论著

肺泡灌洗液靶向高通量测序在鹦鹉热衣原体肺炎中的应用价值

Application of bronchoalveolar lavage fluid targeted next-generation sequencing in Chlamydia psittaci pneumonia

:459-465
 
       目的 探究肺泡灌洗液靶向高通量测序(tNGS)在鹦鹉热衣原体肺炎中应用效果。方法 选取2021年5月—2025年3月我院收治的35例鹦鹉热衣原体肺炎患者进行研究,患者均接受肺泡灌洗液tNGS检测、肺泡灌洗液常规病原检测,以病原学为金标准,分析肺泡灌洗液tNGS对鹦鹉热衣原体肺炎的诊断效能。结果 金标准对鹦鹉热衣原体阳性检出35例,检出率100.00%,肺泡灌洗液tNGS阳性检出率高于传统病原检测,检测结果回报耗时短于肺泡灌洗液传统病原检测(P<0.05)。结论 鹦鹉热衣原体肺炎临床症状缺乏特异性,容易转为重症肺炎,肺泡灌洗液tNGS可提高鹦鹉热衣原体肺炎检出率且结果回报较快,采用四环素类、喹诺酮类抗生素有助于改善患者预后。
     Objective To investigate the application effect of targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in Chlamydia psittaci pneumonia.Methods Thirty-five patients with Chlamydia psittaci pneumonia admitted to our hospital from May 2021 to March 2025 were selected for the study.All patients underwent BALF tNGS and conventional BALF pathogen detection.With etiology as the gold standard,the diagnostic efficacy of BALF tNGS for Chlamydia psittaci pneumonia was analyzed.Results The gold standard detected 35 cases of Chlamydia psittaci positive,with a detection rate of 100.00%.The positive detection rate of tNGS in alveolar lavage fluid was higher than that of traditional pathogen detection,and the results report time of tNGS was shorter than that of traditional pathogen detection(P<0.05).Conclusions Chlamydia psittaci pneumonia lacks specificity in clinical symptoms and is easy to turn into severe pneumonia,bronchoalveolar lavage fluid tNGS can improve the detection rate of Chlamydia psittaci pneumonia and the results return quickly,and the use of tetracyclines and quinolones antibiotics can help improve the prognosis of patients.

论著

首发脑出血患者并发卒中相关性肺炎的风险预测模型构建及验证

Construction and validation of a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage

:472-480
 
       目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料,按照7︰3比例随机化分为训练列(293例)和验证队列(126例)。统计基于开发队列数据,采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素,并构建风险预测模型。基于开发队列和验证队列数据,采用校准曲线、受试者操作特征(ROC)曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎,发生率为26.97%。美国国立卫生研究院卒中量表(NIHSS)评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值(NPAR)、中性粒细胞计数与淋巴细胞计数比值(NLR)、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素(P<0.05)。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型,校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近;ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906(95%CI:0.867~0.937)、0.884(95%CI:0.815~0.934);决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。

      Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage(ICH)and validate the predictive performance of the model.Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022.They were randomly divided into a development cohort(293 cases)and a validation cohort(126 cases)according to a 7∶3 ratio.The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data,and a risk prediction model was constructed.Based on the development cohort data and validation cohort data,the predictive performance of the model was analyzed using calibration curves,receiver operating characteristic(ROC)curve,and decision curve analysis.Results Among 419 patients,113 developed stroke associated pneumonia,with a rate of 26.97%.The National Institutes of Health Stroke Scale(NIHSS)score,swallowing difficulties,initial hematoma volume,neutrophil percentage to albumin ratio(NPAR),neutrophil count to lymphocyte count ratio(NLR),surgical treatment,endotracheal intubation,and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH(P<0.05).Based on the above influencing factors,a risk prediction model for stroke associated pneumonia in patients with ICH was constructed.The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence.The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906(95%CI:0.867-0.937)and 0.884(95%CI:0.815-0.934),respectively.The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%,and the threshold probability of the validation cohort was between 2%-76%,the intervention using this model was more clinically valuable than all/no intervention.
Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score,swallowing difficulties,initial hematoma volume,NPAR,NLR,surgical treatment,tracheal intubation,and indwelling gastric tube has good predictive performance and clinical application value.

