2022年 · 第45卷第06期

Background and Purpose:Patients with community-acquired pneumonia (CAP) are often complicated by obvious pleurisy and pleural effusion. Whether anti-inflammatory therapy with glucocorticoids can improve the prognosis of such patients is unclear. This study was intended to evaluate the efficacy of glucocorticoids in adult parapneumonic pleural effusion.Method:The study was conducted in six Australian medical centres and was a pilot, multicentre, randomized double-blind, placebo-controlled clinical trial. CAP patients with parapneumonic pleural effusion were randomly assigned to intravenous dexamethasone group (4 mg, twice/d ×48 h) or control group at a ratio of 2:1. The patients were followed up for 30 days, and their clinical symptoms, signs, laboratory tests and imaging indexes during this period were evaluated and statistically analyzed.Results:A total of 80 patients with CAP and parapneumonic pleural effusion were enrolled, including one who withdrew prior to treatment, 51 in the dexamethasone group and 28 in the placebo group. Dexamethasone was not found to shorten the time to return to normal for vital signs (including body temperature, oxygen saturation, blood pressure, heart rate, and respiratory rate) (at least 12 h). The median time in the dexamethasone and control groups was [41.0 h (95%CI: 32.3-54.5 h)vs27.8 h (95%CI: 15.4-49.5 h),HR=0.729，95%CI：0.453~1.173，P=0.193］。 The white blood cell count was higher in the dexamethasone group on day 2, and there was no significant difference in C-reactive protein and white blood cell count levels between the two groups. The dexamethasone group and the control group had 49.0%vsThoracocentesis and drainage were required in 42.9% of patients (P=0.60）。 Follow-up chest imaging showed that the pleural effusion volume gradually decreased, and the difference was not statistically significant. Dexamethasone groupvsThere were no significant differences between the mean antibiotic duration and median hospital stay in the placebo group: 22.4 (SD=15.4) dvs20.4（SD=13.8) d, 6.0 (IQR=5.0~10.0) dvs5.5（IQR=5.0~8.0) d. Dexamethasone groupvsThe incidence of serious adverse reactions was 25.5% in the placebo groupvs21.4%。 Compared with placebo, transient hyperglycemia (15.6%vs7.1%) were more common in the dexamethasone group.Conclusion:Intravenous dexamethasone did not benefit adult patients with parapneumonic pleural effusion.

BACKGROUND AND PURPOSE:Mild intermittent hypoxia (MIH) may benefit the outcome of cardiovascular disease, and this study looked at the effects of receiving 15 days of MIH and home continuous positive airway pressure (CPAP) therapy on blood pressure in patients with obstructive sleep apnea (OSA) accompanied by hypertension.Method:The patient received MIH in awake state, 5 d/week, for 3 weeks. Each cycle of MIH contained 2 min hypoxia +2 min normoxia for 12 cycles per day. During the experiment, the end-expiratory carbon dioxide of patients in the MIH group remained 2 mmHg above the baseline value (1 mmHg =0.133 kPa); Patients in the control group were exposed to sham experiments (compressed air). All patients were treated with CPAP at the same time.Results:Sixteen male patients completed the study, including 10 in the MIH group and 6 in the control group. After receiving MIH for 15 days, the resting systolic blood pressure at awake within 24 h was lower than before [(142.9 ± 8.6)vs(132.0 ± 10.7) mmHg,P<0.001], but the blood pressure of the patients in the control group did not change [(149.9±8.6)vs(149.7±10.8) mmHg,P=0.915］。 The experimental group showed a greater decrease in blood pressure from baseline compared to the control group [(-10.91 ± 4.1)vs.(-0.17±3.6) mmHg,P=0.003］。 The changes in blood pressure were accompanied by increased parasympathetic nerve activity and decreased sympathetic nerve activity in patients in the experimental group, estimated from the analysis of blood pressure and heart rate variability. Patients did not develop significant neurocognitive and metabolic impairment after receiving MIH. Conclusion: MIH can improve cardiovascular outcome and autonomic function in men with OSA and hypertension, which is worthy of further investigation.