械通气重症肺炎患者呼吸功能、生命体征及死亡率的影响.方法 选取我院2015年8月-2017年8月收治行机械通气重症肺炎患者共110例,以随机数字表法分为对照组(55例)和观察组(55例),分别给予BAL单用和在此基础上加用强化排痰方案治疗;比较两组患者临床疗效、治疗前后呼吸功能指标水平、生命体征指标水平、机械通气时间、ICU住院时间及随访28d死亡率.结果 观察组患者治疗总有效率显著高于对照组(P<0.05);观察组患者治疗后PaO2/FiO2、Cdyn及WOB水平均显著优于对照组、治疗前(P<0.05);两组患者治疗前后生命体征指标水平比较差异无统计学意义(P>0.05);观察组患者机械通气时间和ICU住院时间均显著短于对照组(P<0.05);两组患者随访28d死亡率比较差异无统计学意义(P>0.05).结论 强化排痰方案辅助BAL治疗行机械通气重症肺炎可有效控制感染症状,改善呼吸功能,加快病情康复进程,且未影响生命体征.

目的 观察辛伐他汀对慢性阻塞性肺疾病(COPD)患者血清IL-8、TNF-α及第1秒用力呼气容积占预计值百分比(FEV1％)水平的影响.方法 55例COPD患者随机采用常规治疗(28例)或加用辛伐他汀治疗(27例),检测COPD患者及健康对照者血清IL-8、TNF-α及FEV1％水平.结果 治疗前COPD患者的IL-8、TNF-α水平均明显高于健康组(P＜0.01),FEW1％明显低于健康组(P＜0.01),以COPD急性发作组更为显著(P＜0.01).治疗后他汀组血清IL-8及TNF-α水平显著低于常规组(P＜0.01),FEV1％水平高于常规组(P＜0.01).结论 辛伐他汀可有效降低COPD患者血清IL-8及TNF-α水平,改善肺功能.

目的:讨论慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者30日再入院率与体重指数的关系.方法:选取2016年7月-2017年6月本院治疗的COPD患者134例,根据体重指数(body mass index,BMI)分为低体重组、正常体重组及超重组.收集三组患者30日内再入院率、非30日内再入院率、住院时间、气流阻塞程度(FEV1％)、稳定期呼吸困难情况,并进行比较.结果:低体重组30日再入院率、住院时间、FEV1％、稳定期呼吸困难情况与正常体重组及超重组比较,差异均有统计学意义(P<0.05).结论:低体重指数患者30日再入院率更高,气流阻塞程度和呼吸困难程度更重,住院时间更长,改善COPD患者的营养状态,对改善患者的生活质量和延长患者的稳定期,具有重要的临床指导价值.

近年来,关于自身免疫反应失衡是否在支气管哮喘（简称哮喘）的发病中起到某种关键作用的话题备受关注 [ 1-2]。有研究发现白介素（IL）-17可通过多种途径参与哮喘的发病和调节,哮喘患者体内IL-17可诱导多种细胞分泌细胞因子以及炎症介质,进而参与哮喘的发生发展过程。1资料与方法选取2015年10月至2017年6月在广东医科大学附属第三医院呼吸内科（38例）及中山大学附

BACKGROUND:This study compared the efficacy and safety of fluticasone propionate (FP) inhalation n solution with budesonide (BUD) suspension for inhalation administered via nebulizer, in Chinese adult patients with severe, persistent asthma.METHODS:This was a multicenter, randomized, active-controlled, single-blind, parallel-group study, conducted at 26 clinical sites in China. Participants were randomized 1:1 to FP nebules 1 mg twice daily or BUD 2 mg twice daily via nebulizer for 12 weeks.RESULTS:A total of 317 adult patients were randomized. The primary endpoint was mean change in morning peak expiratory flow (PEF) over weeks 1-12 from baseline, and analyzed in the ITT (n=315) and PP populations (n=283). Week 12 PEF increase from baseline was 26.7 L/min (14.1%) and 28.0 L/min (15.3%) in the ITT population, and 29.1 L/min (15.7%) and 30.1 L/min (16.2%) in the PP population, in the FP and BUD groups, respectively; all improvements were of clinical significance. Lower limits of the two-sided 95% CIs for the least squares (LS) mean treatment difference (FP minus BUD) were -12.19 L/min (ITT) and -12.95 L/min (PP), both above the pre-specified non-inferiority criteria -12.00 L/min and not clinically meaningful. There was no significant difference in the week 12 mean FEV1 increase between the FP and BUD groups (0.237 L/16.79% vs. 0.236 L/17.73%). Lower limits of the 95% CIs for LS mean treatment difference in morning PEF change from baseline over weeks 1-4 in a post hoc analysis were -10.41 and -11.96 L/min in the ITT and PP populations respectively; both above -12.00 L/min. A review of safety data indicated that rates of AEs, SAEs, and drug-related AEs were similar between two groups.CONCLUSIONS:The 12-week treatment of FP inhalation solution administered via nebulizer is safe and effectively for treating severe, persistent asthma in Chinese patients over 12 week.

