Logistic regression analysis of positive rate of serum Mycoplasma pneumoniae IgM antibody in patients with acute exacerbation of AECOPD in Liangjiang New Area of Chongqing / 公共卫生与预防医学

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.

Detection of respiratory viruses and expression of inflammatory cytokines in patients with acute exacerbation chronic obstructive pulmonary disease in Mongolia China / Detecção de vírus respiratórios e expressão de citocinas inflamatórias em pacientes com doença pulmonar obstrutiva crônica de exacerbação aguda na Mongólia, China

Chronic obstructive pulmonary disease (COPD) was estimated to be the third cause of global mortality by 2020. Acute exacerbation COPD (AECOPD) is a sudden worsening of COPD symptoms and could be due to virus/bacterial infections and air pollution. Increased expression of inflammatory markers in patients with AECOPD is associated with viral infection. This study aimed to detect different viruses and analyze the expression of various inflammatory markers associated with AECOPD patients. Three hundred and forty-seven patients diagnosed with COPD according to GOLD criteria were included in this study. Swab samples and blood were collected for the detection of viruses by RT-PCR and expression of inflammatory markers, respectively. Of the swab samples, 113 (32.6%) of samples were positive for virus detection. Of these, HRV (39.8%) was the predominant virus detected followed by FluB (27.4%) and FluA (22.1%). The presence of HRV was significantly higher (p=0.044) among the other detected viruses. When compared to healthy controls the expression levels of TNF-α, IL-6 and IL-8 were significantly higher (p<0.05) in virus-positive patients. The IL-6 and IL-8 were the next predominantly expressed in markers among the samples. The higher expression rate of IL-8 was significantly (p<0.05) associated with patients having COPD GOLD III severity level and smoking history. Although HRV was the predominant virus detected the combined prevalence of Influenza A and B surpassing the rate of HRV. The high-level expression of well known inflammatory markers of AECOPD, TNF-α, IL-6 and IL-8 indicates a chronic severe illness. These markers play an important role and could be used as a marker for determining the severity of AECOPD.

Estima-se que a doença pulmonar obstrutiva crônica (DPOC) seja a terceira causa de mortalidade global em 2020. A exacerbação aguda DPOC (AECOPD) é um agravamento súbito dos sintomas da DPOC e pode ser devido a infecções por vírus/bactérias e poluição do ar. O aumento da expressão de marcadores inflamatórios em pacientes com AECOPD está associado à infecção viral. Este estudo teve como objetivo detectar diferentes vírus e analisar a expressão de vários marcadores inflamatórios associados a pacientes com AECOPD. Trezentos e quarenta e sete pacientes com diagnóstico de DPOC de acordo com os critérios GOLD foram incluídos neste estudo. Amostras de swab e sangue foram coletadas para detecção de vírus por RT-PCR e expressão de marcadores inflamatórios, respectivamente. Das amostras de esfregaço, 113 (32,6%) amostras foram positivas para detecção de vírus. Nestas, o HRV (39,8%) foi o vírus predominante detectado, seguido do FluB (27,4%) e do FluA (22,1%). A presença de VFC foi significativamente maior (p = 0,044) entre os demais vírus detectados. Quando comparados a controles saudáveis, os níveis de expressão de TNF-α, IL-6 e IL-8 foram significativamente maiores (p <0,05) em pacientes com vírus positivo. A IL-6 e a IL-8 foram as próximas predominantemente expressas em marcadores entre as amostras. A maior taxa de expressão de IL-8 foi significativamente (p <0,05) associada a pacientes com grau de gravidade GOLD III da DPOC e história de tabagismo. Embora o HRV tenha sido o vírus predominante, a prevalência combinada de Influenza A e B ultrapassou a taxa de HRV. O alto nível de expressão de marcadores inflamatórios bem conhecidos de AECOPD, TNF-α, IL-6 e IL-8 indica uma doença crônica grave. Esses marcadores desempenham um papel importante e podem ser usados como um marcador para determinar a gravidade da AECOPD.

