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A pilot study of acid inhalation-induced pulmonary fibrosis in rats

Objective To study the pathology and possible mechanism of experimental hydrochloric acid（HCl） inhalation-indued pulmonary fibrosis in rats.Methods 120 male SD rats were randomly divided into a nomal control group，a bleomycin group，a high dose HCl group，a middle dose HCl group and a low dose HCl group.The bleomycin group was intratracheally injected with bleomycin once to induce pulmonary fibrosis.The three HCl groups were intratracheally injected with HCl once per week.The control group was given saline by the same way.Six rats of each group were randomly sacrificed on day 7，14，28 and 42 respectively.The histological changes of lung tissue were studied by HE and Masson’s trichrome staining.Hydroxyproline level in lung tissue was measured by digestion method.Protein and mRNA expression of transforming growth factor-β1（TGF-β1） were assayed by immunohistochemistry and RT-PCR respectively.Results Alveolitis in three HCl groups was significantl compared to control group，most severe at the second week，then remained at a high level which was equivalent to or exceeded the level of the bleomysin group after 28 days.Pulmonary fibrosis in three HCl groups was also significantly more severe than that in the control group，but milder than that in the bleomysin group.The high-dose and middle-dose HCl groups were not significantly different from the bleomysin group on day 42.There was no difference between three HCl groups in the earlier period，but the high-dose HCl group has a significantly difference from low-dose group on day 42.The content of hydroxyproline in high-dose and middle-dose HCl groups was also significantly higher than that in the control group.On day 42 hydroxyproline content in high-dose HCl dose rather middle –or low dose group was similiar with the level of bleomysin group.Content of TGF-β1 mRNA in three HCl groups was comparable to the level of bleomysin group on day 28 and exceeded on day 42.The expression of TGF-β1 in three HCl groups was not significantly different from the bleomysin group on day 42.Conclusion Experimental acid aspiration might contribute to pulmonary fibrosis in rats.Acid induced alveolar epithelial cell damage，abnormal proliferation and repair and fibrosis could be involved..

吸入剂治疗在慢性阻塞性肺疾病稳定期患者中的应用现状

密闭性燃烧致重度吸入性损伤患者的护理

【摘要】 目的 总结密闭性燃烧致重度吸入性损伤患者的护理。 方法 2009年6月-2009年8月，针对2例密闭性燃烧致重度吸入性损伤患者，成立多学科医护人员救治小组，以特别的治疗和针对性的护理，予以全力抢救。 结果 1例患者38 d后因病情突变死亡，另1例患者病情平稳，转回普通病房继续治疗。 结论 多学科护理合作是吸入性损伤合并特重烧伤患者救治的一项重要措施。

急性吸入性氯氰菊酯中毒13 例临床分析

目的 通过分析氯氰菊酯吸入中毒的临床特点与救治经验, 比较与口服中毒的不同临床特点, 以加深对氯氰菊酯中毒的认识。方法 回顾性分析2012 年6 月群体性5% 高效氯氰菊酯可湿粉吸入中毒13 例患者的临床表现、影像学、实验室检查、治疗及转归。结果 除神经毒性及消化道损害之外, 氯氰菊酯吸入中毒患者中, 咽干( 61. 5% ) 、咳嗽咳痰( 61. 5% ) 、呼吸困难( 30. 8% ) 、胸闷( 23. 1% ) 等呼吸道症状明显。结论 氯氰菊酯吸入中毒可以造成明显的呼吸系统损害, 轻者表现为上呼吸道刺激症状或气管-支气管炎症表现。

Study on the correlation between EOS and clinical features and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease

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.

