Objective To explore the effect of leukotriene receptor antagonist montelukast on physicochemical property of sputum and airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Methods Eighty-four inpatients with acute exacerbation of bronchiectasis were randomly divided into a control group and an experiment group, with 42 cases in each group. The control group received conventional therapy and the experiment group took orally montelukast 10 mg before sleep every day based on conventional therapy for two weeks. At admission and 15 days after admission, the amount in 24 hours, dry/wet weight ratio and viscosity of sputum were observed while the levels of neutrophil elastase (NE) and mucin MUC5ac in sputum were determined by ELISA. The pulmonary ventilation function, airway resistance and blood gas analysis were also measured. Results The sputum amount in 24 hours, dry/wet weight ratio and viscosity of sputum, NE and MUC5ac of sputum, pulmonary ventilation function, blood gas analysis and airway resistance were declined or improved remarkably after treatment compared with before treatment in two groups (P<0.05). Meanwhile, the sputum amount in 24 hours [(5.62±1.83) g vs. (7.53±2.32) g], NE [(3.85±0.97) μg/ml vs. (4.54±1.03) μg/ml], MUC5ac [(0.65±0.21) μg/ml vs. (0.82± 0.29) μg/ml] and the airway resistance [(119.16±11.76)% vs. (128.37±12.08)%] were declined remarkably in the experiment group compare with the control group after treatment (all P<0.05). The viscosity of sputum between the two groups after treatment showed no significant difference. Conclusion In patients with acute exacerbation of bronchiectasis, montelukast can reduce amount of sputum and airway resistance, reduce expression of mucin MUC5ac through down-regulation of NE, thus inhibit airway mucus hypersecretion.
Objective To explore the diagnosis and treatment of critically ill patients suffering from obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Critically ill patients with OSAHS admitted in intensive care unit from January 2003 to December 2007 were retrospectively analyzed. Results Seventy-nine critically ill patients were diagnosed as OSAHS. The initial diagnosis of OSAHS was made by history requiring, physical examination, and Epworth sleepiness score evaluation. The final diagnosis was comfirmed by polysomnography thereafter. Base on the treatment of primary critical diseases, the patients were given respiratory support either with continuous positive airway pressure ( CPAP) or with bi-level positive airway pressure ventilation ( BiPAP) . Two cases died and the remaining 77 patients were cured anddischarged. Conclusions Timely diagnosis of OSAHS is important to rescue the critically ill patients. Respiratory support combined with treatment of primary critical diseases can improve the outcomes of these patients.
ObjectiveTo investigate efficacy of total colectomy-ileorectal anastomosis (IRA) and subtotal colectomy-ileosigmoidal anastomosis (ISA) in treatment of patients with slow transit constipation (STC).MethodsThe clinical data of 45 patients with STC underwent operation from January 2008 to January 2015 were analyzed retrospectively. These patients were divided into an IRA group and ISA group according to the operation method, there were 23 cases in the IRA group and 22 cases in the ISA group. The operative time, intraoperative blood loss, postoperative hospitalization, use of antidiarrheal drugs, and complications rate in both groups were compared. All the patients were followed up at the 3th, 6th, 12th, and 24th month after the operation, the defecation frequency, Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score in two groups were evaluated.ResultsThere were no significantly statistical differences between the two groups in the operation time, intraoperative blood loss, and postoperative complications rate (P>0.05). In the perioperative period, compared with the IRA group, the ISA group had a shorter postoperative hospitalization and a relatively lower proportion of antidiarrheal drugs, the differences were statistically significant between the two groups (P<0.05). On the postoperative 3th, 6th, and 12th month, the frequency of defecation in the IRA group was significantly higher than that in the ISA group (P<0.05). The Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score had no statistical differences between the two groups (P>0.05).ConclusionsISA and IRA are safe and effective in treatment of STC, it might be selected according to patient’s conditions. On premise of strictly grasping indications, ISA has more obvious advantages.