目的 分析肥胖、超重对老年慢性阻塞性肺疾病稳定期患者肺功能的影响.方法 选取2015年2月~2016年3月在我院接受治疗的62例老年慢性阻塞性肺疾病稳定期患者为研究对象,将其按照不同体质量分为肥胖组、超重组与正常组,并比较三组患者的肺功能差异.结果 正常组在呼出75%的肺活量时肺总量(TLC)、最大呼气流量(V25)、最大呼气中段流量(MMF)以及一氧化碳弥散量(DLCO)明显优于肥胖组、超重组,差异有统计学优于(P<0.05).结论 肥胖、超重影响老年慢性阻塞性肺疾病稳定期患者肺功能的正常工作,严重影响患者的生活品质.

[目的]评价西罗莫司洗脱支架的可行性、安全性,明确其对兔子气管支架内再狭窄的作用.[方法]将16只新西兰白兔分为实验组(n=8)和对照组(n=8),实验组横向切开兔气管,置入自制西罗莫司洗脱支架后闭合气管.对照组同等条件下置入裸金属支架.分别于术后2、4周使用超细气管镜观察气管支架内肉芽组织生长情况.术后第4周处死所有动物,取气管标本,HE染色后进行组织学观察.[结果]支架内肉芽组织厚度(μm)实验组(813±236)小于对照组(1578±508)(P=0.004),气管支架区炎症反应程度实验组(平均秩次4.93)少于对照组(平均秩次10.07)(P=0.014).[结论]西罗莫司洗脱支架对兔子气管支架置入后引起的肉芽组织生长及炎症反应有一定程度的抑制作用,是一个安全有效的新型药物洗脱支架,有潜在的临床应用价值.

Stent implantation is a fast effective method for airway stenosis caused by infection,trauma,tumor and other diseases,but the implanted stents can cause abnormal fibrous tissue hyperplasia which result in in-stent restenosis.In recent years,the drug-eluting stents (DES) come out,it can release slowly the drugs which inhibit the granulation growth and also resolve the difficulty of stents to remove.But DES is lack of research on applying to the airway in-stent restenosis,the paper discusses the existing problems and the direction of further research about DES.

Objective To investigate the diagnostic value of CEA by using endogenous marker to quantify the dilution to peripheral lung cancer in bronchoalveolar lavage fluid ( BALF) . Methods 69 patients were inspected with bronchoalveolar lavage ( BAL) , and their levels of total protein, albumin, urea nitrogen, potassium and CEA in&nbsp;serum and BALF were detected. Results 1. There was no significant difference in CEA in blood serum and BALF between the two groups. The level of BFCA in BALF was higher in the lung cancer group than in the non-lung cancer group by using endogenous marker to quantify the dilution. 2. The area under ROC curve of every diagnosis indicator was between 0. 70 and 0. 90. Taking 680. 01 ng/ml of BFCA as optimal cut-off in BALF by using albumin as endoge-nous marker to quantify the dilution, the sensitivity was 96. 9%, and the specificity was 50%. Taking 127. 24 ng/ml of BFCA as optimal cut-off in BALF by using urea nitrogen as endogenous marker, the sensitivity was 59. 4%, and the specificity was 95. 5%. Taking 165. 39 ng/ml of BFCA as optimal cut-off in BALF by using potassium as endoge-nous marker, the sensitivity was 68. 8%, and the specificity was 86. 4%. Taking 2595. 29 ng/ml of BFCA as optimal cut-off in BALF by using total protein as endogenous marker, the sensitivity was 53. 1%, and the specificity was 86. 4%. Conclusion The level of CEA in BALF by using endogenous marker to quantify the dilution can dismiss the effect of dilution, and the combined endogenous marker can improve the sensitivity and specificity.