Heparin treatment for animal model with smoke inhalation injury: a meta-analysis

Objective To systematically review the effectiveness and model building process of heparin treatment for animal model with smoke inhalation injury. Methods Databases including PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect animal experiments about the treatment of heparin for animal model with smoke inhalation injury from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of nine studies involving 11 animal experiments were included. The results showed that building animal model with smoke inhalation injury were through burning of cotton towels or pine sawdust by sheep or rats below 40℃. The results of meta-analysis showed that there was no significant difference in mortality rate between two groups (heparin group vs. control group: RR=0.38, 95%CI 0.14 to 1.05, P=0.06; heparin plus DMSO group vs. DMSO group: RR=0.10, 95%CI 0.01 to 1.51, P=0.10). In addition, the pulmonary artery pressure (MD=–3.31, 95%CI –4.51 to –2.11, P<0.000 01), wet to dry weight ratio (MD=–0.90, 95%CI –1.19 to –0.61, P<0.000 01), and lung water content (MD=–1.18, 95%CI –1.67 to –0.70, P<0.000 01) of the experimental group were lower than those in the control group. PaO2/FiO2 after 12 hours (MD=131.00, 95%CI 59.54 to 202.46, P=0.000 3), PaO2/FiO2 after 24 hours (MD=114.00, 95%CI 60.56 to 167.44, P<0.000 1), PaO2/FiO2 after 48 hours (MD=46.00, 95%CI 20.62 to 71.38, P=0.000 4) were higher than those in the control group. However, there was no significant difference in coagulation function between both groups. Conclusion The current evidence shows that the establishment of animal model of smoke inhalation injury is still lack of standard method. Heparin can decrease pulmonary artery pressure and lung water content in animal models with smoke inhalation injury. Due to the limited quality and quantity of included studies, the above conclusions are still needed to be verified by more high quality studies.

Effect of different nebulization methods in acute exacerbations of chronic obstructive pulmonary disease requiring non-invasive ventilation

ObjectiveTo analyze the effect of different nebulization methods in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring non-invasive ventilators (NIV). MethodsOne hundred and two patients with AECOPD were selected according to the standard, and randomly divided into a control group, a trial group I, and a trial group II according to the random number table. The patients in the control group received NIV intermittent oxygen-driven nebulization; the patients in the trial group I received NIV simultaneous oxygen-driven nebulization; and the patients in the trial group II received NIV simultaneous air-driven nebulization. The dynamic fluctuations of transcutaneous partial pressure of carbon dioxide (PtCO2), arterial blood gas indexes (PaCO2, PaO2, pH), vital signs and pulse oxygen saturation (SpO2) fluctuations were compared. ResultsPtCO2 at 15min of nebulization in the trial group II were lower than the other groups (P<0.05). PtCO2 at 15min of nebulization was higher than the other time points in the control group (P<0.05); there was no statistical difference of PtCO2 at different time points in the trial group I (P>0.05); PtCO2 gradually decreased with time in the trial group II (P<0.05). The difference before and after nebulization of PtCO2 (dPtCO2) was larger in trial group II than the other groups (P<0.05). PtCO2 at 0min and 5min after the end of nebulization in trial group II were lower than the other groups (P<0.05); there were no statistical differences of PtCO2 at 10min and 15min after the end of nebulization among three groups (P>0.05). There were statistical differences of the PtCO2 at each time point in the control group except for the PtCO2 at 10 min and 15min after the end of nebulization, all of which decreased with time; PtCO2 at each time points of nebulization decreased with time in the trial group I (P<0.05). PtCO2 only at 5min after the end of nebulization was lower than that at 0min after the end of nebulization in trial group II (P< 0.05), there were no statistical differences in other times (P>0.05). PaCO2, pH at the 4th day of treatment was lower than the pre-treatment in the control group (P<0.01); there were statistical differences of PaCO2 between the pre-treatment and the rest time points in the trial group I and group II (P<0.05). The number of abnormal fluctuations in vital signs and SpO2 during nebulization in three groups was not statistically different (P>0.05). ConclusionsThree groups can achieve good therapeutic effects. NIV intermittent oxygen-driven nebulization can make PtCO2 rise during nebulization; NIV simultaneous oxygen-driven nebulization can make PtCO2 remain stable during nebulization; NIV simultaneous air-driven nebulization can make PtCO2 fall during nebulization.

