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ObjectiveTo explore the effect of Tanreqing injection combined with Ceftazide on the clinical efficacy， lung function， and laboratory inflammatory index of patients suffering from phlegm heat obstructing lung syndrome in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. MethodFrom June 2021 to June 2023， 76 patients diagnosed with phlegm heat obstructing lung syndrome in AECOPD were enrolled in the respiratory and critical medical department of Jieshou Hospital of Traditional Chinese Medicine. They were randomly divided into a control group and an observation group with 38 cases each. The control group used Ceftazidime intravenous drip and other conventional oxygen inhalation and antispasmodic treatment measures of western medicine. The observation group received Tanreqing injection intravenous drip based on the treatment of the control group， with a course of 10 days. The changes of laboratory indicators such as hs-CRP， calcitonin （PCT）， and interleukin-6 （IL-6） before and after treatment were analyzed， and the improvement of forced expiratory volume in the first second （FEV1）， forced vital capacity （FVC）， one second rate （FEV1/FVC）， assessment and improvement of the British Medical Research Society’s dyspnea index （mMRC）， self-evaluation test of chronic obstructive pulmonary disease patients （CAT）， and traditional Chinese medicine syndrome score was compared. In addition， the total effective rate between the two groups after treatment was compared. ResultAfter treatment， the hs-CRP， PCT， IL-6， FEV1， FVC， FEV1/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation of both groups improved （P<0.01）. After treatment， compared with the control group， the observation group showed more significant improvements in hs-CRP， PCT， IL-6， FEV1， FVC， FEV1/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation， and the difference was statistically significant （P<0.05，P<0.01）. The total clinical effective rate of the control group was 86.84% （33/38）， while that of the observation group was 94.74% （36/38）. The therapeutic effect of the observation group was better than that of the control group （χ2=8.471， P<0.05）. ConclusionTanreqing injection combined with Ceftazidime has obvious efficacy in the treatment of phlegm heat obstructing lung syndrome in AECOPD， which is better than the treatment of Ceftazidime antibiotics alone. It can reduce the risk of acute exacerbation， alleviate clinical symptoms， and delay the decline of lung function.
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ObjectiveTo analyze the effect and possible mechanism of the synergistic treatment with Qingjin Huazhuo Formula （清金化浊方， QHF） on the occurrence of thrombotic events in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and phlegm heat stasis obstructing in the lung syndrome. MethodsIn a retrospective cohort study， 305 AECOPD inpatients with the syndrome of phlegm heat stasis obstructing in the lung were included. According to whether using QHF （the course of treatment ≥ 7 days）， they were divided into the exposure group （193 cases） and the non-exposure group （112 cases）. Totally， 109 pairs of cases were obtained by 1∶1 propensity score matching （PSM）. After matching， the occurrence of thrombotic events during hospitalization， the remission of main symptoms or signs （including cough， expectoration， wheezing， cyanosis） after 10 days （±3 days） of treatment， and the difference of the indicators including D-dimer， percentage of neutrophils （NEUT%）， C-reactive protein （CRP）， arterial partial pressure of oxygen （PaO2）， and arterial partial pressure of carbon dioxide （PaCO2） before treatment and after 10 days （±3 days） of treatment during the first auxiliary examination. ResultsAfter matching， the incidence of thrombotic events during hospitalization in the exposure group （5 cases， 4.59%） were lower than that of the non-exposure group （15 cases， 13.76%， P＜0.05）. The exposure factor that taking QHF for 7 days or above was a protective factor for thrombotic events in AECOPD hospitalized patients with phlegm heat stasis obstructing in the lung syndrome （RR = 0.333， 95% CI 0.126 to 0.885）. The remission rates of cough （100/109， 91.74%）， expectoration （103/109， 94.50%）， wheezing （102/109， 93.58%）， and cyanosis （97/109， 88.99%） in the exposure group were significantly higher than those in the non-exposure group （90/109， 82.57%； 94/109， 86.24%； 89/109， 81.65%； 86/109， 78.90%） after treatment （P＜0.05）. After treatment， the levels of D-dimer， NEUT%， CRP and PaCO2 in both groups significantly decreased （all P＜0.05）， and the level of PaO2 significantly increased （P＜0.05）. The difference of the levels of D-dimer， NEUT% and PaO2 in the exposure group before and after treatment were larger than those in the non-exposure group （P＜0.05）， while the pre-post difference of CRP and PaCO2 were not significantly different between the two groups （P＞0.05）. ConclusionThe synergistic treatment with QHF can effectively reduce the occurrence of thrombotic events， alleviate the clinical symptoms or signs such as cough， expectoration， wheezing， and cyanosis， and can improve lung function in hospita-lized patients with AECOPD and phlegm heat stasis obstructing in the lung syndrome. Its mechanism may be related to improving blood coagulation and inflammatory status.