Detection of respiratory viruses and expression of inflammatory cytokines in patients with acute exacerbation chronic obstructive pulmonary disease in Mongolia China

Abstract Chronic obstructive pulmonary disease (COPD) was estimated to be the third cause of global mortality by 2020. Acute exacerbation COPD (AECOPD) is a sudden worsening of COPD symptoms and could be due to virus/bacterial infections and air pollution. Increased expression of inflammatory markers in patients with AECOPD is associated with viral infection. This study aimed to detect different viruses and analyze the expression of various inflammatory markers associated with AECOPD patients. Three hundred and forty-seven patients diagnosed with COPD according to GOLD criteria were included in this study. Swab samples and blood were collected for the detection of viruses by RT-PCR and expression of inflammatory markers, respectively. Of the swab samples, 113 (32.6%) of samples were positive for virus detection. Of these, HRV (39.8%) was the predominant virus detected followed by FluB (27.4%) and FluA (22.1%). The presence of HRV was significantly higher (p=0.044) among the other detected viruses. When compared to healthy controls the expression levels of TNF-, IL-6 and IL-8 were significantly higher (p 0.05) in virus-positive patients. The IL-6 and IL-8 were the next predominantly expressed in markers among the samples. The higher expression rate of IL-8 was significantly (p 0.05) associated with patients having COPD GOLD III severity level and smoking history. Although HRV was the predominant virus detected the combined prevalence of Influenza A and B surpassing the rate of HRV. The high-level expression of well known inflammatory markers of AECOPD, TNF-, IL-6 and IL-8 indicates a chronic severe illness. These markers play an important role and could be used as a marker for determining the severity of AECOPD.

Resumo Estima-se que a doença pulmonar obstrutiva crônica (DPOC) seja a terceira causa de mortalidade global em 2020. A exacerbação aguda DPOC (AECOPD) é um agravamento súbito dos sintomas da DPOC e pode ser devido a infecções por vírus/bactérias e poluição do ar. O aumento da expressão de marcadores inflamatórios em pacientes com AECOPD está associado à infecção viral. Este estudo teve como objetivo detectar diferentes vírus e analisar a expressão de vários marcadores inflamatórios associados a pacientes com AECOPD. Trezentos e quarenta e sete pacientes com diagnóstico de DPOC de acordo com os critérios GOLD foram incluídos neste estudo. Amostras de swab e sangue foram coletadas para detecção de vírus por RT-PCR e expressão de marcadores inflamatórios, respectivamente. Das amostras de esfregaço, 113 (32,6%) amostras foram positivas para detecção de vírus. Nestas, o HRV (39,8%) foi o vírus predominante detectado, seguido do FluB (27,4%) e do FluA (22,1%). A presença de VFC foi significativamente maior (p = 0,044) entre os demais vírus detectados. Quando comparados a controles saudáveis, os níveis de expressão de TNF-, IL-6 e IL-8 foram significativamente maiores (p 0,05) em pacientes com vírus positivo. A IL-6 e a IL-8 foram as próximas predominantemente expressas em marcadores entre as amostras. A maior taxa de expressão de IL-8 foi significativamente (p 0,05) associada a pacientes com grau de gravidade GOLD III da DPOC e história de tabagismo. Embora o HRV tenha sido o vírus predominante, a prevalência combinada de Influenza A e B ultrapassou a taxa de HRV. O alto nível de expressão de marcadores inflamatórios bem conhecidos de AECOPD, TNF-, IL-6 e IL-8 indica uma doença crônica grave. Esses marcadores desempenham um papel importante e podem ser usados como um marcador para determinar a gravidade da AECOPD.

Detection of respiratory viruses and expression of inflammatory cytokines in patients with acute exacerbation chronic obstructive pulmonary disease in Mongolia China / Detecção de vírus respiratórios e expressão de citocinas inflamatórias em pacientes com doença pulmonar obstrutiva crônica de exacerbação aguda na Mongólia, China

Chronic obstructive pulmonary disease (COPD) was estimated to be the third cause of global mortality by 2020. Acute exacerbation COPD (AECOPD) is a sudden worsening of COPD symptoms and could be due to virus/bacterial infections and air pollution. Increased expression of inflammatory markers in patients with AECOPD is associated with viral infection. This study aimed to detect different viruses and analyze the expression of various inflammatory markers associated with AECOPD patients. Three hundred and forty-seven patients diagnosed with COPD according to GOLD criteria were included in this study. Swab samples and blood were collected for the detection of viruses by RT-PCR and expression of inflammatory markers, respectively. Of the swab samples, 113 (32.6%) of samples were positive for virus detection. Of these, HRV (39.8%) was the predominant virus detected followed by FluB (27.4%) and FluA (22.1%). The presence of HRV was significantly higher (p=0.044) among the other detected viruses. When compared to healthy controls the expression levels of TNF-α, IL-6 and IL-8 were significantly higher (p<0.05) in virus-positive patients. The IL-6 and IL-8 were the next predominantly expressed in markers among the samples. The higher expression rate of IL-8 was significantly (p<0.05) associated with patients having COPD GOLD III severity level and smoking history. Although HRV was the predominant virus detected the combined prevalence of Influenza A and B surpassing the rate of HRV. The high-level expression of well known inflammatory markers of AECOPD, TNF-α, IL-6 and IL-8 indicates a chronic severe illness. These markers play an important role and could be used as a marker for determining the severity of AECOPD.

