Хроническая обструктивная болезнь легких (ХОБЛ) -заболевание, характеризующееся ограничением воз душного потока с развитием неполностью обратимой бронхиальной обструкции; ограничение воздушного потока прогрессирует и связано с усиленным пато логическим воспалительным ответом дыхательных путей на повреждающие частицы или газы [1,2]. Се годня ХОБЛ представляет собой значительную эко номическую и социальную проблему и является единственной болезнью из группы хронических не инфекционных заболеваний, при которой леталь ность продолжает расти [3,4]. Обострение ХОБЛ является одной из самых час тых причин обращения больных за неотложной ме дицинской помощью [5]. Частота обострений про грессивно увеличивается с нарастанием тяжести заболевания [6]. Частое развитие обострений у боль ных ХОБЛ приводит к длительному ухудшению (до нескольких недель) показателей функции дыхания и газообмена [7], более быстрому прогрессированию заболевания [8], значимому снижению качества жизни больных [9] и сопряжено с существенными экономическими расходами на лечение [5,10] РезюмеГиперпродукция мокроты и плохой клиренс бронхиального дерева могут представлять серьезную проблему для многих пациентов с обострением хронической обструктивной болезни легких (ХОБЛ). Улучшить дренаж дыхательных путей возможно при помощи специ альных высокочастотных методов, модулирующих воздушный поток. Цель. Изучение клинической эффективности и безопасности мето да высокочастотных колебаний грудной стенки (ВЧКГС) у больных с обострением ХОБЛ. Материалы и методы. В проспективное ран домизированное контролируемое сравнительное исследование включены больные, госпитализированные в стационар по поводу обост рения ХОБЛ (III и IV стадии по GOLD; средний объем форсированного выдоха за 1 ю секунду -37 %долж.). Все пациенты в 1-2 е сутки госпитализации были случайным методом разделены на 2 группы: терапии ВЧКГС (система Vest ® Airway Clearance System, 15-25 мин 2 раза в сутки, частота осцилляций -10-15 Гц, уровень давления -4-6 cм вод. ст.) и контрольную (только стандартная терапия). Иссле дование завершили 50 пациентов (25 -в группе ВЧКГС и 25 -в группе стандартной терапии). Результаты. При терапии ВЧКГС повы сился объем откашливаемой мокроты на 3 й и 7 й дни исследования (р < 0,001). Использование ВЧКГС способствовало бóльшему сни жению выраженности симптомов по сравнению с терапией в контрольной группе (р = 0,006). Тяжесть симптомов по шале BCSS более значимо достоверно уменьшилась в группе ВЧКГС по сравнению с группой сравнения (в среднем на 3,4 и 1,5 балла соответственно; р = 0,006). У получавших терапию ВЧКГС к концу исследования отмечено более выраженное улучшение показателей оксигенации (р = 0,001) и снижение уровней С реактивного белка (р = 0,001). Заключение. При обострении ХОБЛ с помощью терапии ВЧКГС улуч шается отхождение мокроты, достоверно снижаются выраженность клинических симптомов и уровень С реактивного белка, быстрее улучшается оксигенация. SummaryThis study was aimed at investigation of clinical efficacy and safety of high frequency chest wall oscillati...
The aim of this study was to evaluate changes in lung ventilation and lung diffusing capacity (DLCO) of cystic fibrosis (CF) patients during 1 year after lung transplantation. Methods. Complex lung function was monitored in CF patients underwent bilateral lung transplantation in 2012 – 2016. Results. CF patients (n = 12; mean age, 26.4 ± 4.4 years) were included in the study. Median follow-up after the lung transplantation was 19 (12–57) months. Consistent improvement in lung function parameters and DLCO was observed in 3 months after lung transplantation and maintained during 1 year. The ratio of forced expiratory volume in 1 sec to forced vital capacity was higher the normal level and the bronchial resistance was lower the cut-off values, i.e. the patients did not have bronchial obstruction. The total lung capacity (TLC) decreased to normal according to the anthropometric characteristics of the recipient. Meanwhile, change in the TLC structure, such as non-significant reduction in the vital capacity (VC) together with increase in the functional residual capacity (FRC), residual volume (RV) and RV/TLC ratio, have been developed. Consistent increase in FRC and RV could be explained by changes in the shape and the elasticity of the chest wall after the surgery. DLCO also improved, but was still slightly decreased. Conclusion. The lung function and DLCO improved in a year after bilateral lung transplantation in CF patients. Effects of different factors on postoperative lung function parameters need to be further investigated.
Purpose of the study. To analyze prevalence and characteristics of the cardiovascular diseases (CVD) in patients with urolithiasis, revealed for the first timeMaterials and methods. In a period between 2009 and 2018, was made a retrospective analysis of medical histories of 2311 patients with urolithiasis, which were treated in in the urology departments of the branch No. 1 of the MCHG named after N.N. Burdenko (n=1487) and GBUZ MO Krasnogorsk City Hospital No. 1 (n=824). In 67,6% of the cases (1562 patients) the diagnosis of urolithiasis was diagnosed for the first time on admission. Isolated urolithiasis was recorded in 676 cases (43,3%), in other 154 cases (9,8%) nephrolithiasis was combined with different variants of cardiovascular diseases (CVD) and diabetes. From 732 respondents with urolithiasis and associated cardiovascular diseases (CVD), were formed 3 groups, in the first group (I) were included patients (n=363) with hypertension and arterial hypertension: the second group (II; n=79) was formed from patients with isolated coronary heart disease. In the third group (III) were included 290 patients which had urolithiasis combined with hypertension, arterial hypertension and coronary heart disease. The stages of hypertension and degree of expression of arterial hypertension were given according to the recommendations of Russian science society of cardiology (2004). Stages of congestive heart failure were defined according to c NYHA (New York Heart Association) classification. Functional class of stable angina was defined according to Canadian Cardiovascular Society classification (1970,1976). The obtained data was analyzed using descriptive statistics methods.Results. Average age of patients was 65,4 +– 3,27; 78% of the patients were men. On an emergency basis were hospitalized 30,9% from group I, 27,6% from group 2, and 31,3% from group III. In group I more often were recorded hypertension I + arterial hypertension I (32,5%) and hypertension II + arterial hypertension II (40,2%). In group II effort angina was recorded in 30 cases (38%). Congestive heart failure occurred among 153 patients (20,9%); most often it occurred among patients from III – in 102 cases (35,2%). In the whole sample, congestive heart failure of I and II degrees prevailed – in 88 (12%) and 57 (7,9%) patients. Kidney stones were found in 59,4% of patients, in the ureters – in 30,9% of patients, in kidneys and in the ureters – in 9,9% of patients. Share of the patients with kidney stones in the shape of corals is 3,4% of the whole sample. Average sizes of kidney stones of the patients with congestive heart failure are 9,2–11,8 mm which is different from the sizes in whole sample – 6,9–9,5 mm.Conclusion. During the observation period, share of the patients with first time revealed urolithiasis, complicated with the cardiovascular diseases (CVD) increased in 1,9 times (16,7 versus 31,7%). Congestive heart failure, which was registered in 20,9% of patients, was charged with I and II degrees. The presence chronic cardiovascular diseases (CVD), especially complicated by congestive heart failure in patients with first time revealed nephrolithiasis, implies changes in the algorithms of metaphylactic of nephrolithiasis (regime of water loads, selection of diuretics and anticoagulants).
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