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Objective To analyze the relationship between acute exacerbation of chronic obstructive disease (COPD) hospitalization and climate change in Enshi, Hubei province, and to provide theoretical basis for the prevention and treatment of COPD in Enshi . Methods Patients with acute COPD in Enshi district of Hubei Province from January 2019 to December 2019 were selected, and the clinical data of all patients on admission, including symptoms, signs, onset month, lung function indicators and serum inflammatory factors, were analyzed . FEV1% predictive value, FEV1/FVC and other lung function indexes were determined by pulmonary function detector. CRP and WBC levels were determined by biochemical detector. At the same time, meteorological factors data in Enshi , were collected , including monthly mean temperature, monthly mean humidity, monthly mean wind speed , monthly mean sunshine in Hubei province , etc. Spearman linear correlation was used to analyze the meteorological factors affecting the number of hospitalized AECOPD patients . Results The age of patients with ACUTE exacerbation of COPD was mainly 70-79 years old (34.63%) in Enshi area of Hubei Province , followed by 60-69 years old (22.49%) , and the lowest was 40-49 years old (13.75%). The incidence time mainly concentrated to may for the peak in March , November to January for the secondary peak , June to October for a relatively small number of cases. The main symptoms of COPD acute recombination are frequent cough , shortness of breath , increased sputum volume, etc., while the main signs are emphysema , wheezing , dry and wet rales . The predictive value of FEV1 and FEV1/FVC value of acute recombinant COPD were significantly lower than those of non-acute recombinant COPD (P1=-0.519 , r2=-0.428, P1=0.124 , r2=0.176, P>0.055) . Conclusion The number of patients with ACUTE exacerbation of COPD shows obvious seasonality, and the occurrence of AECOPD should be actively prevented in months with great changes in temperature and humidity.
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Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by sequential mechanical ventilation,so as to provide evidence for clinical practice. Methods The clinical data of 1204 elderly patients (≥60 years old) with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed. Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167 (13.87%) died.Multivariate analysis showed that plasma procalcitonin ≥0.5 μg/L (OR=2.762, 95%CI=1.920-3.972, P<0.001),daily invasive ventilation time ≥12 h (OR=2.202, 95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection (OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa (OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin >6% (OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluation Ⅱ score ≥25 points (OR=2.126,95%CI=1.432-3.156,P<0.001) were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d (OR=0.676,95%CI=0.457-1.000,P=0.048) and sputum excretion>twice/d (OR=0.492, 95%CI=0.311-0.776, P=0.002) were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation. Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.
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Humans , Aged , Middle Aged , Respiration, Artificial/methods , Retrospective Studies , Pulmonary Disease, Chronic Obstructive/therapy , SputumABSTRACT
This study aimed to evaluate the effectiveness and safety of eight oral Chinese patent medicines in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) by network Meta-analysis. Randomized controlled trial(RCT) on the treatment of AECOPD with eight oral Chinese patent medicines was retrieved from databases including CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, EMbase, and Cochrane Library from database inception to August 6, 2022. The information was extracted from the included literature and the quality of the included studies was evaluated using the Cochrane risk of bias assessment tool. The data were analyzed using Stata SE 15.1 and ADDIS 1.16.8 software. Finally, 53 RCTs were included, with 5 289 patients involved, including 2 652 patients in the experimental group and 2 637 patients in the control group. Network Meta-analysis showed that Lianhua Qingwen Capsules+conventional western medicine were optimal in improving clinical effective rate, Shufeng Jiedu Capsules+conventional western medicine in improving FEV1/FVC, Qingqi Huatan Pills+conventional western medicine in improving FEV1%pred, Feilike Mixture(Capsules)+conventional western medicine in improving PaO_2, Lianhua Qingwen Capsules+conventional western medicine in reducing PaCO_2, and Qingqi Huatan Pills+conventional western medicine in reducing C-reactive protein(CRP). In terms of safety, most of them were gastrointestinal symptoms, and no serious adverse reactions were reported. When the clinical effective rate was taken as the comprehensive index of efficacy evaluation, Lianhua Qingwen Capsules+conventional western medicine were the most likely to be the best treatment for AECOPD. There are some limitations in the conclusion of this study. It only provides references for clinical medication.
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Humans , Capsules , Network Meta-Analysis , Pulmonary Disease, Chronic Obstructive/drug therapy , Medicine, Chinese TraditionalABSTRACT
OBJECTIVE@#To observe the clinical effect of electroacupuncture (EA) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with gastrointestinal dysfunction.@*METHODS@#A total of 100 patients with AECOPD complicated with gastrointestinal dysfunction were randomly divided into an EA group (50 cases, 2 cases dropped off, 1 case excluded) and a medication group (50 cases). Both groups were treated with symptomatic and supportive treatment such as low flow oxygen, nebulized inhalation of short-acting β2 agonist (SABA) or short-acting muscarinic antagonist (SAMA) combined with inhaled corticosteroid (ICS). The EA group was treated with EA at Zusanli (ST 36), Yinlingquan (SP 9), Zhongwan (CV 12), Shuifen (CV 9), Tianshu (ST 25), Chize (LU 5) and Lieque (LU 7), with discontinuous wave, 2 Hz in frequency, 30 min each time, once a day. In the medication group, oral mosapride citrate tablets were given, 3 times a day, 5 mg each time. Both groups were treated for 5 d. Before and after treatment, the gastrointestinal symptom rating scale (GSRS) score was observe, serum procalcitonin (PCT), C-reactive protein (CRP), and plasma oxygenation index (PaO2/FiO2) were detected, and patient satisfaction degree was evaluated in the two groups.@*RESULTS@#Compared with before treatment, except for diarrhea dimension in the medication group, the total scores and each dimension scores of GSRS were decreased (P<0.05), serum PCT and CRP were decreased (P<0.05), plasma PaO2/FiO2 was increased (P<0.05) in the two groups after treatment. After treatment, in the EA group, the total score and abdominal pain, dyspepsia, constipation and diarrhea scores of GSRS were lower than those in the medication group (P<0.05), meanwhile serum PCT and CRP were lower and plasma PaO2/FiO2 was higher than those in the medication group (P<0.05). The improvement of gastrointestinal symptoms, life quality and overall satisfaction degree in the EA group were superior to those in the medication group (P<0.05).@*CONCLUSION@#EA could improve the symptoms of patients with AECOPD complicated with gastrointestinal dysfunction, reduce inflammatory response, improve oxygenation and patient satisfaction degree.
