2012年10月14日星期日

期刊報告-陳紀吏 101.10.17

Tiotropium inhibits pulmonary inflammation and remodelling in a guinea pig model of COPD.

Eur Respir J 2011, 38, 789-796.

T. Pera*, A. Zuidhof*, J. Valadas*, M. Smit*, R.G. Schoemaker#, R. Gosens*,H. Maarsingh*, J. Zaagsma* and H. Meurs*

ABSTRACT:
Airway remodelling and emphysema are major structural abnormalities in chronic obstructive pulmonary disease (COPD). In addition, pulmonary vascular remodelling may occur and contribute to pulmonary hypertension, a comorbidity of COPD. Increased cholinergic activity in COPD contributes to airflow limitation and, possibly, to inflammation and airway remodelling.

This study aimed to investigate the role of acetylcholine in pulmonary inflammation and remodelling using an animal model of COPD. To this aim, guinea pigs were instilled intranasally with lipopolysaccharide (LPS) twice weekly for 12 weeks and were treated, by inhalation, with the long-acting muscarinic receptor antagonist tiotropium. Repeated LPS exposure induced airway and parenchymal neutrophilia, and increased goblet

cell numbers, lung hydroxyproline content, airway wall collagen and airspace size. Furthermore, LPS increased the number of muscularised microvessels in the adventitia of cartilaginous airways. Tiotropium abrogated the LPS-induced increase in neutrophils, goblet cells, collagen deposition and muscularised microvessels, but had no effect on emphysema.

In conclusion, tiotropium inhibits remodelling of the airways as well as pulmonary inflammation

in a guinea pig model of COPD, suggesting that endogenous acetylcholine plays a major role in

the pathogenesis of this disease.

2012年10月2日星期二

讀書筆記：

Low free-fat mass (低度無脂體重)：是指上臂肌圍<10%百分位。
肺復健運動療程
每次療程30分鐘(一個循環為1分鐘腳踏車運動，最大做功的140%；1分鐘休息；2分鐘IMT訓練，先從Pimax的30%開始；休息1分鐘；合計6個循環)，然後追加5%-10%/每次，直到70%的Pimax。
IMT(inspiratory muscle traIning)吸氣肌肉訓練
HRQoL(health related quality of life)健康相關生活品質
可用CRQ、MRF-28、SRI問卷來評。
CRQ(chronic respiratory questionnaire)慢性呼吸衰竭問卷，21-147分，分數愈高代表愈健康。分四個面向：dyspnea(5-35分)、fatigue(4-28分)、emotion(7-49分)、mastery(5-35)
ST GEORGE’S RESPIRATORY QUESTIONNAIRE(SGRQ)：The SGRQ is designed to measure health impairment in patients with asthma and COPD. It is also valid for use in bronchiectasis and has been used successfully in patients with kyphoscoliosis and sarcoidosis.
MRF-28(Maugeri Respiratory Failure questionnaire)呼吸失效問卷
SRI(severe respiratory insufficiency)questionnaire嚴重呼吸失效問卷
HADS(hospital anxiety and depression scale)醫院焦慮和憂鬱量表，(0)好--(42)差。
MRC(medical research council,醫療研究會議)呼吸困難評分表，(1)好--(5)差。
6MWD(6-minute walking distance)：6分鐘走路距離
GARS(Groningen Activity and Restriction Scale)：活動與限制評分量表，(18)好--(72)差。

期刊報告 : 洪琪馥 2012 - 9 - 5

兩年期慢性肺病病人在家夜間使用非侵入性通氣合併肺部復健：一個隨機對照試驗

Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: A randomized controlled trial

Marieke L Duiverman, Johan B Wempe, Gerrie Bladder, Judith M Vonk, Jan G Zijlstra, Huib AM Kerstjens and Peter J Wijkstra..