Estima-se que a doença pulmonar obstrutiva crônica (DPOC) seja a terceira causa de mortalidade global em 2020. A exacerbação aguda DPOC (AECOPD) é um agravamento súbito dos sintomas da DPOC e pode ser devido a infecções por vírus/bactérias e poluição do ar. O aumento da expressão de marcadores inflamatórios em pacientes com AECOPD está associado à infecção viral. Este estudo teve como objetivo detectar diferentes vírus e analisar a expressão de vários marcadores inflamatórios associados a pacientes com AECOPD. Trezentos e quarenta e sete pacientes com diagnóstico de DPOC de acordo com os critérios GOLD foram incluídos neste estudo. Amostras de swab e sangue foram coletadas para detecção de vírus por RT-PCR e expressão de marcadores inflamatórios, respectivamente. Das amostras de esfregaço, 113 (32,6%) amostras foram positivas para detecção de vírus. Nestas, o HRV (39,8%) foi o vírus predominante detectado, seguido do FluB (27,4%) e do FluA (22,1%). A presença de VFC foi significativamente maior (p = 0,044) entre os demais vírus detectados. Quando comparados a controles saudáveis, os níveis de expressão de TNF-α, IL-6 e IL-8 foram significativamente maiores (p <0,05) em pacientes com vírus positivo. A IL-6 e a IL-8 foram as próximas predominantemente expressas em marcadores entre as amostras. A maior taxa de expressão de IL-8 foi significativamente (p <0,05) associada a pacientes com grau de gravidade GOLD III da DPOC e história de tabagismo. Embora o HRV tenha sido o vírus predominante, a prevalência combinada de Influenza A e B ultrapassou a taxa de HRV. O alto nível de expressão de marcadores inflamatórios bem conhecidos de AECOPD, TNF-α, IL-6 e IL-8 indica uma doença crônica grave. Esses marcadores desempenham um papel importante e podem ser usados como um marcador para determinar a gravidade da AECOPD.

Pharmacoeconomic evaluation of Suhuang Zhike Capsules using Markov model for inpatients with acute exacerbation of chronic obstructive pulmonary disease / 中国中药杂志

To evaluate the economics of Suhuang Zhike Capsules in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) for inpatients. Based on the published clinical research data, cost-utility analysis was used in this study to evaluate the pharmacoeconomics of Suhuang Zhike Capsules in treatment of AECOPD inpatients from the perspective of medical insu-rance. The test group was treated with Suhuang Zhike Capsules combined with conventional Western medicine, and the control group was treated with conventional Western medicine alone. Treeage software was used to construct a pharmacoeconomic model and perform simulation analysis. The results showed that the cost and output of Suhuang Zhike Capsules combined with the conventional Western medicine were 60 010.18 yuan and 1.92 quality adjusted life year(QALYs), respectively in the simulated 3 years of disease treatment. The cost and output of the conventional Western medicine were 96 730.60 yuan and 1.90 QALYs respectively. Suhuang Zhike Capsules combined with conventional Western medicine required lower cost but achieved higher output, showing cost-utility advantages, so this drug combination was a plan with pharmacoeconomic advantages. The sensitivity analysis results showed that the conclusion was relatively stable. Based on the above results, it is believed that as compared with the conventional Western medicine, Suhuang Zhike Capsules combined with conventional Western medicine have lower cost and higher output for the treatment of AECOPD inpatients, and it is a treatment plan with pharmacoeconomic advantages.

