Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient
ObjectiveTo investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in gerontal patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsA retrospective study was conducted on 76 patients aged 65 years and older with AECOPD who received invasive mechanical ventilation and met the weaning criteria from July 2012 to June 2014. The subjects who passed the spontaneously breathing trial (SBT) and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis. ResultsThere were 53 subjects in the weaning success group and 23 in the weaning failure group. The incidences of sepsis, multiple organ dysfunction syndrome (MODS), fungal infection, hypoproteinemia, duration for mechanical ventilation > 14 d, the prevalences of aeropleura, cardiac failure, diabetes, coronary heart disease and hepatic insufficiency were higher in the weaning failure group than those in the weaning success group (P < 0.05). Logistic analysis revealed that MODS (OR=8.070), duration for mechanical ventilation > 14 d (OR=17.760), cardiac failure (OR=4.597) and diabetes (OR=13.937) were risk factors of weaning failure (P < 0.05). ConclusionMODS, duration for mechanical ventilation > 14 d, cardiac failure and diabetes were associated with the failure of weaning from invasive mechanical ventilation in gerontal patients with AECOPD.
Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
ObjectiveTo investigate the physiologic effects of different pressure assist (PA) on ventilatory status,oxygenation and work of breathing (WOB) when a new generation of proportional assist ventilation (PAV) is applied in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsA prospective,crossover randomized physiologic study was performed.80%PA,60%PA and 40%PA was sequentially randomized to be applied with the duration of 30 minutes,and pressure support ventilation (PSV) with the duration of 30 minutes was applied before each PA.Ventilatory status, oxygenation,dyspnea indexes in PSV and different PA were compared,and WOB of patients and ventilator were compared in different PA. ResultsTwenty-eight patients were recruited into the study.With the decrease of PA,peak inspiratory pressure (PIP),mean airway pressure (Pm),and tidal volume (VT) decreased gradually (P>0.05),respiratory rate (RR) increased gradually (P<0.05),while minute volume (MV),heart rate (HR),systolic blood pressure (SBP),mean arterial pressure (MAP),pH,arterial carbon dioxide tension (PaCO2),and arterial oxygen tension/inspired oxygen fraction (PaO2/FiO2) did not change significantly (P>0.05).Compared with PSV mode,PIP increased significantly in 80%PA (P<0.05),decreased significantly in 60%PA and 40%PA (P<0.05).Pm did not change significantly in 80%PA (P>0.05),decreased significantly in 60%PA and 40%PA (P<0.05).VT increased significantly in 80%PA (P<0.05),decreased significantly in 60%PA and 40%PA (P<0.05).RR did not change significantly in 80%PA (P>0.05),increased significantly in 60%PA and 40%PA (P<0.05).MV did not change significantly in 80%PA (P>0.05),decreased significantly in 60%PA and 40%PA (P<0.05).With the decrease of PA,Borg score and scale for accessory muscle use increased gradually (P<0.05).Compared with PSV mode,Borg score and scale for accessory muscle use did not change significantly in 80%PA (P>0.05),increased significantly in 60%PA and 40%PA (P<0.05).WOB of patients in 40%PA was significantly higher than that in 60%PA (P=0.000) and that in 80%PA (P=0.000),while which in 60%PA was significantly higher than that in 80%PA (P=0.000).On the contrary,WOB of ventilator in 40%PA was significantly lower than that in 60%PA (P=0.004) and that in 80%PA (P=0.000),while which in 60%PA was significantly lower than that in 80%PA (P=0.000). ConclusionThe new generation of PAV can safely and effectively provide respiratory support to patients with AECOPD.Respiratory pattern,levels of dyspnea and accessory muscle use in 80%PA are similar with those in PSV.With the decrease of PA,levels of spontaneous breathing and WOB increase and dyspnea worsens.PAV can promote spontaneous breathing and prevent respiratory muscle disuse atrophy even more, but easily lead to respiratory muscle fatigue with inappropriate use.
Objective To evaluate the clinic outcomes of coronary artery bypass grafting （CABG） on patients of coronary artery disease complicated with chronic obstructive pulmonary disease（COPD）. Methods The data of 27 patients of coronary artery diseases complicated with COPD who had received CABG from Jan. 1998 to Dec. 2004, were retrospectively summarized. 18 patients received off-pump CABG （off-pump group）,and 9 cases received on- pump CABG （on-pump group）. All patients accepted the evaluation about clinical respiratory complications, oxygenation index （PaO2/FiO2）, related respiratory function index, plasma intercellular adhesion molecule 1 （ICAM-1） and the amount of neutrophil in pulmono-alveolar perfusion fluid at the different time point including the start of CPB （for off-pump group, the measurement accepted at the start of operation）, end of CPB （end of operation for off-pump group）, and at 2, 6, 12, and 24h after operation. Results There was no operation-related death in two groups. One died of respiratory failure 14 days after operation in the hospital in off-pump group, there were more respiratory complications in on-pump group than that in off-pump group, and PaO2/FiO2 in on-pump group was higher than that in off-pump group at CPB 30min （at the start of operation）, but lower than that in off-pump group postoperative at 6 h, 12 h（P〈0. 05）, the concentration of plasma ICAM-1 had obvious difference between two groups from CPB 30 min （at the start of operation） to post-operative 24 h （P 〈 0. 05）. The neutrophils in bronchoalveolar lavage in on-pump group was higher than that in off-pump group from CPB 30 min （at the start of operation） to 24 h after operation （P〈0. 05）. Conclusion Off-pump CABG seems more suitable than on-pump CABG for coronary artery disease patients with COPD due to less damage on oxygen-exchange capability and less respiratory complication.