Objective To use the endobronchial ultrasonographic features of peripheral lung cancer with clinical data and establish a model to estimate the probability of malignancy in peripheral pulmonary lesions(PPLs),and evaluate its clinical diagnostic value.Methods Between September lst 2010 and May 30th 2015,endobronchial ultrasonography (EBUS)were performed in 150 patients with peripheral pulmonary lesions.At last,the EBUS images of the 135 cases were en-rolled,who had a definite pathological diagnosis.Analyse and record the characters of endobronchial images.Results According to the result of binary multivariable logistic regression analysis,we concluded two clinical data and five distinct EBUS image patterns which contribute to predicting the presence of malignancy.The equation of malignancy probability for any patient was:P = l/[l + e-(-2.9861.993smorking +2.293CEA +1.552 borderline +l.616 heterogeneity-2.011 air bronchogram +1.748 anechoic area)];the area under the ROC curve (AUC)was 0.926(95% CI:0.883-0.969),with P≥0.62 for the diagnosis of community values,it is concluded that the sensi-tivity of this equation was 69/77=89.6% and specificity was 42/58=72.4%,the accuracy rate was 82.2%.Conclusion ①Endobronchial ultrasonography in diagnosis of benign and malignant pulmonary peripheral lesions have a high value,and is an effective method of imaging.②Combining image results with the clinical data to establish binary logistic models to predict the malignant probability could raise the accuracy.

[目的]应用气道内超声(EBUS)检测慢性阻塞性肺疾病(COPD)患者的气道重塑,并探讨EBUS测量的COPD患者气道径线与患者肺功能之间的关系.[方法]40例受试者分为COPD组(20例)和对照组(20例)两组,均进行EBUS及肺功能检查.EBUS检查受试者的左主支气管、左上叶支气管、右中叶支气管和右下叶后基底段支气管(B10),并测量其管壁总厚度(T)、黏膜层厚度(TL1)、黏膜下层厚度(T12)、外膜层总厚度(T1.3～L5)、管腔面积(Ai)和管壁面积(WA).[结果]左主支气管:COPD组的T、TL1、T12 、WA大于对照组,P均＜0.05,两组T1.3～L5、Ai相近;左上叶支气管:COPD组的T、TL1、WA大于对照组,P均＜ 0.05,两组T12、T1.3～L5、Ai相近;右中叶支气管和右B10:COPD组的T、TL1、T12、 WA大于对照组,Ai小于对照组,P均＜ 0.05,两组T1.3～L5相近.相关性分析:左主支气管的径线与肺功能无显著相关关系.叶支气管的黏膜层和黏膜下层的增厚与COPD的气流受限相关,结果如下:COPD患者左上叶支气管T1.1与FEV1、FVC(r=-0.517～-0.448)呈负相关.右中叶支气管的TL1与FEV1/FVC呈负相关(r=-0.533);TL1.2与FEV1、FVC(r=-0.590 ～-0.507)呈负相关.相对于叶支气管,右B10黏膜层和黏膜下层厚度与气流受限的相关性更强,管壁总厚度和面积与气流受限的相关性不及黏膜(L1)和黏膜下层(L2)强,结果如下:右B10的T与FEV1、FEV1％、FVC和FVC％(r=-0.519 ～-0.504)呈负相关;TL1与FEV1、FEV1％、FVC、FVC％和FEV1/FVC(r=-0.902～-0.566)呈负相关;TL2与FEV1、FEV1％和FVC％呈负相关(r=-0.597～-0.472);Ai与FEVi(r=0.475)、FEV1％、FVC和FVC％呈正相关(r=0.457 ～ 0.527);WA与FEV1％和FVC％(r=-0.502 ～-0.470)呈负相关.[结论]COPD患者1～4级支气管的气道壁明显增厚,尤其是黏膜层和黏膜下层,管腔有狭窄趋势,这些气道的径线与气流受限存在一定的相关性,并且这种相关关系在分级较高的支气管中较明显;EBUS相对无创,并且可以精确的反映气道壁各层厚度的实际变化,是理想的气道形态学检测方法,并有希望成为COPD气道重塑的诊断手段.