Out-of-pocket Healthcare Costs of COPD Exacerbation Episodes: A Hidden Cost and Growing Strain on Family Budgets

Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) appears to be the main reason for hospitalization among chronic obstructive pulmonary disease (COPD) patients. This study aimed to evaluate the substantial economic burden of COPD in terms of out-of-pocket costs (OOPCs) among COPD patients. Methods: This study consisted of 67 consenting patients with AECOPD. A cross-sectional study was performed via convenience sampling. Data were gathered based on per episode of exacerbation and the calculation of OOPCs was done based on direct and indirectcosts. Results:This study showed that the mean length of hospital stay for four severity levels (according to GOLD guidelines) was 3.4, 7.2, 10.3 and 14.1 days, respectively. The mean OOPCs per episode of exacerbation according to the severity level were 139.1, 153.3, 171.4 and 365.8 USD, respectively Conclusion: Impacts of OOPCs regarding AECOPD episodes on healthcare resources are worthy of attention. Cost estimation from patients’ perspective especially OOPCs estimation is important in decision and policy-making to improve healthcare states of a population

Effect of Qingjin Huatantang on AECOPD Inflammatory Factors by Regulating p62 / 中国实验方剂学杂志

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.

Aspergillus spp. infection as a cause of acute exacerbations of chronic obstructive pulmonary disease: a prospective observational study

Background: Majority of exacerbations of COPD (AECOPD) are due to infections. Usual agents causing AECOPD are gram negative bacteria, but rarely viruses and fungi are also implicated. However, the role of fungal infection, especially Aspergillus spp. in the clinical deterioration of COPD still remains unclear. This prospective observational study looks at the prevalence of aspergillus infection in AECOPD. The Objectives of this study were to analyse the prevalence and risk factors associated with Aspergillus infection in AECOPD, and to investigate the clinical outcomes.Methods: Patients admitted with AECOPD for a period of 3 months from 1st October 2017 to 31st December 2017 were prospectively included from ICU and general ward of Pulmonary Medicine department of a tertiary care hospital. Clinical, radiological and microbiological data were collected at admission and during the hospital stay. Clinical course and outcome are recorded.Results: There were 104 cases of AECOPD during the study period out of which 96 were males and 8 were females. 17 patients had evidence of aspergillus infection and diabetes was found to be an independent risk factor for aspergillus infection.Conclusions: Aspergillus infection is an important cause of COPD exacerbation and this is directly related to diabetes mellitus.

Clinical Profile of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients in a Tertiary Care Hospital in North-East India: A Retrospective Study

Studies regarding clinical profile of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is extremely rare from the north-eastern part of India. This necessitates the present study. Aim: The present study aimed to describe the clinical profile of Acute Exacerbation of COPD (AECOPD) patients admitted in the Department of Respiratory Medicine, JNIMS, Imphal. Methods: The hospital records of all Acute Exacerbations of COPD patients admitted during the period Sept 2015 to Aug 2016 in the IPD of the Department of Respiratory Medicine, JNIMS were recorded retrospectively and analyzed by using descriptive statistics. Results: A total of 100 patients were admitted during the study period of one year. The mean age (SD) of the patients was found to be 71.3 (10.567) years. Female patients outnumbered male patients (M:F=1:1.08). The last quarter of the year (Sept-Dec) showed the least number of patients admitted while remaining months of the year had variable but relatively higher number of patients admitted with a peak in August. Dyspnoea was the commonest symptom which was found in almost all the patients (99%). Co-amoxiclav, Cephalosporin, Macrolide and Fluoroquinolone were the antibiotics most frequently used. In addition to the antibiotics mentioned above, steroids were needed and administered in 74 cases (74%). Methylprednisolone and Hydrocortisone were the main steroidal preparations used. Ventilation support was needed by two (2%) patients. And altogether three patients died during the study period (3%). The period of stay in IPD by all the patients ranged from 2-35 days with a mean (SD) of 8.51 (6.268) days. Conclusion: COPD exacerbation was seen in ageing population of both sexes. Dyspnoea was commonest symptom and mean hospital stay was 8.51 days. Antibiotics and steroid commonly prescribed were Coamoxiclav and methylprednisolone respectively. 3% of study population expired.