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Humans , Electroacupuncture , Gastrointestinal Diseases/therapy , Pulmonary Disease, Chronic Obstructive/therapy , Diarrhea , Abdominal Pain , C-Reactive ProteinABSTRACT
Objective To analyze the positive rate of serum mycoplasma pneumoniae antibody IgM in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Liangjiang New Area of Chongqing and the related risk factors, so as to provide a theoretical basis for clinical diagnosis and treatment of AECOPD. Methods Retrospective analysis of 728 cases of AECOPD patients from January 2020 to December 2021 in Chongqing Liangjiang New Area Third Class Hospital. ELISA was used to determine Mycoplasma pneumoniae IgM antibodies. According to the detection of Mycoplasma pneumoniae IgM antibodies, the patients were divided into infection group and non-MP infection group. Clinical data such as gender, age, length of stay, place of residence, smoking status, home oxygen therapy, GOLD grade of COPD, number of acute exacerbations in the previous year, mechanical ventilation, and application of anti-infective drugs were collected. Univariate analysis and logistic regression were used to analyze the risk factors of MP infection in AECOPD patients. Results The positive rate of MP-IgM in 728 AECOPD patients was 15.38% (112/728), including 67 males and 45 females. There was no significant difference in the positive rate of MP-IgM in AECOPD patients between different seasons (χ2=2.840, P>0.05). Age ≥60 (OR=3.243), smoking (OR=2.559) and GOLD grade 3-4 (OR=3.760) were independent risk factors for MP infection in AECOPD patients. Conclusion The incidence of MP infection in AECOPD patients in Liangjiang New Area of Chongqing is relatively high, especially in AECOPD patients with age ≥ 60, smoking, GOLD grade 3-4, which should be warned of the possibility of mycoplasma pneumoniae infection , and targeted treatment measures can improve the cure rate.
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@#BACKGROUND: To investigate the effects of early standardized enteral nutrition (EN) on the cross-sectional area of erector spine muscle (ESMcsa), plasma growth differentiation factor-15 (GDF-15), and 28-day mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with invasive mechanical ventilation (MV). METHODS: A total of 97 AECOPD patients with invasive MV were screened in the ICUs of the First People's Hospital of Lianyungang. The conventional EN group (stage I) and early standardized EN group (stage II) included 46 and 51 patients, respectively. ESMcsa loss and GDF-15 levels on days 1 and 7 of ICU admission and 28-day survival rates were analyzed. RESULTS: On day 7, the ESMcsa of the early standardized EN group was significantly higher than that of the conventional EN group, while the plasma GDF-15 levels were significantly lower than those in the conventional EN group (ESMcsa: 28.426±6.130 cm2 vs. 25.205±6.127 cm2; GDF-15: 1661.608±558.820 pg/mL vs. 2541.000±634.845 pg/mL; all P<0.001]. The 28-day survival rates of the patients in the early standardized EN group and conventional EN group were 80.40% and 73.90%, respectively (P=0.406). CONCLUSION: ESMcsa loss in AECOPD patients with MV was correlated with GDF-15 levels, both of which indicated acute muscular atrophy and skeletal muscle dysfunction. Early standardized EN may prevent acute muscle loss and intensive care unit-acquired weakness (ICU-AW) in AECOPD patients.