论著

基于Caprini量表评估的干预模式联合充气加压泵预防慢性阻塞性肺疾病急性加重期患者静脉血栓的效果

Effect of intervention mode based on Caprini score combined with inflatable pump in preventing VTE in patients with AECOPD

:507-512
 
      目的 观察慢性阻塞性肺疾病急性加重期(AECOPD)患者应用基于Caprini量表评估的干预模式联合充气加压泵(IPC)预防静脉血栓(VTE)的效果。方法 选取河南省人民医院在2023年11月—2024年11月收入的82例AECOPD患者作为研究对象,经随机数表法分为对照组41例予以VTE常规干预,观察组41例在对照组的基础上接受基于Caprini量表评估的干预模式联合IPC预防。比较两组AECOPD患者肢体情况及深静脉血栓(VTE)发生情况、凝血指标及股静脉血流速度。结果 观察组肢体肿胀率、肢体疼痛率及VTE发生率均低于对照组(P<0.05)。干预前,两组AECOPD患者凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体水平比较差异无统计学意义(P>0.05);干预后,两组患者TT、PT、APTT、D-二聚体水平均降低,观察组较低(P<0.05)。干预前,两组AECOPD患者平均流速、血流峰速及阻力指数比较差异无统计学意义(P>0.05);干预后,两组患者平均流速、血流峰速均升高,观察组高于对照组(P<0.05);阻力指数均降低,观察组低于对照组(P<0.05)。结论 AECOPD患者应用基于Caprini量表评估的干预模式联合IPC能有效降低肢体肿胀率、肢体疼痛率及VTE发生率,改善凝血指标与股静脉血流速。
   Objective To observe the effect of a Caprini score?based intervention model combined with intermittent pneumatic compression(IPC)in preventing venous thromboembolism(VTE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 82 AECOPD patients admitted to Henan Provincial People’s Hospital from November 2023 to November 2024 were selected as subjects and randomly divided into a control group(41 cases)and an observation group(41 cases)using a random number table.The control group received routine VTE prevention,while the observation group received the Caprini score?based intervention combined with IPC in addition to the routine care.The extremity conditions,occurrence of VTE,coagulation parameters,and femoral venous blood flow velocity were compared between the two groups.Results The rates of extremity swelling,extremity pain,and VTE incidence in the observation group were lower than those in the control group(P<0.05).Before the intervention,there were no statistically significant differences in thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),or D?dimer levels between the two groups(P>0.05).After the intervention,TT,PT,APTT,and D?dimer levels decreased in both groups,with lower values in the observation group(P<0.05).Before the intervention,there were no statistically significant differences in mean flow velocity,peak flow velocity,or resistance index between the two groups(P>0.05).After the intervention,mean flow velocity and peak flow velocity increased in both groups,with higher values in the observation group(P<0.05),while the resistance index decreased,with a lower value in the observation group(P<0.05).Conclusions The application of a Caprini score?based intervention model combined with IPC in AECOPD patients can effectively reduce the rates of extremity swelling,extremity pain,and VTE incidence,and improve  coagulation parameters and femoral venous blood flow velocity.
论著

尼达尼布联合格隆溴铵治疗合并肺纤维化的慢性阻塞性肺疾病患者的效果及对肺功能影响

Efficacy and effect on pulmonary function of nintanib combined with glycopyrrolate in the treatment of chronic obstructive pulmonary disease with pulmonary fibrosis

:513-519
 
      目的 合并肺纤维化的慢性阻塞性肺疾病(COPD)是COPD的特殊亚型,患者兼具气流受限与肺组织纤维化病理特征,临床症状更严重、肺功能下降更快,且现有单一治疗方案难以同时改善气流受限与纤维化进展,预后较差。基于此,本研究旨在分析尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD患者的效果及对肺功能的影响,为优化临床治疗方案提供依据。方法 选取2022年3月—2024年12月收治的96例合并肺纤维化的COPD患者,采用前瞻性随机对照研究设计,应用随机数字表法分为试验组与对照组。所有患者均采取常规治疗,对照组48例采取尼达尼布治疗,试验组采取尼达尼布联合格隆溴铵治疗。两组均治疗24周后,比较治疗前后症状评分、肺功能、纤维化指标、炎症指标,并分析两组治疗安全性。结果 治疗后,两组CAT评分、mMRC评分及VAS降低(P<0.05);且与对照组比较,试验组CAT评分、mMRC评分及咳嗽VAS评分较低(P<0.05)。治疗后,两组FVC、FEV1、DLCO及FEV1/FVC比值均较治疗前改善(P<0.05);且与对照组比较,试验组FVC、FEV1、DLCO及FEV1/FVC比值较优(P<0.05)。治疗后,两组血清KL-6、SP-D水平及CT纤维化评分均降低(P<0.05);且与对照组比较,试验组血清KL-6、SP-D水平及CT纤维化评分较低(P<0.05)。治疗后,两组血清IL-6、TNF-α及TGF-β1水平降低(P<0.05);且与对照组比较,试验组血清IL-6、TNF-α及TGF-β1水平较低(P<0.05)。试验组总不良反应发生率为8.33%(4/48),对照组为10.42%(5/48),两组比较差异无统计学意义(P>0.05)。结论 尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD效果良好,可减轻患者临床症状,改善肺功能与肺纤维化,降低机体炎症反应,安全性较高。

