目的:探讨慢性阻塞性肺病(慢阻肺)合并呼吸衰竭的临床护理及其预后之间的关系,为临床提供慢阻肺合并呼吸衰竭患者的护理经验及病例资料。方法:对2008年3月至2009年5月间在我院住院治疗的60例确诊为慢阻肺合并呼吸衰竭的患者,均采用贯序通气治疗,营养支持治疗,以及常规氧疗,根据护理期间营养支持治疗中是否接受静脉点滴脂肪乳而划分为两组，各30例。结果:接受完全肠道外营养患者的治疗时间较未接受者短，治愈率优于未接受者（927%比50%），没有死亡者（0比10%）。结论:有效的护理方法,尤其是恰当的营养支持治疗,对慢肺阻合并呼吸衰竭患者具有极其重要的意义。
摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
ObjectiveTo assess the lung capacity and diffusing capacity in patients with chronic obstructive pulmonary disease (COPD) at different stages. MethodsPatients who were diagnosed with COPD between January and March 2015 were recruited in the study. The data of clinical characteristics and spirometry test (the forced expiratory volume in the first second, FEV1) were collected. Total lung capacity (TLC) and residual volume (RV) were determined by body plethysmography and helium dilution method, and single breath diffusing capacity for carbon monoxide (DLCO) was also measured. Lung capacity and the deviations between two methods, and DLCO%pred were compared among the COPD patients at different stages. The correlation of spirometry with lung capacity and DLCO%pred were analyzed. ResultsA total of 170 patients with COPD were enrolled. With the severity of COPD, TLC%pred, RV%pred, RV/TLC and the deviations of the ones between two methods increased significantly, but DLCO%pred reduced significantly. FEV1%pred were negatively correlated with the deviations of lung capacity between two methods, and positively correlated with DLCO%pred. ConclusionsCompared with helium dilution method, the body plethysmography is more accurate for evaluating the lung capacity of COPD. With the severity of airflow limitation, the diffusing capacity of COPD decreases gradually.
ObjectiveTo investigate and compare the clinical characteristics of chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). MethodsA case-control study was conducted in 139 patients with COPD who admitted between March 2013 and September 2013. The patients were divided into a COPD-only group and an ACOS group. Clinical data were collected and compared between two groups. ResultsOf all 139 patients, 93 patients were diagnosed with COPD only (66.9%) and 46 patients were diagnosed with ACOS (33.1%). Compared with the COPD-only group, the ACOS group had a lower ratio of exposure to cigarette smoking (80.4% vs. 93.5%), but high possibility of a history of asthma (89.1% vs. 4.3%), allergies (60.9% vs. 9.6%) and airway hyperreactivity (80.4% vs. 6.5%) (P < 0.05). In clinical symptoms, the ACOS group had a higher ratio of breathless as the first complaint of symptom (26.1% vs. 8.6%) and dry and moist rales in lung by auscultation (67.4% vs. 31.2%) (P < 0.05). In laboratory examination, the ACOS group had increased levels of peripheral blood eosinophils and IgE than those of the COPD-only group (21.7% vs. 5.4%, 18.3% vs. 4.3%, P < 0.05). In treatment, the ACOS group was more likely to use systemic glucocorticoid (58.7% vs. 24.7%) and be treated with higher dosage of glucocorticoid (80 mg, P < 0.05). ConclusionsACOS and COPD-only are two subtypes of COPD. Compared with COPD-only patients, ACOS patients might be more likely to be breathless and have dry and moist rales in clinical symptoms, more likely to have increased levels of peripheral blood eosinophils and IgE in blood test, and more inclined to receive systemic glucocorticoid treatment.
Objective To observe the changes in pulmonary function in chronic obstructive pulmonary disease (COPD) patients with different GOLD grades, diffusing capacity for carbon monoxide in percent predicted value (DLCO%pred), and the relationship between DLCO%pred and hyperinflation parameter, the ratio of residual volume to total lung capacity (RV/TLC). Methods Their age, sex, body mass index (BMI), and lung function parameters were recorded. Group according to GOLD grade, and compare the lung function among different groups; With DLCO%pred 60% as the cut-off value, the lung function of each group was compared. Pearson and Spearman correlation determined the relationship between DLCO%pred and age, RV/TLC, and other factors. Results Four hundred and thirty-one patients were enrolled. With the increase of GOLD grade, the pulmonary function became worse (P<0.05). Compared with DLCO%pred ≥ 60%, the group with DLCO%pred<60% had lower BMI (t=–5.642, P<0.001) and worse pulmonary function (P<0.001). The correlation analysis showed that BMI (r=0.352, P<0.001), forced vital capacity in percent predicted value (FVC%pred) (r=0.349, P<0.001), forced expiratory volume in one second in percent predicted value (FEV1%pred) (r=0.414, P<0.001), the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) (r=0.434, P<0.001), peak expiratory flow in percent predicted value (PEF%pred) (r=0.335, P<0.001), maximal mid expiratory flow in percent predicted value (MMEF%pred) (r=0.405, P<0.001), inspiratory capacity in percent predicted value (IC%pred) (r=0.301, P<0.001) were positively correlated with DLCO%pred; while RV/TLC (r=–0.328, P<0.001), GOLD grade (r=–0.430, P<0.001) were negatively correlated with DLCO%pred; However, there was no significant correlation between age (r=–0.012, P=0.810), sex (r=0.076, P=0.117) and DLCO%pred. Conclusions With the increase of GOLD grade, DLCO%pred decreases, and RV/TLC increases. RV/TLC is negatively correlated with DLCO%pred. Attaching importance to the evaluation of hyperinflation and diffusing capacity of COPD patients is helpful in evaluating COPD in all aspects, and has particular clinical significance.