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Objective:To investigate of optimal flow oxygen-driven aerosol inhalation of budesonide in patients with acute exacerbation of chronic obstructive pulmonary disease, to provides a reference for improving the atomization effect.Methods:Totally, ninety-six patients with acute exacerbation of chronic obstructive pulmonary disease in Guangzhou Red Cross Hospital from June 2019 to December 2020 were collected and assigned to the low flow group, middle flow group and high flow group according to the random number table method, with 32 cases in each group. All patients received oxygen-driven aerosol inhalation of budesonide therapy, the oxygen flow were 4 L/min, 6 L/min and 8 L/min in the three groups, respectively. Before and after 7 days of treatment, the indices including respiratory dynamics, pulmonary function and blood gas analysis were compared among the three groups.Results:There was no significant difference in the indices including respiratory dynamics, pulmonary function and blood gas analysis before treatment among the three groups( P>0.05). After 7 days of treatment, the peak airway pressure, plateau airway pressure, inspiratory resistance were (22.53 ± 3.83) cmH 2O(1 cmH 2O=0.098 kPa), (15.97 ± 3.01) cmH 2O, (23.25 ± 2.92) cmH 2O·L -1·s -1 in the middle flow group, lower than those in the low flow group (26.09 ± 3.04) cmH 2O, (18.13 ± 2.54) cmH 2O, (26.31 ± 3.65) cmH 2O·L -1·s -1 and high flow group (26.13 ± 3.28) cmH 2O, (17.44 ± 2.02) cmH 2O, (25.06 ± 3.56) cmH 2O·L -1·s -1, the pulmonary dynamic compliance was (33.16 ± 4.43) ml/cmH 2O in the middle flow group, higher than that in the low flow group and high flow group (29.84 ± 3.73), (30.47 ± 3.53) ml/cmH 2O, the differences were statistically significant ( F values were 5.96-11.82, all P<0.05). The FEV 1, FEV 1/FVC, ratio of FEV 1 to estimated vital capacity were (1.36 ± 0.26) L, (49.91 ± 5.94)%, (44.81 ± 5.53)% in the middle flow group, higher than those in the low flow group and high flow group (1.23 ± 0.19) L, (45.22 ± 6.56)%, (40.88 ± 5.97)% and (1.20 ± 0.18) L, (46.41 ± 5.30)%, (41.78 ± 6.32)%, the differences were statistically significant ( F=4.91, 5.36, 3.84, all P<0.05). The PaO 2, oxygenation index were (73.06 ± 7.24), (176.18 ± 17.62) mmHg(1 mmHg=0.133 kPa) in the middle flow group, higher than those in the low flow group and high flow group (67.16 ± 5.10), (164.54 ± 12.34) mmHg and (69.44 ± 7.10), (167.07 ± 16.24) mmHg, PaCO 2 was (52.75 ± 6.22) mmHg in the middle flow group, lower than that in the low flow group and high flow group(57.97 ± 6.75), (56.31 ± 6.45) mmHg, the differences were statistically significant ( F=6.61, 4.96, 5.42, all P<0.05). Conclusions:Oxygen-driven aerosol inhalation of budesonide for acute exacerbation of chronic obstructive pulmonary disease patients, oxygen flow are 6 L/min can effectively improve the indices of respiratory dynamics and blood gas analysis as well as improve pulmonary function.
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Objective:To re-evaluate the methodological quality, evidence quality and reporting quality of the systematic review and meta analysis of Traditional Chinese Medicine (TCM) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:We searched the databases of CNKI, Wanfang, VIP, Cochrane Library, PubMed, EMbase, and retrieved the systematic reviews or meta-analysis literatures on the treatment of AECOPD with TCM from the establishment of the database to February 28, 2021. We applied AMSTAR2 scale and GRADE Tools, PRISMA statement to evaluate methodological quality, evidence quality and report quality.Results:A total of 15 systematic reviews were included, including 85 outcome indicators. The evaluation results of AMSTAR2 scale showed that 9 articles were low-quality methodology and 6 articles were very low-quality methodology. The GRADE results showed that the quality of evidence for 23 outcome indicators was moderate, the quality of evidence for 30 outcome indicators was low, and the quality of evidence for 32 outcome indicators was very low. The results of the PRISMA statement showed that the quality of the reporting is relatively adequate.Conclusion:TCM combined with western medicine can improve the clinical efficacy of AECOPD to a certain extent, but the methodological quality of reviews and the quality of evidence are generally low. In the future, researchers should standardize the writing of systematic reviews/meta-analysis, in order to provide clinicians with more authentic and reliable evidence-based evidence.
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Objective:To explore the changes of peripheral blood Th17/Treg and serum cytokines in AECOPD patients with secondary pulmonary fungal infection.Methods:Selected the clinical data of 27 AECOPD patients who were admitted between January 2018 to March 2020 in the Department of Respiratory Medicine, Hai'an People's Hospital Affiliated to Nantong University with fungal infection (fungal infection group), and 58 AECOPD patients without fungal infection (non-fungal infection group) who received treatment in the hospital during the same period. Compared the general clinical data, peripheral blood Th17 and Treg cell levels, Th17/Treg ratio, interleukin-17 (IL-17), interleukin-23 (IL-23), interferon-γ (interferon-γ, IFN-γ), and transforming growth factor-β (TGF-β) levels. Meanwhile, compared the levels of Th17 and Treg cells in peripheral blood, the ratio of Th17/Treg and serum cytokines in patients with different infection severity in fungal infection group. The measurement data with normal distribution were compared by independent samplet t-test between the two groups, one-way ANOVA between multiple groups, LSD-t test for pairwise comparision, and χ 2 test for counting data. Results:In the 27 AECOPD patients with fungal infection group, the pathogen distribution was 65.52% (19/27) of candida albicans, 10.34% (3/27) of candida tropicalis,10.34% (3/27) of candida albicans, and 6.90% (2/27) of Aspergillus. The level of Th17 [(16.18±3.15) % and (12.34±2.64) %, t=5.87, P<0.001)], the ratio of Th17/Treg [(4.70±0.85) and (2.41±0.51), t=22.87, P<0.001] in Patients with fungal infection group were higher than those in the non-fungal group. The level of Treg [(3.42±0.42) % and (5.13±0.51) %, t=20.77, P<0.001] in Patients with fungal infection group was lower than those in the non-fungal group. The levels of IL-17 [(85.67±21.51) μg/L and (53.64±14.36) μg/L, t= 8.12, P<0.001], and IL-23 [(61.38±16.58) μg/L and (38.29±12.60) μg/L, t=7.10, P<0.001] in Patients with fungal infection group were higher than those in non-fungal infection group, but the levels of IFN-γ ((47.75±17.72) μg/L and (62.37±19.06) μg/L, t=3.37, P=0.001) and TGF-β ((110.34±26.03) μg/L and (131.40±35.03) μg/L, t=2.87, P=0.007) were lower than those in non-fungal infection group, and the differences were statistically significant. There were statistically significant differences in the ratio of Th17/Treg, and the levels of Th17, Treg cells and cytokine among patients with different infection severity in the fungal infection group. With the increase of infection severity, the levels of Th17 ((13.06±1.98)%, (15.94±2.11)%, (17.75±2.20)%, F=10.19, P<0.001), the ratios of Th17/Treg ((5.01±0.60), (5.66±0.69), (6.52±0.65), F=10.77, P<0.001), the levels of IL-17 ((63.39±11.64) μg/L,(78.66±12.82) μg/L, F=9.01, P=0.001), and IL-23 ((42.52±13.11) μg/L, (59.97±15.25) μg/L, (69.75±14.30) μg/L, F=7.41, P=0.003) were increase, the levels of Treg ((4.33±0.39)%, (3.32±0.42)%, (2.50±0.35)%, F=44.42, P<0.001), IFN-γ ((57.78±10.52) μg/L, (48.82±10.39) μg/L, (38.90±10.56) μg/L, F=6.50, P=0.006), TGF-β ((126.62±18.94) μg/L, (115.34±13.66) μg/L, (102.52±17.73) μg/L, F=4.25, P=0.026) were significantly decreased. Conclusion:The imbalance of Th17/Treg ratio and related serum cytokines play an important role in the process of lung fungal infection in AECOPD patients, and their imbalance is related to the severity of fungal infection. Therefore, the levels of Th17/Treg and serum cytokines should be closely monitored in AECOPD patients.
