Objective To evaluate the effects of cardioselective beta-blockers on respiratory function in patients with chronic obstructive pulmonary disease ( COPD) . Methods We used computer to search the Cochrane Controlled Trials Register database, Medline, Netherlands EMBASE/Excerpta Medica,EBSCO database, China Academic Journal and the Chinese Biomedical Literature Database, as well as respiratory magazines and conference abstracts, without language restrictions. The information was retrieved until December 2011. We collected all the randomized, blinded, controlled clinical trails ( RCTs ) of cardioselective beta-blockers on respiratory function in patients with COPD. Then two evaluators evaluated the quality of RCTs according to the Cochrane Review Manual 4. 2 independently. Meta-analysis was performed using statistical software Stata 11. 0. X2 test was used to analyze their heterogeneity. Standardizedmean difference ( SMD) was used to describe continuous variables. Relative risk degree ( RR) was used to describe categorical variables, and 95% CI was used to describe treatment effect. Results 22 trails met the selection criteria. Meta-analysis showed no change of FEV1 in COPD patients after taking single dose of cardioselective beta-blockers [ SMD - 0. 367, 95% CI( - 0. 786, 0. 052) ] and no respiratory symptoms aggravation [ RR1. 000, 95% CI( 0. 848, 1. 179) ] . Meta-analysis also showed no change of FEV1 in COPD patients who received long-term cardioselective beta-blockers treatment [ SMD - 0. 236, 95% CI( - 0. 523,0.051) ] , and no respiratory symptoms aggravation [ RR 1. 000, 95% CI ( 0. 830, 1. 205) ] . Inhaled beta-2 agonists showed no effect on FEV1 in COPD patients after either long-term administration [ SMD - 0. 200,95% CI( - 0. 586, 0. 187) ] or single dose administration of cardioselective beta-blockers [ SMD - 0. 078,95% CI( - 0. 654, 0. 497) ] . Conclusion Cardioselective beta-blockers, given to patients with COPD in conditions such as heart failure, coronary artery disease and hypertension in the identified studies did not produce adverse respiratory effects.
ObjectiveTo investigate the role on adverse prognosis and risk factors of acute kidney injury (AKI) in hospitalized patients with chronic obstructive pulmonary disease (COPD). MethodsClinical data from hospitalized patients with COPD between January 2009 and June 2012 were studied retrospectively.AKI was diagnosed and classified by AKIN criterion. ResultsThree hundred and sixty-nine patients were enrolled,among whom 69(18.6%) were complicated with AKI.The patients with AKI were older,and had higher levels of hemoglobin,hematocrit value and sodium concentration,and higher rates of comorbidities of diabetes mellitus,proteinuria and shock,compared with the controls.Those with AKI had a 24.1% increased risk for ventilator,121.5% for intensive care,and 89.8% for death.And a higher AKI grade was related to a worse prognosis.The increased risk of AKI was 142.1% for every 5-year increase of age,155.7% for every 0.1 increase of hematocrit value,70.5% for every 0.1 increase of sodium concentration,and 49.1%,89.2%,148.2% and 685.7% for being complicated with proteinuria,coronary artery disease,diabetes mellitus and shock. ConclusionAKI is associated with adverse prognosis in hospitalized patients with COPD.Age,proteinuria,increased levels of hematocrit value and sodium concentration,and comorbidities of coronary artery disease,diabetes mellitus and shock are independent risk factors for AKI
Objective To compare outcomes after single versus bilateral lung transplantation in patients with end-stage chronic obstructive pulmonary disease (COPD) with retrospective cohort study, and to provide a reference for surgical selection. Methods One hundred and two patients with end-stage COPD who received lung transplantation in Wuxi People's Hospital affiliated to Nanjing Medical University from January 2010 to May 2019 were evaluated, including 97 males and 5 females, aged from 42 to 82 years, with an average age of (59.8±8.0) years. Recipients were divided into single lung transplantation (SLT) group (31 cases) and bilateral lung transplantation (BLT) group (71 cases). Preoperative characteristics, postoperative outcomes, postoperative complications, functional improvement and survival between the two groups were analyzed retrospectively. Results The SLT group were significantly older than the BLT group [(62.6±8.8) years vs. (58.6±7.4) years, P<0.05], which was consistent with the practice mode of single lung transplantation in the elderly patients in this center. The FEV1% predicted and the six‐minute walk distance (6-MWD) in the BLT group were better than those in the SLT group (P<0.05). The cumulative survival rate in 1, 3 and 5 years after operation in the BLT group was higher than that in the SLT group (70.4%, 63.2%, 61.5%, respectively vs. 67.7%, 58.1%, 54.6%, respectively), but there was no statistical difference (P=0.388). The two groups were comparable in other preoperative clinical data (P>0.05). The cold ischemia time and total operation time were shorter in the SLT group than in the BLT group, and the intraoperative blood loss was less than that in the BLT group, but more patients required intraoperative extracorporeal membrane oxygenation support than the BLT group (P<0.05). There were no significant differences in postoperative ventilator support, reoperation, length of intensive care unit stay, postoperative hospital stay, and perioperative mortality (P>0.05). In terms of postoperative complications, the incidence of primary graft dysfunction grades 3 was higher in the SLT group than in the BLT group (35% vs. 8%, P=0.001). There were no significant differences between the two groups in chest complications, airway complications, acute rejection, infection, and bronchial occlusion syndrome (P>0.05). Nine patients (29%) developed acute native lung hyperinflation in the SLT group. ConclusionsBilateral lung transplantation is superior to single lung transplantation in the treatment of end-stage COPD. The advantage is mainly reflected in the simple perioperative management, better functional improvement after operation. Single lung transplantation as a beneficial supplement to double lung transplantation should still be considered in selected patients.