/ / A/ B 16/17 COPD 18mcg COPD COPD COPD 1
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- あいり ひろもり
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1 / / A/ B 16/17 COPD 18mcg COPD COPD COPD 1 FEV1.0 %FEV1.0 70% 1 FEV1.0 / FVC 70% COPD 1 10mg ACE COPD mcg 1 1 MDI 1 200mcg2 100mcg2 1 3 MDI
2 FEV1.0 FEV1.0 1 FVC 1 COPD 2 QOLSGRQ AQ ACE FEV1.0 FEV1.0 FEV1.0 LOCF COPD Least Favorable prior observation carried forwardlfcf FEV1.0 Vist2 95% Visit2 52 Visit7 232
3 COPD Visit Number X 1) X 2) X X X X X X X X X QOL SGRQ AQ20 3 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 1Visit wash out 3AQ20 233
4 % 97/ %43/51 9.1%10/ %4/ FEV FEV L%FEV % 14.5%16/ %7/ % 67.1% p= FEV1.0 p= (p=0.1295) FEV p= N (%) N (%) N (%)
5 FEV * Fisher S.D. 19 p FEV1.0(L) %FEV1.0(%) FEV1.0 / FVC(%) FVC(L) * 235
6 N % N % N % (90.9%) 46 (90.2%) 146 (90.7%) 77 (70.0%) 34 (66.7%) 111 (68.9%) Flutropium 3 (2.7%) 1 (2.0%) 4 (2.5%) Ipratropium Bromide 4 (3.6%) 4 (7.8%) 8 (5.0%) Oxitropium 70 (63.6%) 29 (56.9%) 99 (61.5%) 2 31 (28.2%) 13 (25.5%) 44 (27.3%) Fenoterol 2 (1.8%) 0 (0.0%) 2 (1.2%) Procaterol 16 (14.5%) 9 (17.6%) 25 (15.5%) Salbutamol 13 (11.8%) 5 (9.8%) 18 (11.2%) Tulobuterol 2 (1.8%) 0 (0.0%) 2 (1.2%) 2 18 (16.4%) 12 (23.5%) 30 (18.6%) Clenbuterol 11 (10.0%) 2 (3.9%) 13 (8.1%) Fenoterol 0 (0.0%) 1 (2.0%) 1 (0.6%) Hexoprenaline 1 (0.9%) 1 (2.0%) 2 (1.2%) Mabuterol 1 (0.9%) 0 (0.0%) 1 (0.6%) Procaterol 4 (3.6%) 7 (13.7%) 11 (6.8%) Trimetoquinol 1 (0.9%) 0 (0.0%) 1 (0.6%) Tulobuterol 0 (0.0%) 1 (2.0%) 1 (0.6%) 2 11 (10.0%) 10 (19.6%) 21 (13.0%) Tulobuterol 11 (10.0%) 10 (19.6%) 21 (13.0%) p* (10.0%) 3 (5.9%) 14 (8.7%) (18.2%) 10 (19.6%) 30 (18.6%) Beclomethasone 13 (11.8%) 6 (11.8%) 19 (11.8%) Fluticasone 7 (6.4%) 4 (7.8%) 11 (6.8%) 6 (5.5%) 0 (0.0%) 6 (3.7%) Betamethasone 1 (0.9%) 0 (0.0%) 1 (0.6%) Prednisolone 5 (4.5%) 0 (0.0%) 5 (3.1%) 74 (67.3%) 34 (66.7%) 108 (67.1%) Aminophylline 1 (0.9%) 0 (0.0%) 1 (0.6%) Theophylline 73 (66.4%) 34 (66.7%) 107 (66.5%) Fisher
7 FEV1.0 FEV L 0.94 L FEV L S.E FEV FEV FEV L L p= p= FEV
8 FEV FEV1.0L SE 19 (N=100) (N=46) p 95% * (0.02) -0.00(0.03) 0.12(0.03) ( 0.06, 0.18) (0.02) -0.02(0.03) 0.11(0.03) ( 0.05, 0.18) 0.16(0.01) 0.20(0.02) -0.04(0.02) (-0.08, 0.00) (0.02) 0.16(0.03) 0.04(0.04) (-0.03, 0.12) (0.02) 0.14(0.03) 0.05(0.04) (-0.03, 0.12) * common baseline COPD COPD COPD COPD 19 Score N SE N SE