Respiratory Research 2011, 12:112-122

報告者 : 洪琪馥

指導者 : 鄭瑞駿
報告日期 : 2012 - 9 - 5

背景

由於缺少長期數據，慢性高碳血症呼吸衰竭之阻塞性肺部疾病(COPD)患者間歇使用非侵入性正壓通氣(NIPPV)仍有爭議。

本研究目的是在比較兩年期慢性高碳血症呼吸衰竭之COPD患者在家夜間間歇使用非侵入性通氣合併肺部復健和單獨使用肺部復健治療(PR)結果。

方法

對66位病人在家使用兩年的追蹤進行分析。使用截距隨機效應之線性混合效應模式與以及基準值的調整評估非侵入性正壓呼吸器(NIPPV)加上肺部復健(PR)治療和單獨使用肺部復健治療(PR)之間的差異。主要結果為健康相關生活品質( HRQoL)；次要結果是情緒狀態，呼吸困難，氣體交換，功能狀況，肺功能，以及惡化頻率。

結果

比較單獨使用肺部復健治療(PR)和合併非侵入性正壓通氣(NIPPV)並沒明顯改善慢性呼吸問卷量表(CRQ)( 群組間平均差異變化為-1.3分【 95％CI：-9.7～7.4 】)，使用Maugeri呼吸衰竭問卷量表評估顯示肺部復健治療(PR)合併非侵入性正壓通氣(NIPPV)可改善健康相關生活品質 (HRQoL) (-13.4％【-22.7 ～ -4.2；p=0.005】)，情緒狀態(醫院焦慮和憂鬱量表-4.0【-7.8～0.0；p=0.05】)，呼吸困難分數(醫學研究委員會MRC -0.4【-0.8 ～-0.0；p=0.05】)，日間動脈血液氣體(PaCO2：-0.4 KPa【-0.8～-0.2；p=0.01】；PaO2：0.8 KPa【 0.0～1.5；P=0.03】)，6分鐘步行距離 (77.3公尺【46.4～108.0；P＜0.001】)，Groningen 活動和限制量表(-3.8【-7.4～-0.4；p=0.03】)，和第一秒用力吐氣容積FEV1 (115ml【19～211；p=0.019】)，惡化率頻沒有改變。

結論

慢性高碳血症呼吸衰竭COPD患者使用非侵入性通氣合併肺部復健兩年可改善健康相關生活品質( HRQoL)，情緒狀態，呼吸困難，氣體交換，運動耐受力和肺功能衰退，好處可隨時間增加。

2012年9月9日星期日

The ACIF(Acute Care Index of Function)(急性照護功能指數) would be appropriate for the acute care neurological setting, index items were chosen and defined by experienced physical therapists involved in the assessment and treatment of patients with acute neurological disorders.

圖片來源：Physical Therapy 1988,68,1102-1108.

The mental status items were included to improve the instrument's ability to separate the patients by score into groups consistent with discharge placement. Mental status items are rated as either "yes" or "no" according to the presence or absence of the defined behavior.

The remaining three subsets address the patient's ability to perform various gross motor activities (Fig. 1). The 16 items within these three subsets were selected specifically for use with patients with acute neurologic disorders. Items with a low level of difficulty (eg, bed mobility) were included because we believed

that patients with acute neurologic disorders would demonstrate change in their ability to perform these

activities.

1. Unable—Patient cannot physically assist to perform the activity.

2. Dependent—Patient assists to perform the activity but requires physical or verbal assistance to complete

the activity.

3. Independent—Patient performs the activity meeting all stated criteria without verbal or physical assistance.

The rating "unable" a score of 0, "dependent" a score of 1, and "independent" a score of 2.

Rate of perceived exertion (Borg Scale)

用於一般運動強度訓練或用於吸氣肌肉強度訓練

圖片來源：http://www.huffandbuff.com/2010/07/08/exercise-exertion-talk-test/

一般吸氣肌肉訓練時，自覺式呼吸費力指數(Borg Scale) 達到7分以上就要停止。

SF-36 健康生活品質量表，測量受試者對自己身心健康的看法，為一般性的心理測量工具，非針對特定的年齡、疾病或治療而設計。

原著作者：Dr. John Ware, 1996委由長庚大學盧瑞芬副教授負責台灣版使用授權，信效度介於0.62-0.96之間。

量表分為八個概念：

1.physical functioning
2.impact of physical health on role performance(role-physical)
3.pain
4.health perceptions
5.vitality
6.social functioning
7.mental health
8.impact of emotional health on role performance (role-emotional)

每個概念的分數從0-100，分數愈高，身體健康狀態愈好。

SF-36 健康生活品質量表(原版)：