   Objective To analyze the effects of the combination of nintedanib and glycopyrrolate in treating chronic obstructive pulmonary disease(COPD)patients with associated pulmonary fibrosis and its impact on lung function,providing a basis for optimizing clinical treatment strategies.Methods Ninety-six COPD patients with pulmonary fibrosis admitted from March 2022 to December 2024 were selected,and divided into experimental group and control group using a random number table method.Using a prospective randomized controlled study design,all patients received conventional treatment,with 48 cases in the control group receiving treatment with nintedanib and the experimental group receiving treatment with nintedanib combined with glycopyrrolate bromide.After 24 weeks of treatment in both groups,the symptom scores,lung function,fibrosis indicators,and inflammation indicators were compared before and post-treatment,and the drug safety of the two groups was analyzed.Results Post-treatment,CAT score,mMRC score and VAS decreased in both groups(P<0.05).Compared with the control group,CAT score,mMRC score and cough VAS score were lower in the experimental group(P<0.05).Post-treatment,FVC,FEV1,DLCO and FEV1/FVC ratio of both groups improved compared with that before treatment(P<0.05).Compared with the control group,FVC,FEV1,DLCO and FEV1/FVC ratio of the experimental group were better(P<0.05).Post-treatment,serum KL-6,SP-D levels and CT fibrosis scores of both groups decreased(P<0.05).Compared with the control group,serum KL-6,SP-D levels and CT fibrosis scores of the experimental group were lower(P<0.05).Post-treatment,serum IL-6,TNF-α and TGF-β1 levels in both groups decreased(P<0.05).Compared with the control group,serum IL-6,TNF-α and TGF-β1 levels in the experimental group were lower(P<0.05).The incidence of total adverse reactions in the experimental group was 8.33%(4/48),and that in the control group was 10.42%(5/48).There was no difference between the two groups(P>0.05).Conclusions The combination of nintedanib and glycopyrrolate has a significant effect on the treatment of COPD complicated with pulmonary fibrosis,which can alleviate its clinical symptoms,improve lung function and pulmonary fibrosis,reduce the body’s inflammatory response,which is relatively safe.

桑白皮汤加减辅助常规西药对痰热郁肺型保留比率的肺功能减损患者治疗效果的多维度指标评价

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目的 探讨桑白皮汤加减辅助常规西药治疗痰热郁肺型保留比率的肺功能减损(PRISm)患者的治疗效果,并分析其对中医证候积分、肺功能、气道阻力、免疫功能的影响。方法 选取2024年6月~2025年6月于本院诊治的88例PRISm患者为研究对象,按照随机数字表法将其分为对照组(常规西药治疗)、研究组(桑白皮汤加减联合常规西药治疗),各44例。比较两组临床疗效、不良反应及治疗前后中医证候积分、慢阻肺评估测试(CAT)量表、改良版英国医学研究委员会呼吸困难问卷(mMRC)、吸入支气管扩张剂后检测肺功能、肺弥散功能[一氧化碳弥散量占预计值百分比(DLCO%pred)、残气量/肺总量(RV/TLC)]、气道阻力[抗阻指数(R5-20)、共振频率(Fres)、呼吸总阻抗(Zrs)]、炎症指标[白细胞介素-6(IL-6)、可溶性细胞间黏附分子-1(sICAM-1)、单核细胞趋化蛋白-1(MCP-1)、嗜酸性粒细胞(EOS)、肿瘤坏死因子-α(TNF-α)]、气道重塑[基质金属蛋白酶-2(MMP-2)、缺氧诱导因子-1α(HIF-1α)、转化生长因子-β1(TGF-β1)、碱性成纤维细胞生长因子(bFGF)]、T淋巴细胞亚群水平。结果 研究组总有效率高于对照组(P<0.05);治疗后,与对照组比较,研究组中医证候积分、CAT评分、mMRC评分级RV/TLC降低,FEV1、FEV1/FVC、FEV1%pred、VC%pred、DLCO%pred升高(P<0.05);治疗后,与对照组比较,研究组R5-20、Fres、Zrs降低(P<0.05);治疗后,与对照组比较,研究组血清IL-6、sICAM-1、MCP-1、EOS、TNF-α及MMP-2、HIF-1α、TGF-β1、bFGF水平降低(P<0.05);治疗后,与对照组比较,研究组CD3+、CD4+、CD4+/CD8+水平升高(P<0.05);两组不良反应比较无明显差异(P>0.05)。结论 桑白皮汤加减辅助常规西药治疗PRISm患者的疗效显著,可改善临床症状、肺功能,提高生活质量,降低气道阻力,并可减轻炎症反应,缓解气道重塑,增强机体免疫功能,且具有一定安全性。