9 COPD p< COPD
10 COPD 19 N N P 95% * (0.05) (0.07) -0.00(0.09) ( -0.17, 0.17) (0.05) (0.07) 0.03(0.09) ( -0.14, 0.20) (0.04) (0.06) 0.07(0.08) ( -0.09, 0.22) (0.05) (0.07) 0.00(0.08) ( -0.16, 0.16) (0.05) (0.08) 0.02(0.09) ( -0.17, 0.21) * (0.05) (0.08) -0.09(0.09) ( -0.27, 0.09) (0.05) (0.08) -0.05(0.09) ( -0.23, 0.13) (0.05) (0.08) 0.08(0.09) ( -0.10, 0.27) (0.05) (0.08) -0.04(0.09) ( -0.22, 0.14) (0.06) (0.09) 0.03(0.10) ( -0.17, 0.24) * (0.10) (0.15) -0.10(0.18) ( -0.46, 0.26) (0.10) (0.15) -0.25(0.18) ( -0.61, 0.11) (0.11) (0.16) -0.53(0.19) ( -0.91, -0.15) (0.10) (0.15) -0.39(0.18) ( -0.73, -0.04) (0.10) (0.15) -0.45(0.18) ( -0.80, -0.09) * (0.03) (0.05) 0.07(0.06) ( -0.04, 0.18) (0.04) (0.06) -0.04(0.08) ( -0.19, 0.11) (0.04) (0.05) -0.02(0.07) ( -0.14, 0.11) (0.04) (0.06) -0.10(0.07) ( -0.24, 0.03) (0.04) (0.07) 0.01(0.08) ( -0.15, 0.17) * common baseline 240
11 St. George's Respiratory QuestionnaireSGRQ SGRQ 19 N SE N SE Symptoms Activity Impact Total p< p<
12 SGRQ SGRQ SE 19 N N p 95% (1.62) (2.41) -5.35(2.90) (-11.08, 0.39) (1.76) (2.63) -9.11(3.16) (-15.36, -2.85) (1.42) (2.12) -3.65(2.56) ( -8.70, 1.40) (1.45) (2.16) -8.03(2.61) (-13.18, -2.87) (1.27) (1.89) -4.21(2.28) ( -8.71, 0.30) (1.34) (2.00) -4.02(2.41) ( -8.79, 0.74) (1.10) (1.64) -4.18(1.97) ( -8.08, -0.28) (1.16) (1.72) -5.96(2.08) (-10.06, -1.86) * common baseline 242
13 SGRQ % % % p< % 19 (N=102) (N=46) (95% ) P* (-18.38, 16.42) (-3.70, 29.11) (-13.01, 21.71) (3.68, 36.99) * Fisher 243
14 4 SGRQ 4 SGRQ Jones Jones 2) SGRQ 3) 4 COPD SGRQ 4 4 4) SGRQ QOL 1. Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respir Med 1991; 85: Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: Hajiro T, Nishimura K, Tsukino M, et al. Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: COPD QOL minimum clinically important difference. 12 C
15 COPD COPD COPD Kaplan-Meier COPD COPD COPD p=0.0525, Log-rank COPD 100 patient-years COPD p=0.0835p=0.0701wilcoxon Prob Tiotropium (N=110) Oxitropium (N=51) Days The number of at risk cases Tiotropium Oxitropium Kaplan-Meier COPD COPD 19 COPD p /100 patients-years Wilcoxon rank-sum test COPD P /100 patients-years Wilcoxon rank-sum test
