RESUMO
OBJECTIVE: To review the efficacy, symptoms, inflammatory factors and pulmonary function of different doses of budesonide aerosol inhalation in the treatment of patients with asthma. METHODS: The Chinese and English literature databases were searched with "Effects of different doses of budesonide aerosol inhalation on the efficacy, lung function, inflammation, symptoms and adverse reactions in patients with asthma" as the search direction, and a Meta-analysis was performed. RESULTS: Compared with the low dose group, the efficacy, PEF and FEV1 were significantly increased and the clinical symptom score, TNF-α and IL-4 were significantly decreased in the high dose group (p < 0.05). There was no significant difference in IFN-γ level and the incidence of adverse reactions between the two groups (p > 0.05). CONCLUSION: High-dose budesonide aerosol inhalation therapy can improve the efficacy and lung function of patients, reduce inflammation and clinical symptoms, and does not increase the risk of adverse reactions, which is worthy of clinical promotion.
RESUMO
OBJECTIVE: To determine the optimal positive end-expiratory pressure (PEEP) according to inflation and deflation pressure-volume curve (P-V curve) in patients with acute respiratory distress syndrome (ARDS). METHODS: ARDS models were reproduced in 20 dogs, and they were randomly divided into two groups. In both groups, Levenberg-Marquardt iterative algorithm was employed using software to explore parameters fitting with Boltzmann formula, by which the real inflection point of pressure (Pinf d) in deflation limb or lower inflection point pressure (PLip) in inflation limb on P-V curve were defined. For the control group (inflation curve) P-V curve of PLip + 2 cm H(2)O [1 cm H(2)O = 0.098 kPa] was applied as the best PEEP value. In the experimental group (deflation curve) the Pinf d was taken as the best PEEP value. The heart rate (HR), blood pressure (BP), fingertip pulse oxygen saturation [SpO(2)], static lung compliance (Cst), arterial partial pressure of oxygen [PaO(2)] and arterial partial pressure of carbon dioxide [PaCO(2)] were monitored at 0, 2, 6, 12, 24 and 48 hours. RESULTS: Oxygenation index increased significantly both in control and experimental groups. In experimental group, oxygenation index (mm Hg, 1 mm Hg = 0.133 kPa) of 12, 24 and 48 hours was respectively significantly higher than that of the control group (12 hours: 177.63 ± 8.94 vs. 165.60 ± 8.90, 24 hours: 194.19 ± 10.67 vs. 168.70 ± 10.60, 48 hours: 203.15 ± 13.21 vs. 171.26 ± 9.21, all P < 0.01). Cst [ml/cm H(2)O] at 2, 6, 12, 24 and 48 hours was respectively higher than that of the control group (2 hours: 41.00 ± 4.17 vs. 36.20 ± 3.90, 6 hours: 44.00 ± 4.65 vs. 36.88 ± 3.39, 12 hours: 46.92 ± 5.47 vs. 37.92 ± 3.10, 24 hours: 42.83 ± 8.97 vs. 37.92 ± 3.09, 48 hours: 42.64 ± 9.04 vs. 37.97 ± 2.98, P < 0.05 or P < 0.01). CONCLUSION: Determining optimal PEEP for ARDS with deflation P-V curve was better than that of inflation curve.