基于FMEA的复方磺胺甲噁唑治疗耶氏肺孢子菌肺炎用药风险管控

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目的:分析复方磺胺甲噁唑治疗耶氏肺孢子菌肺炎用药风险,构建基于失效模式及影响分析的药学管控路径。方法:回顾性选取67例耶氏肺孢子菌肺炎住院病例,按照临床药师介入时间分组为:介入前组33例与介入后组34例。围绕初始剂量、疗程、肾功能校正、毒性监测、宣教随访建立FMEA表,计算风险优先数,比较两组治疗失败、临床疗效、用药执行达标情况。结果:介入后临床治愈率由66.67%升至85.29%,用药执行达标率由69.70%升至91.18%。关键失效模式风险优先数下降。结论:FMEA可定位复方磺胺甲噁唑治疗PJP的高风险环节,呼吸抗感染临床药师前移处方审核、床旁评估、毒性监测、出院宣教,可提高给药方案规范性,减少可预防失败。

肺癌患者联合药物治疗间歇期症状评估问卷的修订及信效度评价

Revision of the Symptom Assessment Questionnaire for Lung Cancer Patients During Combined Drug Therapy Intervals and Testing of Its Reliability and Validity

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目的 修订肺癌患者联合药物治疗间歇期症状评估问卷,并评价其信效度。方法 以中文版安德森症状评估量表及肺癌特异性模块为基础,经文献分析、专家会议和认知性访谈形成测试版问卷。于2023年10-12月便利选取福州、莆田2所三级甲等医院278例肺癌患者进行调查,评价其信效度及偏倚风险。结果 修订后问卷含7个症状系统、60个条目,跳转式作答后实际作答21个条目。总问卷Cronbach's α系数为0.856,各维度为0.639~0.747;内容效度指数为0.81。验证性因子分析显示模型拟合尚可(χ2/df=2.366,RMSEA=0.070,CFI=0.858),各维度因子载荷、组合信度及平均方差提取量均达到可接受标准,区分效度良好。COSMIN-RoB评价结果为良好。结论 该问卷信效度良好,可用于评估肺癌患者联合药物治疗间歇期症状严重程度。
Objective To revise the Symptom Assessment Questionnaire for Lung Cancer Patients During Combined Drug Therapy Intervals and evaluate its reliability and validity. Methods Based on the Chinese version of the M. D. Anderson Symptom Inventory and its lung cancer-specific module, a preliminary questionnaire was developed through literature review, expert panel discussions, and cognitive interviews. From October to December 2023, a convenience sample of 278 lung cancer patients was recruited from two tertiary hospitals in Fuzhou and Putian, China. Reliability, validity, and risk of bias were evaluated. Results The revised questionnaire comprised seven symptom-system domains and 60 items, with 21 items completed through a skip-logic design. The overall Cronbach's α coefficient was 0.856, and the coefficients for each domain ranged from 0.639 to 0.747. The content validity index of the questionnaire was 0.81. Confirmatory factor analysis demonstrated an acceptable model fit (χ2/df = 2.366, RMSEA = 0.070, CFI = 0.858). Factor loadings, composite reliability, and average variance extracted of all domains met acceptable standards, indicating good discriminant validity. The overall risk of bias was rated as good according to the COSMIN Risk of Bias checklist. Conclusion The revised questionnaire demonstrated satisfactory reliability and validity and can be used to assess symptom severity in lung cancer patients during combined drug therapy intervals.