Correlation Between RhoA Gene in Wnt/PCP Signaling Pathway and Traditional Chinese Medicine Syndrome of AECOPD / 中国实验方剂学杂志

Objective: To investigate the correlation between Ras homolog gene family member A (RhoA) gene in Wnt/PCP signaling pathway and acute exacerbation chronic obstructive pulmonary disease (AECOPD) traditional Chinese medicine(TCM)syndrome, attempting to provide an objective standard for the diagnosis of AECOPD TCM syndrome. Method: The 100 AECOPD patients were collected and divided into 5 groups:phlegm turbid obstructing lung syndrome,, phlegm-heat obstructing lung syndrome, syndrome of orifices confused by phlegm, deficiency of pulmonary and renal Qi, and edema due to yang deficiency, with 20 people in each group. 15 normal people were selected as a normal control group. All patients received fasting hemospasia, using a kit to extract blood total RibonucleicA(RNA) according to instructions. Real-time quantitative polymerase chain reaction (Real-time PCR) was adopted to detect the mRNA expression of RhoA gene in blood of patients with AECOPD TCM syndrome, and to explore the correlation. Result: There was no difference between phlegm-heat obstructing lung syndrome group and syndrome of orifices confused by phlegm group. The mRNA expression of RhoA gene in phlegm turbid obstructing lung syndrome group, phlegm-heat obstructing lung syndrome group, syndrome of orifices confused by phlegm group, deficiency of pulmonary and renal Qi group, and edema due to Yang deficiency group were significantly higher than that in normal group (PConclusion: The significant difference in mRNA relative expression of RhoA gene in Wnt/PCP signaling pathway among the five AECOPD TCM syndrome groups may provide some objective diagnostic criteria for AECOPD TCM syndromes and reveal their disease severity.

Relationship Study on Serum Levels of Procalcitonin and Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease / 现代检验医学杂志

Objective To study the relationship between the serum levels of procalcitonin (PCT) and pulmonary function in patients with chronic obstructive pulmonary disease (COPD).Methods From January 2016 to May 2107,88 cases of patients with COPD and 100 cases of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were chosen as the object of study,pulmonary function was measured in all patients,grouped according to the standard of pulmonary function classification,and detected the serum levels of PCT by immunoturbidimetry.Results The serum levels of PCT were not statistically different among the COPD patients (F=1.401,P＞0.05).But among the AECOPD patients,the serum levels of PCT in the Ⅳ class of pulmonary function were significantly higher than that in the Ⅰ,Ⅱ class and Ⅲ class and this difference was statistically significant (F=9.128,P＜0.05).Conclusion The serum levels of PCT had significant reference value for the judgement of the severity of pulmonary function impairment in AECOPD patients.

The research on the clinical effect of clustered NIV in the treatment for patients with AECOPD complicated with HE / 中国医学装备

Objective: To observe the clinical effect of clustered non-invasive mechanical ventilation strategy in the treatment for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with hypercapnia encephalopathy(HE) so as to evaluate the safety and effectiveness of the scheme. Methods: According to the inclusion criteria, 164 patients with AECOPD complicated with HE were divided into the observation group(74 cases) and the control group (90 cases) as the random method. The patients of observation group were treated with clustered non-invasive ventilation(NIV), and the patients of control group were treated with invasive mechanical ventilation(IMV). The blood gas indexes of the two groups before and after 2 hours of treatment were observed, and the improved situations of the two groups were evaluated by KPS score. Besides, the hospitalization time and the mechanical ventilation time of the two groups were observed, and the incidence of adverse events and case fatality rate of 1 year in the two groups were counted and analyzed, and the reliability of the clustered NIV scheme was further evaluated. Results: Before treatment, there were no significant differences in pH, oxygenation index(PaO2/FiO2), partial pressure of carbon dioxide in artery (PaCO2) level and KPS score between the two groups(t=1.021, t=1.301, t=0.985, t=1.017, P>0.05). Although these indicators were obviously improved after these patients of two groups were treated, the differences of them between before and after treatment were no significant(t=2.017, t=1.825, t=1.163, t=1.520, P>0.05). On the other hand, the differences of time of mechanical ventilation, the hospitalization time and the times of intubation between the observation group and the control group were significant(t=7.018, t=8.523, t=7.954, P<0.05). In the observation group, there were 12 cases were failure, and 4 patients died in hospital, while the number of died in hospital were 18 cases in control group, and the difference of the number of died in hospital between the two groups was significant(x2=5.631, P<0.05). Besides, the difference of complication between the two groups was significant(x2=7.014, P<0.05). And the difference of case fatality rate of 1 year between the two groups was no significant. Conclusion: It is safe and effective for patients with AECOPD complicated with HE to implement cluster noninvasive mechanical ventilation strategy on the basis of meeting the condition of non-invasive mechanical ventilation. And it has clinical application value.