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Objective:To explore the application value of two-dimensional speckle tracking imaging (2D-STI) in evaluating diaphragm function, and to compare the ability of 2D-STI and conventional diaphragm ultrasonography in diagnosing diaphragmatic dysfunction and evaluating disease severity in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 58 AECOPD patients admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January to October 2021 were retrospectively enrolled as AECOPD group, and 34 healthy subjects were recruited as control group during the same period. Repeatability test of diaphragmatic 2D-STI was performed. According to modified Medical Research Council (mMRC) dyspnea scores system and COPD Assessment Test (CAT), mMRC 0-1 and CAT<10 was classified as group A, mMRC≥2 and CAT≥10 was classified as group B. The baseline characteristics, conventional diaphragm ultrasonography parameters(thickening fraction and excursion) and 2D-STI parameters (longitudinal and radial strains) were compared between the AECOPD group and the control group, and the Spearman correlation between parameters of AECOPD group and forced expiratory volume in one second (FEV1) was analyzed. The differences of these parameters between group A and B were also compared. The ROC curve of conventional diaphragm ultrasonography parameters and 2D-STI parameters was plotted to differentiate group A from group B, and the diagnostic efficacy was evaluated.Results:Great intra- and inter-observer reproducibility was found for all diaphragmatic 2D-STI parameters, with ICCs above 0.80 for all measurements. The control group and the AECOPD group did not differ in age, sex and body mass index( P>0.05), whereas there were significant differences in smoking history, lung function, bilateral thickening fraction, excursion, longitudinal and radial strains( P<0.05). Compared with control group, patients in group A had a significant increase in diaphragm thickness ( P<0.05), while there was no significant difference in that between group B and control group ( P>0.05). The bilateral longitudinal strains, radial strains and thickening fraction of diaphragm were linearly correlated with FEV1 (right side rs=0.828, 0.794, 0.843, respectively; all P<0.001; left side rs=0.757, 0.704, 0.752, respectively; all P<0.001 ), while the correlation between excursion and FEV1 was not significant(right side rs=0.247, left side rs=0.253; all P>0.05). There were significant differences in bilateral longitudinal strains, radial strains and thickening fraction between group A and group B(all P<0.05), whereas there was no significant difference in excursion between the two groups ( P>0.05). ROC analysis showed bilateral longitudinal and radial strains had higher accuracy in distinguishing group A from group B than thickening fraction and excursion(right side AUCs 0.90, 0.84, 0.78 and 0.62, respectively; left side AUCs 0.85, 0.83, 0.77 and 0.62, respectively). Conclusions:2D-STI is a real-time noninvasive technique for diaphragm function assessment, which has high clinical value. Compared with conventional ultrasonography, 2D-STI shows more accuracy and effectiveness in diagnosing diaphragmatic dysfunction and evaluating disease severity of patients with AECOPD.