Application of Sufficient Doses of Nebulized Budesonide in the Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease with Severe Airflow Restriction

目的:评价足量布地奈德溶液雾化治疗重度慢性阻塞性肺疾病急性加重期患者的临床应用价值。方法: 90例30%≤FEV1lt;50%的重度COPD急性加重期患者随机分为3组: 布地奈德组给予布地奈德溶液雾化吸入2mg/次,每8小时1次;甲泼尼龙组给予口服甲泼尼龙片24mg /次,1/日;对照组不使用任何糖皮质激素。疗程10d,观察3组患者治疗后肺功能,动脉血气和呼吸困难评分变化,以及糖皮质激素主要不良反应。结果: 与对照组相比,吸入布地奈德组和口服甲泼尼龙组在FEV1,PaO2,PaCO2和呼吸困难评分改善值方面,有显著差异性(Plt;005);吸入布地奈德组和口服甲泼尼龙组两组各项指标改善程度相似(Pgt;005);吸入布地奈德组和对照组的不良反应少于口服甲泼尼龙组 (Plt;005)。〖HTH〗结论:〖HTSS〗足量布地奈德溶液雾化治疗与口服糖皮质激素疗效相近,全身副作用小,安全性好,是重度COPD急性加重期糖皮质激素的有效选择。

吸入激素在支气管扩张症中的应用

支气管扩张症(简称支扩)是以进行性和不可逆性气道破坏和扩张为特征的慢性气道炎症性疾病[1]，大多表现为长期咳嗽、咳脓性痰，反复急性发作，肺功能受损，后者主要表现为阻塞性通气功能障碍，气道反应性增高，晚期患者常常出现劳力性呼吸困难，严重影响患者生活质量[2,3] 。大部分支扩患者第1秒用力呼气容积(FEV )每年下降大约50mL [4] 。在我国支扩的发病率为0.3‰～0.5‰。2005年美国成人支扩发病率约为52．3／100 000。发病率随年龄而增加，在所有年龄阶段女性发病率均较男性高，预计在美国有18岁以上的支扩患者110 000例，每年医疗费用约6．3亿美元[5]。

A study on the application of recumbent rehabilitation exercises combined with oscillatory positive expiratory pressure training in pulmonary rehabilitation of patients with moderate to severe inhalation injuries

Objective To explore the application effect of recumbent rehabilitation exercise combined with oscillatory positive expiratory pressure training in pulmonary rehabilitation of patients with moderate to severe inhalation injury. Methods Fifty-seven patients with moderate-to-severe inhalation injuries admitted to the Department of Burns and Plastic Surgery of the People’s Hospital of North Jiangsu Province from January 2021 to March 2023 were selected by convenience sampling. The patients were randomly divided into Group A, Group B, and Group C. Group A received conventional treatment, Group B received the recumbent rehabilitation exercise on the basis of Group A, and Group C received the concussive expiratory pressure training on the basis of Group B. The three groups were compared before and after the intervention with respect to forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), sputum properties, sputum difficulty, sputum viscosity, average daily sputum output, Borg shortness of breath score, and 1-minute sitting and standing test. Results The improvement values of FEV1, FVC, sputum viscosity, average daily sputum discharge, Borg shortness of breath score, and 1-minute sit-to-stand test were compared among the three groups after intervention, and the differences were statistically significant (all P<0.05). The improvement values of Borg shortness of breath score, and 1-minute sit-to-stand test in group B were significantly better than those in group A (all P<0.05). The improvement values of FEV1, FVC, and sputum properties in group C were significantly better than those in group A (all P<0.05), Coughing difficulty, sputum viscosity, total average daily sputum expectoration, Borg shortness of breath score, and 1-minute sit-to-stand test improvement values were significantly better than those of group A (all P<0.05). Improvement values of FEV1, average daily sputum expectoration, and Borg shortness of breath score in group C were significantly better than those of group B (all P<0.05). Conclusion For pulmonary rehabilitation of patients with moderate-to-severe inhalation injuries, prone rehabilitation exercises combined with oscillatory positive expiratory pressure training can effectively improved the patients’ exercise capacity and respiratory function, and improve their quality of life.