Effects of Sufentanil Combined with Dexmedetomidine on ICU Acquired Weakness of AECOPD Patients Receiving Mechanical Ventilation / 中国药房

OBJECTIVE:To investigate the effects of sufentanil combined with dexmedetomidine on ICU acquired weakness(ICU-AW)of AECOPD patients receiving mechanical ventilation. METHODS:A total of 120 AECOPD patients in ICU of our hospital during Oct. 2015-Oct. 2016 were divided into group A and B according to random number tablet,with 60 cases in each group. Group A was given analgesia and sedation of sufentanil combined with propofol;group B was given analgesia and sedation of sufentanil combined with dexmedetomidine. RAAS sedation score and British Medical Research Committee(MRC)score were compared between 2 groups before treatment and 7 d after treatment. The incidence of ICU-AW,delirium and tracheal extubation were observed. The staying time in ICU,total hospitalization time and the occurrence of ADR were compared between 2 groups after diagnosed as ICU-AW. RESULTS:After treatment,the scores of RASS sedation degree scale in 2 groups were decreased significantly compared to before treatment,with statistical significance (P<0.05);there was no statistical significance between 2 groups(P>0.05). MRC score of group A was decreased significantly compared to before treatment,and significantly lower than group B,with statistical significance(P<0.05). There was no statistical significance in MRC score of group B before and after treatment(P>0.05). After 7 d of treatment,the incidence of ICU-AW in group B was significantly lower than group A(40.00% vs. 56.67%);the incidence of tracheal extubation in group B was significantly higher than group A(70.00% vs. 53.33%),the incidence of delirium was significantly lower than group A(13.33% vs. 20.00%);the staying time in ICU and total hospitalization time in group B after diagnosed as ICU-AW were significantly shorter than group A,with statistical significance(P<0.05). There was no statistical significance in the total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Compared with sufentanil combined with propofol, sufentanil combined with dexmedetomide shows similar analgesia and sedation effect,but has better influence on the muscle strength of the patient,reducing the incidence of ICU-AW and delirium,shortening the duration of mechanical ventilation,staying time in ICU and total hospitalization time in AECOPD patients receiving mechanical ventilation,with similar safety.

Study on the relationship between the level of D-dimer and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease / 国际检验医学杂志

Objective To explore the role of D-dimer (D-D) level in patients with acute exacerbation of chronic obstructive disease (AECOPD) in predicting the prognosis of patients.Methods 99 patients with AECOPD in our hospital from July 2008 to December 2010 were selected as the subjects,and were divided into observation group (n=50) and control group (n=49) according to the expression of D-D in patients with positive (D-D level cutoff value of 500 g/L).The basic information and survival of the two groups of patients were investigated,and the level of serum D-D was detected by scatter turbidimetry.The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of D-D on the survival of the patients.The survival time of the two groups was compared by Kaplan-Meier.Results There was no statistically significant difference in gender,age and GOLD score between the two groups (P＞0.05).The level of D-D,the time of first hospitalization,the number of re hospitalization,the first hospital mortality and re hospitalization mortality in the observation group were significantly higher than those in the control group (P＜0.05).The ROC curve showed that the truncated value of D-D was 1 171.34 g/L and 893 g/L,respectively.The average survival time of patients in the observation group was 30.37 months and the control group was 46.37 months,respectively;Kaplan-Meier study showed that the survival time of patients in the observation group was significantly lower than that in the control group (x2 =6.371,P＜0.05).Conclusion The level of D-D in patients with AECOPD is of great value in predicting the prognosis of patients,which can be used as an independent indicator of disease progression.

Clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol / 中国生化药物杂志

Objective To explore clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol.Methods72 patients with AECOPD in our hospital were randomly divided into control group and treatment group.The control group was treated with conventional AECOPD method,the treatment group was treated on the base of the treatment group with a small dose of corticosteroids,CRP, IL-6, TNF-α, FEV1, PCT and other indicators, as well as patients with ventilation, shock and mortality were compared after the end of treatment.ResultsThe time of non mechanical ventilation, the time of non-mechanical ventilation, and the time of non-shock were increased, the shock and the mortality was lower in the treatment group,(P<0.05);The CRP level of patients in the treatment group was lower(P<0.05);IL-6, TNF-α, PCT levels of patients in the treatment group was lower (P<0.05);FEV1, FVC and FEV1/FVC level in the treatment group were higher(P<0.05).ConclusionSmall dose glucocorticoid can improve the pulmonary function of patients with AECOPD complicated by severe disease, and alleviate the disease, significantly reduce the levels of inflammatory factors, promote the improvement of the lung function.