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Objective:To explore the correlation between Traditional Chinese Medicine (TCM) excessive patterns and clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease (COPD) complicated with chronic pulmonary heart disease (CPHD) in high altitude environment.Methods:Patients with acute exacerbation of COPD complicated with CPHD admitted to the Pulmonology Department of Qinghai Provincial Hospital of Traditional Chinese Medicine from December 2016 to November 2017 were selected. Demographic data and clinical medical characteristics data of the patients were collected, and TCM patterns differentiation was conducted. The correlation between each pattern type and clinical characteristics and all collected laboratory indexes were analyzed by multivariate logistic regression.Results:Phlegm obstructing lung pattern showed a negative correlation relationship with mMRC score [ OR=0.419, 95% CI (0.219-0.802), P=0.009], PCT [ OR=8.132×10 -11, 95% CI (1.632×10 -16-4.1×10 -5), P<0.001], Hb [ OR=0.971, 95% CI (0.952-0.989), P=0.002] and PaCO 2[ OR=0.914, 95% CI (0.853-0.980), P=0.011]; turbid phlegm obstructing lung pattern showed a negative correlation relationship with gender(0 male, 1 female) [ OR=0.427, 95% CI (0.204-0.892), P=0.024], Hb [ OR=0.960, 95% CI (0.945-0.975), P<0.001], and there was a positive correlation relationship with LVEF [ OR=1.061, 95% CI (1.006-1.118), P=0.028]; phlegm-heat obstructing lung pattern showed a negative correlation relationship with Hb [ OR=0.950, 95% CI (0.927-0.974), P<0.001]and cardiac function grade [ OR=0.468, 95% CI (0.248,0.881), P=0.019], and there was a positive correlation relationship with PCT [ OR=1.118×10 8, 95% CI (1.466×10 4-8.523×10 11), P<0.001] and D-D [ OR=2.283, 95% CI (1.300-4.010), P=0.004]; there was a negative correlation between phlegm and stasis blocking lung pattern with cardiac function grade[ OR=0.309, 95% CI (0.167-0.570), P<0.001], and there was a positive correlation relationship with Hb[ OR=1.060, 95% CI (1.042-1.078), P<0.001]; there was a negative correlation between wet phlegm and blood stasis heat pattern with PCT [ OR=1.266×10 -13, 95% CI (1.658×10 -21-0.1×10 -4), P<0.001], SaO 2 [ OR=0.934, 95% CI (0.892-0.979), P=0.004], LVEF [ OR=0.896, 95% CI (0.826-0.971), P=0.008], D-D [ OR=0.030, 95% CI (0.002-0.508), P=0.015], and there was a positive correlation relationship with CRP [ OR=1.042, 95% CI (1.018-1.067), P<0.001], RBC [ OR=3.411, 95% CI (1.684-6.910), P<0.001], cardiac function grade [ OR=8.573, 95% CI (2.410-30.504), P<0.001], pulmonary arterial pressure difference [ OR=2.091, 95% CI (1.243-3.516), P=0.005]. Conclusions:Male patients are more prone to phlegm and turbidities than female patients. PCT and D-D were the main risk factors of phlegm-heat obstruction syndrome. Elevated hemoglobin is a risk factor for patients with phlegm stasis and lung syndrome. Heart function classification is the main risk factor of phlegm-dampness-stasis heat syndrome.
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OBJECT IVE To investigate the influential factors of direct economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD）patients in hospital ，and to provide related suggestions to reduce the direct economic burden of hospitalization. METHODS During Dec. 1st，2019-Oct. 31st，2020，the data of 1 923 AECOPD patients admitted into the First Affiliated Hospital of Guangzhou Medical University were collected. The information of demographic sociological characteristics，clinical characteristics and cost characteristics were collected ；descriptive analysis ，single factor regression analysis and multiple linear stepwise regression analysis were adopted to investigate the influential factors of direct economic burden of hospitalization. On the basis of literature review ，relevant suggestions were put forward to reduce the direct economic burden of AECOPD patients in hospital. RESULTS & CONCLUSIONS The median of hospitalization cost of AECOPD patients was 15 621.00 yuan. The multiple linear stepwise analysis regression analysis revealed that the influential factors of direct economic burden of AECOPD patients in descending order （by partial regression coefficient ）were the length of stay （logarithmic conversion value ）， admission to ICU ，surgical treatment ，discharge outcome ，whether to salvage ，the use of respirator ，common complications and smoking history （model F＝572.200，R2＝0.750，P＜0.001）. It is suggested to strengthen comprehensive hospital management and promote multidisciplinary cooperation to reduce hospitalization days ；strictly follow the diagnosis and treatment guidelines and clinical pathways to avoid deterioration of the condition and transfer to ICU treatment ；control indications for surgery to avoid“ask for great treatment with only miner illness ”；do a good job in the publicity and education of disease and smoking cessation ，and improve the self-management ability of patients.
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Objective:To investigate the clinical effect of setting proportional pressure support (PPS) parameters by target tidal volume (VT) method.Methods:The study was conducted retrospectively on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients admitted to Tianjin Third Central Hospital from January 2016 to December 2020. According to the PPS parameter setting method, the patients were divided into the airway blocking group and target VT group. The baseline characteristics, initial setting values of flow assist (FA) and volume assist (VA), respiratory system parameters, and clinical outcomes were collected and compared between the two groups.Results:Fifty-nine patients were enrolled, 29 patients in the airway blocking group, and 30 in the target VT group. There was no statistically significant difference in baseline characteristics, compliance, resistance, and initial settings of FA and VA between the two groups. Compared with the target VT group, the respiratory rate (RR), mean arterial pressure (MAP), VT, and arterial partial pressure of oxygen (PaO 2) recorded 1 hour after the initial setting of the PPS parameters in the airway block method group were significantly reduced [RR (times/minute): 21.0 (18.5, 22.5) vs. 23.0 (21.0, 25.0), MAP (mmHg, 1 mmHg = 0.133 kPa): 84.0 (79.0, 90.5) vs. 90.0 (87.0, 96.2), VT (mL): 305.24±41.07 vs. 330.87±46.84, PaO 2 (mmHg): 68.0 (66.0, 73.5) vs. 74.0 (69.8, 82.5), all P < 0.05], while arterial partial pressure of carbon dioxide (PaCO 2) and oral closure pressure (P0.1) were both increased significantly [PaCO 2 (mmHg): 41.0 (39.0, 46.0) vs. 37.5 (35.0, 42.2), P0.1 (cmH 2O, 1 cmH 2O = 0.098 kPa): 1.42±0.78 vs. 0.90±0.67, both P < 0.05]. Compared with airway blocking group, the duration of weaning, ICU stay, and hospital stay in the target VT group were significantly shorter [duration of weaning (hours): 42.0 (24.0, 70.5) vs. 64.0 (30.5, 97.5), ICU stay: 10.00±3.38 to 13.28±5.41, hospital stay (days): 12.07±3.40 vs. 15.41±5.60, all P < 0.05]. There was no statistically significant difference in the invasive mechanical ventilation time, weaning failure rate, ICU mortality and in-hospital mortality between the two groups. Conclusion:This study suggested that the target TV method has the advantages of practicality, safety, convenience, and rapid to set PPS parameters than the airway block method, which shortens the duration of weaning and ICU stay, and has a good clinical prospect.