Objective To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease (COPD) with different blood eosinophil percentage (EOS%). Methods One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects, and the patients were divided into group A according to EOS% (EOS%<2%) and B group (EOS%≥2%). Then the A and B groups were randomly divided into four subgroups A1, A2 and B1, B2, and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation. The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids. Namely A1 group (EOS%<2%, dual therapy), A2 group (EOS%<2%, triple therapy), B1 group (EOS%≥2%, dual therapy), B2 group (EOS%≥2%, triple therapy). The patients were instructed to take medication regularly as in hospital after discharge. After discharge, patients were followed up by telephone every two weeks for a period of one year. The number of acute exacerbations, the change of forced expiratory volume in the first second as a percentage of the expected value (FEV1%pred) and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year. Results In the patients with EOS%≥2%, triple therapy reduced the number of acute attacks by 40% during treatment compared with dual therapy patients (average 0.875 vs. 1.471 times per patient per year, P=0.0278). While in the patients with EOS%<2%, it was reduced by 4% (1.080 vs. 1.125 times, P=0.3527). In the same use of glucocorticoid-containing triple preparations, the number of acute exacerbations in the patients with EOS%≥2% during medication was 19% less than that of the patients with EOS%<2% (an average of 0.875 to 1.080 times per patient per year, P=0.0462). Regardless of EOS%≥2% or <2%, there was no significant difference in the changes of FEV1%pred between triple therapy and double therapy patients before and after treatment (P>0.05). Regardless of EOS%≥2% or <2%, there was no statistically significant difference in the incidence of pneumonia between patients with triple therapy and double therapy during medication (P>0.05). Conclusion Inhaled glucocorticoid triple therapy is suitable for moderate to severe COPD patients with high percentages of blood eosinophils.
目的:评价无创正压通气(NIPPV)在救治慢性阻塞性肺疾病(COPD)急性加重期并严重呼吸衰竭患者中的临床疗效。方法:对2006年1月至2008年1月入选的47例COPD急性加重期并严重呼吸衰竭患者使用双水平无创正压呼吸机面罩辅助通气, 患者均伴有不同程度的意识障碍,动态观察NIPPV治疗前和治疗后2 h、8 h、1 d及3 d动脉血气、神志、治疗后患者的转归,NIPPV的不良反应及并发症。结果:本组47例患者中,41例经NIPPV治疗2 h、8 h、1 d及3 d后与治疗前比较,PaO2明显升高Plt;0.01,PaCO2明显降低Plt;0.01,pH明显升高Plt;0.01,均脱机出院,有效率达87.23%(41/47);6例改为有创通气,其中3例经有创机械通气治疗后脱机成功,1例因上消化道出血死亡,2例自动出院.结论:双水平无创正压通气对有选择的COPD急性加重期并严重呼吸衰竭患者治疗疗效确切,它能迅速缓解病情,减少患者的气管插管和气管切开以及相应的并发症,提高生活质量。
ObjectiveTo explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) by cluster analysis and provide a basis for individualized treatment.MethodsA total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis.ResultsThe patients were divided into three categories of phenotype: " mild-glucocorticoid resistance-antibiotic dependent”," mild-glucocorticoid sensitive”, and " serious complication”. The patients with the first two phenotypes had a milder condition and lower hospitalization costs. There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease.ConclusionCluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.
ObjectiveTo investigate the risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD).MethodsA total of 97 mechanically ventilated non-hypertensive patients with COPD who were admitted to this department from January 2018 to October 2018 were selected as subjects. The patients were divided into 49 cases with delirium and 48 cases non-delirium according to the Consciousness Assessment Method for the Intensive Care Uint. The examined data were collected in the patients such as pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), neuron-specific enolase (NSE), and Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores were calculated in the pre-mechanical (d0) and mechanically ventilated 3rd (d3), 5th (d5) days. The mechanical ventilation days were recorded in the two groups. Logistic regression analysis was used to screen the risk factors influencing delirium of patients.ResultsThe PaCO2, NSE, APACHEⅡ scores and mechanical ventilation days were higher in the delirium group than in the non-delirium group ［(88.1±7.5) vs. (85.3±6.2) mm Hg; (28.4±5.8) vs. (26.1±3.3) μg/L; (23.7±3.9) vs. (21.7±2.6); (7.5±1.3) d vs. (6.6±1.2) d］ and PaO2 were lower than non-delirium group ［(54.9±5.5) vs. (57.2±3.1) mm Hg］, the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that PaO2, NSE, APACHEⅡ scores and mechanical ventilation days were risk factors for delirium in mechanically ventilated patients with COPD (regression coefficients were –0.177, 0.163, 0.203, 0.597 respectively, P<0.05). The PaO2 and APACHEⅡ scores of mechanical ventilation on the 3rd and 5th day of the two groups ［d3 (88.3±5.3) vs. (89.1±6.9) mm Hg; d5 (90.3±9.0) vs. (91.3±6.4) mm Hg; d3 (21.7±3.0) vs. (21.4±2.2); d5 (20.9±2.8) vs. (20.7±2.1)］ were not statistically significant (P>0.05).The NSE changes on the 3rd and 5th day of mechanical ventilation ［d3 (30.0±5.3) vs. (26.8±3.6) μg/L; d5 (27.3±4.3) vs. (25.7±2.6) μg/L］ were statistically significant (P<0.05).ConclusionPaO2, NSE, APACHEⅡ score and mechanical ventilation days are risk factors for delirium in COPD patients with mechanical ventilation and NSE is one of the more important risk factors.