ABSTRACT
Objective To investigate the clinical efficacy of the treatment of long-term non-invasive positive pressure ventilation (NIPPV) combined with inhaling corticosteroids in patients with stable chronic o0bstructive pulmonary disease(COPD) complicated with respiratory failure,and to investigate the impact of longterm NIPPV combined with inhaling corticosteroids on serum levels of matrix metalloproteinase-9 (MMP-9).Methods Eighty outpatients of stable severe COPD complicated with respiratory failure divided them equally into two treatment groups (the experimental and the control groups).The two groups of patients were given oxygen therapy,inhalation of Salmeterol and fluticasone propionate powder for one year.The experimental group received additionally NIPPV therapy for 1 year.The outcomes measured included St.George's questionnaire (SGRQ) score,MMRC score,6-min working time (6-MWT),arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide(PaCO2),Forced expiratory volume in 1 (FEV1％),and the serum levels of MMP-9 before and after treatment,and frequency of acute exacerbations of COPD and hospital says in the last one year and the following 12 months.Results After 1 year,the differences of SGRQ score,MMRC score,6-MWT,PaO2,PaCO2,FEV1％,MMP-9 in the experimental group ((63.38 ±4.46) vs.(52.93 ±4.30),t =10.67,P =0.00;(3.60±0.50) vs.(2.40 ±0.50),t =10.82,P=0.00;(159.90 ±6.50) m vs.(247.10±9.66) m,t=47.39,P=0.00;(56.85 ± 1.67) mm Hg vs.(66.10 ±2.59) mm Hg,t =10.67,P =0.00;(60.38 ±3.58)mm Hgvs.(51.88 ±3.05)mm Hg,t=10.82,P=0.00; (38.93 ±3.22)％ vs.(42.12 ±3.11)％,t=47.39,P =0.00;(182.58 ±6.60) μg/L vs.(171.73 ±6.19) μg/L,t =7.58,P =0.00) were statistically significant compared to the control group ((63.88 ± 4.88) vs.(54.30 ± 4.13),t =8.77,P =0.00; (3.65 ± 0.48) vs.(2.70±0.46),t =8.97,P =0.00;(157.98 ±5.97) m vs.(218.08±13.12) m,t =26.38,P=0.00;(56.65 ±1.51)mm Hg vs.(62.60 ± 1.91)mm Hg,t=8.77,P=0.00; (60.20 ±3.52)mm Hg vs.(56.25 ±3.09)mm Hg,t =8.97,P =0.00; (38.93 ±2.96) ％ vs.(40.70 ±3.27)％,t =26.38,P =0.00; (180.55 ±4.78) μg/L vs.(173.05 ± 5.28) μg/L,t =6.66,P =0.00).The frequency of acute exacerbations of COPD and hospital stay days were significantly decreased in the experimental group than in the control group.Conclusion Long-term NIPPV combined with inhaling corticosteroids could significantly improve the quality of life and lower the serum levels of MMP-9 of patients with severe stable COPD complicated with respiratory failure.
ABSTRACT
Objective To study the preventive and therapeutic effects of blood pressure control on hematoma expansion and neurological function in patients with ultra-early basal ganglia intracerebral hemorrhage.Methods From November 2009 to November 2011,120 patients with ultra-early basal ganglia intracerebral hemorrhage from our Hospital were enrolled and randomly divided into intensive blood pressure reduction group and general blood pressure reduction group in equal numbers (n =60).The antihypertensive agent were used intravenously to reduce the systolic blood pressure by 130-140 mm Hg within l hour after treatment in patients of intensive blood pressure reduction group; and the general blood pressure reduction group was control by 160-180 mm Hg.The blood pressure of patients in both groups was maintained for 24 hours.The volume of haematoma in CT was measured before and 24 hours after treatment.The National Institutes of Health Stroke Scale (NIHSS) score was assessed 24 hours before and after treatmentand 14 days after treatment respectively.Statistical analyses were conducted.Results Between 24 hours before and after treatment,therewere significant difference in the hematoma volume((11.99 ± 6.90) ml vs.(14.74 ± 7.75) ml,t =2.049,P =0.043) and the number of cases of hematoma enlargement(5 vs.14,x2 =5.07,P =0.024) between the two groups.Between 24 hours before and after treatment,there was no significant difference in NIHSS scale in intensive blood pressure reduction group ((9.74 ± 4.49) vs.(9.25 ± 4.10),P ＞ 0.05).Between 24 hours before and 2 weeks after treatment,there were significant difference in NIHSS scale in both groups ((9.74 ± 4.49) vs.(6.28 ± 3.68),P ＜ 0.05 ; (9.50 ± 4.81) vs.(7.82 ± 4.28),P ＜ 0.05,respectively).At two weeks after treatment,there was significant difference in NIHSS scale between two groups ((6.28 ± 3.68) vs.(7.82 ± 4.28),P ＜ 0.05).Conclusion Intensive reduction of blood pressure is safe for the treatment of ultra-early basal ganglia intracerebral hemorrhage and reduce the incidence of hematoma enlargement and improve patient's early neurological function.