16 %, % Total N ( %) N ( %) N ( %) Exposure (days) 1 1 (0.9) 1 (2.0) 2 (1.2) (0.9) 0 1 (0.6) (3.6) 3 (5.9) 7 (4.3) (0.9) 0 1 (0.6) (2.7) 2 (3.9) 5 (3.1) (4.5) 2 (3.9) 7 (4.3) (86.4) 43 (84.3) 138 (85.7) SD % % 74.5% 3% 17.3 %19/ %6/ %4/ %4/110 () 7.3 %8/ %6/ %54/ %19/ %3/ %6/
17 2 No.1* No.2* No.3* No.4* %4/ mg/dL 6.4 %7/ %4/ %3/
18 % 19 WHO Preferred Term N % N % () () COPD ()
19 %9/ %5/ No.5* No.6*5 600mg/ 5mg/ 50mcg 211 X 55 % 10mg/ 5mg/ 15mg/ / 0.25mg C 0.4mg 32.6mcg/mL 820mcg/mL 400mg/ / 3 249
20 N % N % (n=46) (n=17) (n=64) (n=34) N % N % N % N %
21 (n=19) (n=3) (n=91) (n=48) N % N % N % N % (N=14) (N=9) (N=50) (N=19) (N=46) (N=23) N % N % N % N % N % N %
22 % 2.7% 3.9%0% 1.8% 2.0% 1.8%0% WHOWHO Preferred Term N % N % ( ) () () ()
23 %20/ %14/ WHO ( ) WHO Preferred Term N % N % ( ) COPD
24 No.6* 1.5 No.7* No.6* mg/ mg/ml mL/ mcg/ mg/ mg/ mg/ 100mg/ X 55% 10mg/ mg/ 10mg/ / mg/ml mg/ mg/ 5mg/ mg/ml / 400 mg/day
25 No.7*
26 / % 4/51 7.8% WHO WHO Preferred Term N % N % ( ) ( ) ()
27 * 19 N N (0.9) 50 1(2.0) 1(2.0) 108 2(1.9) 1(0.9) 50 2(4.0) 1(2.0) 108 2(1.9) 5(4.6) (6.0) ALT (GPT) (1.9) (2.0) AST(GOT) (1.9) (4.6) (2.0) LDH 108 1(0.9) 3(2.8) (2.0) (3.7) (2.0) 108 3(2.8) (2.0) (2.8) (2.0) BUN (4.6) (4.0) (4.6) (6.0) (2.8) (4.0) ( ) % * FEV1.0 SGRQ % 74.5% 17.3% 5.9% 5.5% COPD 10.9% 17.6%
28 WHO preferred * term 6* X 55% 10mg/ 5mg/ 10mg/ / 0.25mg C 0.4mg 32.6 mcg/ml 820 mcg/ml 600mg/ 400mg/ 5mg/ / 8* MRI A R *
29 (WHO preferred term) * 7* D ( ) RF g/dL 43 A g/dL *
30 WHO preferred term * 9* * ATP ATP40mg 1/2A ATP Visit Visit Visit Visit GOT U/L H 74 H 84 H GPT U/L H 60 H 54 H GTP U/L 176 H 172 H 223 H 515 H 442 H H ALP U/L 489 H 510 H 524 H H LDH U/L 244 H H H *
31 WHO preferred term * 11* X 7 8 X 11 X * CT (4cm) ( ) * S 5cm 3 *
32 WHO preferred * term 14* mm 2 ( ) * CT 15mm PL VG 16* 6 59 CT 2 ( ) *
33 (WHO preferred term) * 17* COPD T3 COPD * COPD COPD mg/dLPaO mmHgPaCO mmHg 11 ( 14 ) 19* COPD COPD PaO2 45.8mmHg PaCO mmHg X 9,700/mm 3 CRP 6.4mg/dL 10 6,200/mm 3 CRP 8 COPD *
34 WHO preferred term * 20* COPD 7 COPD X COPD 21* PL COPD PL 2 CRP 12.9mg/dL 3 CRP 5.9mg/dL * L *