基于E-Coach健康管理模式的营养管理联合主动循环呼吸训练应用于非小细胞肺癌化疗患者的效果分析

Effect Analysis of Nutrition Management Based on E-Coach Health Management Model Combined with Active Cycle of Breathing Technique in Patients Undergoing Chemotherapy for Non-Small Cell Lung Cancer

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摘要目的 探讨基于E-Coach健康管理模式的营养管理联合主动循环呼吸训练(ACBT)在非小细胞肺癌(NSCLC)化疗患者中的应用效果。方法 选取2023年6月至2025年8月我院收治的98例NSCLC化疗患者,采用随机数字表法将所有研究对象分为联合组和常规组,每组49例。常规组给予常规干预,联合组在常规组基础上予以E-Coach健康管理模式的营养管理联合ACBT干预。比较两组干预前后营养状况、肺功能、运动耐力、生活质量以及营养不良发生率。结果 干预12周后,两组BMI、ALB、PA、Hb均较干预前上升且联合组高于常规组(P<0.05);联合组FVC、FEV1、MVV及6MWT均显著高于常规组(P<0.05);干预前两组6MWT组间对比差异无统计学意义(P>0.05),干预4周、6周、8周、12周后,两组6MWT均较干预前增加,且联合组远于常规组(P<0.05);干预12周后,两组身体功能、社会或家庭功能、情感功能、功能性状况得分均较干预前上升,且联合组高于常规组(P<0.05)。结论基于E-Coach健康管理模式的营养管理联合ACBT能够有效改善NSCLC化疗患者的营养状况和肺功能,提高生活质量和运动耐力。
Abstract Objective To investigate the application effect of nutrition management based on the E-Coach health management model combined with active cycle of breathing technique (ACBT) in patients undergoing chemotherapy for non-small cell lung cancer (NSCLC). Methods A total of 98 NSCLC patients receiving chemotherapy in our hospital from June 2023 to August 2025 were selected and randomly divided into a combination group and a conventional group using a random number table method, with 49 cases in each group. The conventional group received routine intervention, while the combination group received nutrition management based on the E-Coach health management model combined with ACBT in addition to the routine intervention. The nutritional status, lung function, exercise endurance, quality of life, and incidence of malnutrition were compared between the two groups before and after the intervention. Results After 12 weeks of intervention, BMI, ALB, PA, and Hb in both groups increased compared with baseline, and the levels in the combination group were higher than those in the conventional group (P<0.05). The FVC, FEV1, MVV, and 6MWT in the combination group were significantly higher than those in the conventional group (P<0.05). There was no statistically significant difference in 6MWT between the two groups before intervention (P>0.05); after 4, 6, 8, and 12 weeks of intervention, the 6MWT in both groups increased compared with baseline, and the walking distance in the combination group was significantly longer than that in the conventional group (P<0.05). After 12 weeks of intervention, the scores of physical function, social/family function, emotional function, and functional well-being in both groups increased compared with baseline, and the scores in the combination group were higher than those in the conventional group (P<0.05). Conclusion Nutrition management based on the E-Coach health management model combined with ACBT can effectively improve the nutritional status and lung function of NSCLC patients undergoing chemotherapy, and enhance their quality of life and exercise endurance.

清咳平喘颗粒联合乙酰半胱氨酸治疗痰热闭肺型大叶性肺炎患儿的临床疗效研究

Clinical efficacy of Qingke Pingchuan granules combined with acetylcysteine in the treatment of children with lobar pneumonia of phlegm-heat obstructing lung type

