国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2010年
3期
144-147
,共4页
支气管哮喘%哮喘控制%肺量测定%β2受体激动剂
支氣管哮喘%哮喘控製%肺量測定%β2受體激動劑
지기관효천%효천공제%폐량측정%β2수체격동제
Bronchial asthma%Asthma control%Spoirometry%β2-agonist
目的 临床医师每天面对的支气管哮喘(简称哮喘)患者复杂多样,如何针对每例患者的具体情况,选择合适的药物种类和剂量,实现哮喘控制目标,是需要解决的问题.方法 对2008年5月至2009年3月北京协和医院呼吸科门诊控制不好的32例哮喘患者在治疗的同时进行2周动态肺量和症状监测,对其中4例进行病例分析和文献复习.结果 例1患者中年女性,咳嗽喘息10余天,夜间症状明显.2周动态肺量监测同时妥洛特罗贴剂2 mg/晚.监测初期第1秒用力呼气容积和最大呼气峰流速明显晨降,随治疗进展第1秒用力呼气容积恢复正常.最大呼气峰流速晨降消失.2周后患者开始了联合吸入肾上腺糖皮质激素和长效β2受体激动剂的治疗.例2老年女性,哮喘10多年,未正规治疗.开始联合吸入肾上腺糖皮质激素和长效β2受体激动剂治疗时,短期加用妥洛特罗贴剂,2周后肺功能基本恢复正常,未出现心血管系统不良反应.例3咳嗽变异性哮喘,吸入肾上腺糖皮质激素气雾剂后咳嗽加重,改妥洛特罗贴剂和复方甲氧那明全身用药,咳嗽很快缓解.2周后开始吸人肾上腺糖皮质激素干粉剂.3个月随访,症状控制.例4长期没有控制好的哮喘,需要寻找合适的治疗方案,联合吸入肾上腺糖皮质激素和长效β2受体激动剂治疗同时短期妥洛特罗贴剂,动态监测2周达到哮喘控制.结论 针对患者具体情况制定个体化的诊疗方案有助于提高哮喘的控制水平.
目的 臨床醫師每天麵對的支氣管哮喘(簡稱哮喘)患者複雜多樣,如何針對每例患者的具體情況,選擇閤適的藥物種類和劑量,實現哮喘控製目標,是需要解決的問題.方法 對2008年5月至2009年3月北京協和醫院呼吸科門診控製不好的32例哮喘患者在治療的同時進行2週動態肺量和癥狀鑑測,對其中4例進行病例分析和文獻複習.結果 例1患者中年女性,咳嗽喘息10餘天,夜間癥狀明顯.2週動態肺量鑑測同時妥洛特囉貼劑2 mg/晚.鑑測初期第1秒用力呼氣容積和最大呼氣峰流速明顯晨降,隨治療進展第1秒用力呼氣容積恢複正常.最大呼氣峰流速晨降消失.2週後患者開始瞭聯閤吸入腎上腺糖皮質激素和長效β2受體激動劑的治療.例2老年女性,哮喘10多年,未正規治療.開始聯閤吸入腎上腺糖皮質激素和長效β2受體激動劑治療時,短期加用妥洛特囉貼劑,2週後肺功能基本恢複正常,未齣現心血管繫統不良反應.例3咳嗽變異性哮喘,吸入腎上腺糖皮質激素氣霧劑後咳嗽加重,改妥洛特囉貼劑和複方甲氧那明全身用藥,咳嗽很快緩解.2週後開始吸人腎上腺糖皮質激素榦粉劑.3箇月隨訪,癥狀控製.例4長期沒有控製好的哮喘,需要尋找閤適的治療方案,聯閤吸入腎上腺糖皮質激素和長效β2受體激動劑治療同時短期妥洛特囉貼劑,動態鑑測2週達到哮喘控製.結論 針對患者具體情況製定箇體化的診療方案有助于提高哮喘的控製水平.
목적 림상의사매천면대적지기관효천(간칭효천)환자복잡다양,여하침대매례환자적구체정황,선택합괄적약물충류화제량,실현효천공제목표,시수요해결적문제.방법 대2008년5월지2009년3월북경협화의원호흡과문진공제불호적32례효천환자재치료적동시진행2주동태폐량화증상감측,대기중4례진행병례분석화문헌복습.결과 례1환자중년녀성,해수천식10여천,야간증상명현.2주동태폐량감측동시타락특라첩제2 mg/만.감측초기제1초용력호기용적화최대호기봉류속명현신강,수치료진전제1초용력호기용적회복정상.최대호기봉류속신강소실.2주후환자개시료연합흡입신상선당피질격소화장효β2수체격동제적치료.례2노년녀성,효천10다년,미정규치료.개시연합흡입신상선당피질격소화장효β2수체격동제치료시,단기가용타락특라첩제,2주후폐공능기본회복정상,미출현심혈관계통불량반응.례3해수변이성효천,흡입신상선당피질격소기무제후해수가중,개타락특라첩제화복방갑양나명전신용약,해수흔쾌완해.2주후개시흡인신상선당피질격소간분제.3개월수방,증상공제.례4장기몰유공제호적효천,수요심조합괄적치료방안,연합흡입신상선당피질격소화장효β2수체격동제치료동시단기타락특라첩제,동태감측2주체도효천공제.결론 침대환자구체정황제정개체화적진료방안유조우제고효천적공제수평.
Objective Tailoring bronchial asthma(asthma)treatment based on individual patient condition is an important issue in translation of guideline recommendations into real-world asthma control.Methods Thirty-two patients with poorly controlled asthma at pulmonary clinic of Peking Union Medical College Hospital from May 2008 to March 2009 were assessed and monitored for 2 weeks.Four cases were reported.Results Case one of a professional mid-age woman presented with cough and wheezing at night for 10 days.Daily,three times recording of spirometry demonstrated recurrent morning and(or)night falls in forced expiratory volume in 1s(FEV1)and peak expiratory flow(PEF),which improved significantly with tulobuterol patch 2 mg once-daily.Diagnosis was confirmed and combination of inhaled corticosteroid (ICS)and long-acting β2-agonist(LABA)initiated.Case two of an elder woman presented with a recent exacerbation of 10-year poorly controlled asthma.ICS/LABA plus short-term use of tulobuterol patch relieved symptoms and achieved nearly normal lung function in two weeks without obvious cardiovascular side effect.Case three of a young man with cough variant asthma worsened with ICS,which was replaced by tulobuterol patch and oral methoxyphenamine with significant improvement.ICS turbuhaler was initiated a few weeks later and the patient appeared well at 3-month follow-up.Case four of long-term uncontrolled asthma needed an appropriate therapy.Two weeks of assessment and monitoring revealed good responsiveness to ICS/LABA and short-term use of tulobuterol patch.Long-term ICS/LABA was recommended.Conclusions Tailoring asthma treatment based on individual patient condition enhances asthma control.