Evaluation of Intervention Effects of Standardized Pharmaceutical Care on Clinical Treatment of AECO-PD Patients / 中国药房

OBJECTIVE:To evaluate the intervention effects of standardized pharmaceutical care on clinical treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients. METHODS:A total of 127 AECOPD patients were col-lected from respiratory medicine department of our hospital during Sept. 2014-Mar. 2015,and then divided into control group(63 cases)and observation group(64 cases)according to random number table. Control group only received traditional medical service and drug therapy. Observation group was additionally given standardized pharmaceutical care provided by clinical pharmacists ac-cording to AECOPD clinical pharmacy pathway on the basis of control group. The patients were followed up 1 month after dis-charge. The use of antibiotics during hospitalization,medication adherence,the occurrence of ADE,patient satisfaction and medica-tion bias during hospitalization and after discharge,the rates of ADR awareness and return visit after discharge were compared be-tween 2 groups. RESULTS:In both groups,1 patient withdrew from the study during hospitalitation;33 patients didn't complete return visit after discharge. During hospitalization,the rate of medication adherence and the total satisfaction of traditional medical procedures and medication guidance in observation group were significantly higher than control group;the utilization ratio of antibi-otics and combined use of antibiotics,AUD,the incidence of ADE,the proportion of medication bias were significantly lower than control group,with statistical significance(P0.05). CONCLUSIONS:The standardized pharmaceutical care can significantly improve medication compliance and satisfaction of inpatients,contribute to ratio-nal use of antibiotics,reduce the incidence of ADE and medication bias,but have no significant effect on medication compliance, the rate of return visit and medication bias of discharged patients.

Evaluation of Antibiotics Use in Acute Exacerbation of Chronic Obstructive Pulmonary Diseases in Our Hospital during 2013-2015 / 中国药房

OBJECTIVE:To evaluate the effectiveness,safety and economics of antibiotics for inpatients with acute exacerba-tion of chronic obstructive pulmonary diseases (AECOPD),in order to promote rational use of antibiotics. METHODS:In retro-spective study,AECOPD inpatients were selected as research objects during 2013-2015 to evaluate the use of antibiotics. RE-SULTS:Three thousand one hundred and eighty-six AECOPD patients were enrolled in the study,and utilization ratio of antibiot-ics was above 90%. DDDs of Cefordizime sodium for injection ranked the first place in 3 years and was decreased in 2015,while those of β-lactam and carbapenems were increased. DDC of Meropenem for injection and Imipenem/cilastatin sodium for injection were the highest. Drug utilization index(DUI)of Cefodizime for injection was far more than 1.0,while DUI of Piperacillin sodi-um and sulbactam sodium for injection was much less than 1.0. Sort ratio(B/A)of Cefodizime sodium for injection ranged 1-2 in 3 years. B/A of Piperacillin sodium and sulbactam sodium for injection,Imipenem and cilastatin sodium for injection,Meropenem for injection were lower than 1.0. CONCLUSIONS:The indication of anti-infective treatment in AECOPD patients have been mas-tered strictly in our hospital;the utilization ratio of antibiotics is decreased year by year;the types of antibiotics are rational rela-tively,and the number of antibiotics which is rationally used is increased year by year. But the rationality of Cefodizime sodium for injection and Piperacillin sodium/sulbactam sodium for injection need to be improved.

Clinical observation of the treatment based on Peitushengjin theory in patients with AECOPD with Ⅱ respiratory failure / 重庆医学