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目的 探讨清咳平喘颗粒联合乙酰半胱氨酸对痰热闭肺型大叶性肺炎(LP)患儿的治疗效果。方法 回顾性选取我院收治的118例痰热闭肺型LP患儿(选例时间:2023年1月~2025年11月)为研究对象,根据治疗方案分为参照组(59例,采用乙酰半胱氨酸治疗)、联合组(59例,采用清咳平喘颗粒联合乙酰半胱氨酸治疗)。对比两组临床疗效、不良反应及治疗前、后肺功能[潮气量(VT)、达峰时间比(TPTEF/TE)、吸呼比(Ti/Te)、达峰容积比(VPEF/VE)]、中医证候、免疫功能、炎症因子[白细胞介素-8(IL-8)、趋化因子配体3(CCL3)、肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白B1(HMGB1)]水平。结果 联合组总有效率为96.61%,高于参照组的83.05%(P<0.05);与参照组相比,治疗后联合组各中医证候积分均较低(P<0.05);联合组治疗后VT、TPTEF/TE、Ti/Te、VPEF/VE水平均较参照组高(P<0.05);联合组治疗后CD8+水平较参照组低,CD3+、CD4+、CD4+/CD8+水平较参照组高(P<0.05);治疗后联合组血清IL-8、CCL3、TNF-α、HMGB1水平均较参照组低(P<0.05);不良反应发生情况组间比较,无明显差异(P>0.05)。结论 清咳平喘颗粒联合乙酰半胱氨酸可提高痰热闭肺型LP患儿治疗效果,减轻临床症状,改善肺功能、免疫功能,降低机体炎症反应程度。
Objective To explore the therapeutic efficacy of Qingke Pingchuan granules combined with acetylcysteine on children with lobar pneumonia (LP) of phlegm-heat obstructing lung type. Methods A total of 118 children with LP of phlegm-heat obstructing lung type admitted to our hospital from January 2023 to November 2025 were retrospectively selected as the research subjects. According to different treatment regimens, they were divided into the control group (59 cases, treated with acetylcysteine) and the combined group (59 cases, treated with Qingke Pingchuan granules combined with acetylcysteine). The clinical efficacy, adverse reactions, as well as the levels of pulmonary function indicators [tidal volume (VT), time to peak tidal expiratory flow ratio (TPTEF/TE), inspiration-expiration ratio (Ti/Te), volume to peak tidal expiratory flow ratio (VPEF/VE)], traditional Chinese medicine (TCM) syndrome scores, immune function and inflammatory factors [interleukin-8 (IL-8), C-C motif chemokine ligand 3 (CCL3), tumor necrosis factor-α (TNF-α), high mobility group box 1 protein (HMGB1)] before and after treatment were compared between the two groups. Results The total effective rate of the combined group was 96.61%, which was higher than 83.05% of the control group (P<0.05). After treatment, the TCM syndrome scores of the combined group were lower than those of the control group (P<0.05). The levels of VT, TPTEF/TE, Ti/Te and VPEF/VE in the combined group were higher than those in the control group after treatment (P<0.05). After treatment, the level of CD8? in the combined group was lower, while the levels of CD3?, CD4? and CD4?/CD8? were higher than those in the control group (P<0.05). The serum levels of IL-8, CCL3, TNF-α and HMGB1 in the combined group were significantly lower than those in the control group after treatment (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of Qingke Pingchuan granules and acetylcysteine can enhance the therapeutic efficacy on children with LP of phlegm-heat obstructing lung type, relieve clinical symptoms, improve pulmonary function and immune function, and reduce systemic inflammatory response.

布地格福吸入联合NIPPV对AECOPD合并呼吸衰竭患者临床疗效、病情控制、血气指标、肺功能、炎性因子、氧化应激的影响

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目的 分析布地格福吸入、无创正压通气(NIPPV)联合治疗慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭的效果。方法 本研究采用回顾性对照研究。选取2024-06—2025-05我院96例AECOPD合并呼吸衰竭者,根据治疗方案不同分组,每组48例。对照组接受NIPPV治疗,研究组接布地格福吸入、NIPPV联合治疗,持续治疗1周。观察并对比两组疗效、病情程度、血气指标[动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)]、肺功能[最大呼气压(MEP)、一秒率(FEV1/FVC)]、炎性因子指标[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、氧化应激指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化脂质(LPO)]及不良反应。结果 研究组治疗有效率为91.67%(44/48),高于对照组75.00%(36/48)(P<0.05);治疗1周后与对照组相比,研究组mMRC分值、CAT分值均较低(P<0.05);治疗1周后,与对照组相比,研究组MEP、FEV1/FVC、PaO2较高,PaCO2较低(P<0.05);治疗1周后与对照组相比,研究组CRP、TNF-α、IL-6较低(P<0.05);治疗1周后与对照组相比,研究组SOD、GSH-Px较高,LPO较低(P<0.05);两组不良反应无明显差异(P>0.05)。结论 布地格福吸入、NIPPV联合治疗AECOPD合并呼吸衰竭,可明显减轻症状,改善血气指标与肺功能,抑制炎症反应,调节氧化应激,且保障安全性。
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