肺癌切除术围手术风险控制与获益——干预COPD 改善肺功能.ppt

* 复读上面内容，重点强调速乐还有抗炎和气道重塑的作用 * 在COPD，胆碱能张力可能是气道狭窄的唯一可逆因素。 - Peter J. Barnes 1、在COPD病人中噻托溴铵的支扩作用较LABA强，因为COPD的支气管收缩主要由胆碱能神经张力增加所致 2、COPD患者多半是上年纪的人，气道?2受体减少 3、噻托溴铵的支扩作用不受?2受体变异的影响 * 心胸外科医生很关心的是肺癌手术的成功，术前和术后的肺功能是确保顺利手术的重要指标 * 手术前没有阻塞性肺病的是零，用噻托溴铵治疗以后增加了3个，有轻度的COPD治疗前7个，治疗后增加到8个，极重度的COPD治疗前2个，治疗后没有了。说明噻托溴铵治疗后疾病状况有好转。 * Two weeks of preoperative treatment with tiotropium signi?cantly improved pulmonary function as compared with pretreatment measurements a图是：FVC用噻托溴铵治疗后都升高了， B图：FEV1的值治疗后也改善了， C 图：FEV1的百分比%治疗后也都升高了，术前应用两周噻托溴铵显著改善肺功能。 * Figure 2 The correlation between response to tiotropium and severity of COPD in lung cancer patients with COPD who received 2-week preoperative treatment with tiotropium. There was a signi?cant inverse correlation between the increase in FEV1 (L) and FEV1% before treatment (r =-0.59, P = 0.0049). There were signi?cant improvements in FVC (median3.43 L (interquartile range 2.87–3.99) vs 3.52 L (2.96–4.07)), FEV1 (2.06 L (1.63–2.49) vs 2.32 L (1.88–2.76))and FEV1% (73.2% (59.6–86.8) vs 81.0% (69.3–92.7))(P 0.001 for all). 在肺癌伴有COPD的患者术前应用两周噻托溴铵，其噻托溴铵疗效与COPD严重程度的关系表明：与治疗前比较，在增加FEV1 (L) and FEV1% 之间存在显著负相关。本组病人均显著改善了FVC (median3.43 L (interquartile range 2.87–3.99) vs 3.52 L (2.96–4.07)), FEV1 (2.06 L (1.63–2.49) vs 2.32 L (1.88–2.76))and FEV1% (73.2% (59.6–86.8) vs 81.0% (69.3–92.7))(P 0.001 for all). * Two-week preoperative treatment with tiotropium signi?cantly improved respiratory symptoms and pulmonary function as re?ected by FVC (median 3.43 L pretreatment vs 3.52 L post-treatment), FEV1 (median 2.06 L vs 2.32 L) and FEV1%(73.2% vs 81.0%) (all P 0.001).Postoperative FEV1% was signi?cantly increased from a median of 56.0% (interquartile range 51.6–60.3) to 63.4% (60.8–66.0)(P 0.001). The increase in FEV1 was inversely associated with severity of COPD (r =-0.59, P 0.005). Lung resections were successfully accomplished without complications. The postoperative FEV1 predicted prior to tiotropium t