Objective to observe the effect of lung and spleen mixture on lung spleen deficiency AECOPD with Ⅱ respiratory failure of TCM symptoms integral,nutrition,blood gas and related indicators.Methods in accordance with AECOPD with Ⅱ type of respiratory failure need to use the noninvasive or have a respirator assisted ventilation,and conform to the type of TCM for patients with spleen-deficiency type,40 cases were divided into two groups,control group to the conventional western medicine therapy and Chinese medicine group on the basis of western medicine treatment for reasons of Yifeijianpi mixture,oral or tube feeding,a week for a period of treatment,observation of patients before and after treatment of TCM symptoms and physical signs integral,APACHE Ⅱ score,serum albumin,pre-albumin,neutrophil percentage,CRP and blood gas analysis and related indicators was conducted.Results The results show that the TCM group can improve the patients' TCM symptoms and physical signs integral,there was significant difference between the two groups after treatment (P＜ 0.05);compare the serum albumin,pre-albumin,transferrin,neutrophil percentage,CRP and arterial blood gas between two groups of patients after treatment,Chinese medicine group is superior to the control group,with statistical significance (P＜ 0.05);And compared with control group,the APACHE Ⅱ improvement situation of Chinese medicine group were superior to control group after the treatment after a week,with statistical significance (P＜ 0.05).Conclusion on the basis of using conventional western medicine treatment,treatment based on the theory of ridging raw gold formulae of Yifeijianpi mixture has good effect in the treatment of AECOPD combined type Ⅱ respiratory failure,and can improve the nutritional status of patients and the indicators of arterial blood gas analysis.

Effect of seretide combined with singulair on lung function improvement and prognosis of moderate to severe AECOPD / 中国生化药物杂志

Objective To study the effect improvation of lung function and prognosis of singulair and seretide for moderate to severe AECOPD . Methods 78 patients associated with moderate to severe AECOPD from January 2014 to June 2016 in our hospital were researched.They were divided randomly into observation and control groups according to the order of admission, 39 cases in each group.In the control group, they were treated by conventional anti-infective, expectorant, oxygen, suction seretide.In the observation group, using singulair on the basis of the control group.Clinical data, clinical efficacy, clinical symptoms begin to improve time, hospitalization time, blood gas analysis (PaO2, PaCO2) after five days and pulmonary function after treatment forced expiratory volume in one second ( FEV1 ) , call gas peak velocity ( PEF) , forced expiratory volume in one second than the forced vital capacity (FEV1/FVC), maximum mid-expiratory flow rate (MMEF) were compared with each other.Results Their clinical data of patients and other general information and basic condition had no significant difference between each other.The effective rate of observation group and control group were 97.44%and 87.18%, clinical effecicy of observation group was better than the control group, the difference was statistically significant (u=2.2805, P<0.05).Postoperative hospital stay, time of symptoms began to improve of the observation group were shorter than the control group, the difference was statistically significant (P<0.05), PaO2 of 5-day post-treatment of observation group was higher, and PaCO2 was lower, the difference was statistically significant (P<0.05).Lung function of two groups of patients had no significant difference before treatment, after treatment, pulmonary function in the observation group (including FEV1, PEF, FEV1/FVC, MMEF) was better than the control group, the difference was statistically significant (P<0.05).Conclusion Seretide combined with singulair to treat severe AECOPD has a good effect, it can significantly improve the therapeutic effect and improve the patient's lung function.

Bacteriological Profile in Acute Exacerbation of Chronic Obstructive Lung Disease (AECOPD).

Background: In COPD, acute exacerbation is the common problem during natural course. Studies of sputum samples using standard culture and molecular techniques have demonstrated that it is associated with increased prevalence of bacteria. Methods: 200 clinically diagnosed cases of AECOPD of age ≥45 years were recruited. Two sputum samples each were processed by conventional methods. Preparation of media, reagents, Gram staining, identification of culture isolates, different tests, including antibiotic sensitivity tests were carried out following standard laboratory. Results: The prevalence of AECOPD was more common in the age group of fifty six to sixty five years (43%) with ratio between male and female of 2.12:1. Klebsiella pneumonia was the predominant organism isolated in 42.55%, followed by Staphylococcus aureus in 28.73%, P. aeruginosa in 14.89%, E coli in 8.51%, CONS in 4.26% and S. pneumoniae in 1.06%. Gram negative bacteria were most sensitive to meropenem, imepenem, amikacin, followed by cefotaxime ceftriaxone, levofloxacin, Cefepime and aztreonam. Gram-positive bacterial isolates were most sensitive to linezolid (34.04%) followed by vancomycin (32.98%), cefoxitin (31.91%).Conclusion: Sputum culture is a good and simple diagnostic tool to study the etiology due to bacteria in AECOPD. Antibiogram helps in the formation of the correct treatment protocol, screening resistant pathogens and better drug for treatment, thereby helping to decrease the mortality and morbidity.