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Objective:To explore the early application effect of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 102 patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD treated in Shanghai Public Health Clinical Center from June 2018 to December 2019 were selected and divided into the control group and the research group by random digits table method with 51 cases in each group. The control group was given the conventional treatment and nursing measures; and the research group was given the bedside sitting respiratory training. Pulmonary functional and blood -gas analysis parameters, clinical outcome of patients, etc. before and after the intervention between the two groups were compared. Results:After the intervention, the forced expiratory volume in one second (FEV 1), forced vital capacity(FVC), FEV 1/FVC were (1.79±0.22) L, (3.09±0.28) L, (62.16±5.94)% in the research group, and (1.43±0.18) L, (2.66±0.23) L, (53.48±5.31)% in the control group, the differences were statistically significant(t values were 8.36, 8.00, 7.19, P<0.01). Arterial partial pressure of carbon dioxide (PaCO 2) and arterial partial pressure of oxygen (PaO 2) in blood gas analysis were (51.14±3.79) mmHg(1 mmHg=0.133 kPa), (71.07±5.49) mmHg in the research group, and (57.52±3.86) mmHg, (65.62±5.27) mmHg in the control group, the differences were statistically significant ( t values were -7.78, 4.72, P<0.01). The non-invasive positive pressure ventilation time, hospital stays were (7.41±1.76) d, (11.27±2.41) d in the research group, and (9.79±2.11) d, (15.46±3.12) d in the control group, the differences were statistically significant ( t values were -5.71, -6.70, P<0.01). The incidence of adverse events was 3 cases in the research group, 1 case in the control group, the difference was no statistically significant ( P>0.05). Conclusions:The application of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD can effectively improve the pulmonary physiological function, shorten the noninvasive positive pressure ventilation time and hospitalization time, which has clinical application value.
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OBJECTIVE@#To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound.@*METHODS@#A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO@*RESULTS@#On day 3, 7 and 10 of treatment, PaO@*CONCLUSION@#Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.
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Humans , Acupuncture Points , Acupuncture Therapy , Diaphragm , Pulmonary Disease, Chronic Obstructive/therapy , Respiratory Insufficiency/therapyABSTRACT
OBJECTIVE：To study the improvement effects of Weijing deco ction on AECOPD model rats and its possibile mechanism. METHODS ：Totally 55 male SD rats were randomly divided into normal group ，model group ，Weijing decoction low-dose and high-dose groups （8.37，16.74 g/kg，by crude drug ），dexamethasone group （positive control group ，0.09 mg/kg），with 11 rats in each group. Except for normal group ，AECOPD model was induced by cigarettes combined with lipopolysaccharide in other groups. After modeling ，normal group and model group were given constant volume of water intragastrically ，and other groups were given relevant medicine intragastrocally ，twice a day ，for 14 days. After last intragastric administration ，the serum level of IL- 1 β was determined，and pathological changes of lung tissue and bronchus were observed in each group ；mRNA expression of MMP-9 and TIMP- 1 genes in lung tissue were detected ；protein expression of Ras homologous gene family member （RhoA）， dishevelled associated activator of morphogenesis- 1（DAAM1）and hyperplasic suppress gene （HSG）in lung tissue were also determined. RESULTS ：Compared with normal group ，the levels of IL- 1β in serum，mRNA expression of MMP- 9 and TIMP-1 as well as protein expression of RhoA and DAAM 1 in lung tissue were increased significantly in the model group（P＜0.05），while protein expression of HSG in lung tissue was decreased significantly （P＜0.05）；there were many chronic inflammatory cells infiltrating around the bronchus ，some airway mucosa epithelium exfoliating ，alveolar compensatory dilation，pulmonary septal capillary dilation and hyperemia. Compared with model group ，the levels of IL- 1β in serum，mRNA expression of MMP- 9 and TIMP- 1 in lung tissue were decreased significantly in Weijing decoction high-dose group （P＜0.05）；the protein expression of RhoA and DAAM 1 in lung tissue were decreased significantly in Weijing decoction low-dose and high-dose groups（P＜0.05），while the protein expression of HSG in lung tissue was increased （P＜0.05）；the pathological changes of Weijing decoction high-dose group ，such as inflammatory cells infiltrating around the bronchus and shedding of airway mucosa ， were improved significantly ， and there was complete alveolar epithelium structure but no obvious pulmonary dilation. CONCLUSIONS：Weijing decoction can improve AECOPD model rats to certain extent ；its mechanism may be associated with down-regulating mRNA expression of MMP- 9 and TIMP -1 as well as protein expression of RhoA and DAAM 1 in lung tissue ， up-regulating protein expression of HSG in lung tissue so as to inhibit the airway remodeling.
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Objective:To regulate autophagy protein p62 of airway epithelial cells in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) rats with Qingjin Huatantang, in order to explore its effect on interleukin (IL) -1β and tumor necrosis, tumor necrosis factor-α (TNF-α), leukotriene B4 (LTB4), and leukotriene C4 (LTC4). Method:Airway epithelial cells and AECOPD airway epithelial cells were cultured. Sixty SPF male SD rats were randomly divided into 6 groups, namely high, medium and low-dose Qingjin Huatantang groups, western medicine group, model group and normal group. Except for the normal group, the remaining groups were included into the AECOPD model by lipopolysaccharide (LPS) tracheal instillation method + fumigation method. After modeling, the dosage of the high-dose traditional Chinese medicine group was 30 g·kg-1·d-1, that of the middle-dose group was 15 g·kg-1·d-1, that of the low-dose group was 7.5 g·kg-1·d-1, the positive control group was given luo erythromycin (0.017 5 g·kg-1·d-1), the model group and the blank control group were orally given normal saline with the volume of 20 mL·kg-1·d-1. Serum was extracted two weeks after administration, and the cells were intervened with drug-containing serum. The content of interleukin IL-1β, TNF-α, and LTB4 in cell supernatants were detected by enzyme-linked immunosorbent assay (ELISA). And LTC4 content, p62 mRNA and protein expressions in lung airway epithelial cells were detected by quantitative real-time fluorescence polymerase chain reaction (Real-time PCR) and Western blot. Result:Compared with the normal group, ELISA results showed that IL-1β, TNF-α, LTB4, and LTC4 in the model group were significantly increased (P<0.01). Compared with the model group, IL-1β, TNF-α, LTB4, LTC4 in cell supernatants in each administration group were significantly reduced (P<0.01), mRNA and protein expressions in p62 showed that compared with the normal group, mRNA and protein expressions in p62 of model group significantly decreased (P<0.01). Compared with the model group, the mRNA and protein expressions of p62 in each administration group significantly increased to different degrees (P<0.01). The expression of autophagy in Qingjin Huatantang high-dose group and western medicine group was comparable. Conclusion:Qingjin Huatantang can reduce the inflammatory response in airway epithelial cells, which may be related to the regulation of autophagy protein p62.
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Background: Chronic obstructive pulmonary disease (COPD) is one of the most important reasons for hospitalizationworldwide with high 30-day readmission rates. Although the prognostic significance of early readmission is not fully understood,they are often associated with poor outcomes including high mortality rates of 4%–19% at 30 and 365 days, respectively.Similarly, in acute exacerbations of COPD (AECOPD) cases receiving emergency department care, current status on lungfunction and cardiovascular comorbidities are considered as best predictors for both 30- and 90-day COPD readmission rates.Dual bronchodilator strategy with long-acting muscarinic antagonist (LAMA)/long-acting beta-agonists (LABA) is thereforerecommended by GOLD (2019) in the postdischarge phase following an acute exacerbation.Aim: To further assess the clinical impact of dual bronchodilators including glycopyrronium and arformoterol as home nebulizationin the post-discharge phase of AECOPD, the current postapproval, observational study was conducted.Materials and Methods: An observational, concurrent, and non-inferiority study with glycopyrronium and arformoterol homenebulizing solutions on patients with moderate and severe COPD was conducted at two centers in India. An estimated samplesize of 40 patients involving moderate and severe COPD cases was factored for per-protocol analyses with P < 0.05 consideredas statistically significant. A concurrent study analysis for the follow-up visit was conducted as per the principles of InternationalConference of Harmonization for Good clinical practice and Declaration of Helsinki while ensuring confidentiality during accessof patient support registration sheets.Results: Per protocol analyses for consecutive 46 cases from two centers receiving Nebulized glycopyrronium (25 mcg) andarformoterol (15 mcg), as separate formulations are given as admixed solution with follow-up visit for at least 4 weeks wascarried out. Baseline demographics for the overall group showed exacerbation history (46, 100%), hospitalization for AECOPD(21, 45.6%); ED visit (25, 54.3%), forced expiratory volume in one second (FEV1) 1.2 ± 0.6 L/min; FEV1/FVC64.8% ± 10.6;reversibility 8.4% ± 11.8; CAT 34.6 ± 2.3; and vibrating mesh nebulizer (46, 100%). The mean predose FEV1 (∆) at the end of 4weeks for overall, moderate and severe COPD cases were observed as of 9.6±3.1%, 11.8% ± 3.1, and 8.4% ± 1.6, respectively(P < 0.0001). Similarly, the mean CAT(∆) score at the end of 4 weeks was observed as of 18.1 ± 0.69, 20.6 ± 0.69, and 18.26 ±0.6 for overall, moderate and severe COPD cases, respectively (P < 0.0001). The intergroup differences for rescue medicationuse for a lone case with severe COPD (1, 2.04%) complied with the suggested non-inferiority margin between the groups.There were no other treatment-emergent adverse events or serious adverse events that warranted treatment modification orwithdrawals in both groups.