35 WHO preferred term 23* (13,800 / L)CRP 6.1mg/dL 2g2/2 5 4,210 /L 11 CRP 0.6mg/dL 24* X COPD 25* WBC 11,700/mm 3 CRP 6.9 mg/dl *
36 WHO preferred * term 26* * L 4 X 4 X * S D3 27 *
37 WHO preferred term * 29* L CRP 25.2mg/dL 6 12 CRP (1.5mg/dL) 19 BOOP CRP 0.6mg/dL 23 Haemophililus influenzae BOOP * 6 COPD CRP 4.05mg/dL 0.5L/min *
38 WHO preferred term * 31* COPD 6 COPD 194 SpO L/min ph 7.18PaCO torrPaO 2 100torr 24 / COPD L/min (2 ) 0.5L/min ph 7.46PaCO 2 42torrPaO 2 60torr 32* 5 COPD 135 CRP 2.8mg/dL CRP 0.2mg/dL 24 *
39 mg/dL WHO preferred term * 33* 7 61 CRP L 55.1mg/dL 2.8mg/dL 3 2.0mg/dL mg/dl CRP 23.1 mg/dl 5 MS CRP 3.3mg/dL 36 CRP 1.1mg/dL 46 CRP 58 CRP 3.0mg/dL mg/dL X Consolidation 73 CRP 0.8mg/dL X * X CRP (22.73mg/dL) 15 35* CRP S PL 4 36
40 (WHO preferred term) * 36* CT MRI 12 37* 7 PL 2 ( ) ( ) * 7 274,, * *
41 A/ B 16/ / /15 18mcg FEV CRF Visit CRF mcg 271
42 / / / A/ B COPD COPD COPD MDI COPD 1 FEV1.0 %FEV1.0 70% 1 FEV1.0 / FVC 70% pack-year 3 40 COPD 1 10mg ACE 1 1 COPD 1FEV1.0 %FEV1.0 65% 1 FEV1.0/FVC 70% 210 pack-year /mm mg 20mg 6 6 COPD 1FEV1.0 %FEV1.0 65% 1 FEV1.0/FVC 70% 210 pack-year /mm mg 20mg A B
43 / / / A/ B 1 1 FEV1.0 1 FEV1.0 ( 1 ( 1 2 FEV1.0 ) ) ( 2) 2 FEV1.0 3 FEV ) FEV FVC FEV1.0 FVC FEV1.0 FVC FEV1.0 COPD COPD QOLSGRQ COPD AQ20 COPD COPD COPD QOLSGRQ SF36 Mahler Dyspnea Index QOL SGRQ SF36 Mahler Dyspnea Index Pharmaco-economic variables Pharmaco-economic variables
44 %(30/161) 42.0%(387/921) 80.6%(431/535) 67.1%(108/161) 23.6%(217/921)15.9%(85/535) %(44/161) 99.2%(914/921)38.3%(205/535) FEV L 1.03L1.22L FEV1.0 %FEV % 38.7% 43.1% 274
45 /128 14/ A/126B 16/17 Total Total < > Mean StdDev Median Min Max Mean StdDev Median Min Max Mean StdDev Median Min Max Mean StdDev Median Pack-years Min Max Mean StdDev Median () Min Max (18.2%) (19.6%) (18.6%) (43.5%) (39.9%) (42.0%) (80.3%) (81.0%) (80.6%) (67.3%) (66.7%) (67.1%) (22.4%) (25.3%) (23.6%) (16.3%) (15.1%) (15.9%) (28.2%) (25.5%) (27.3%) (99.3%) (99.2%) (99.2%) (39.0%) (36.9%) (38.3%) * 2 275
46 /128 14/ A/126B 16/17 Total Total N Mean StdDev * FEV1.0 L Median Min Max % (40.5%) (29.4%) (37.0%) (29.6%) (33.7%) (31.3%) (18.5%) (16.8%) (17.9%) 30% * 50% (39.6%) (54.9%) (44.4%) (46.7%) (43.7%) (45.5%) (46.9%) (58.7%) (50.8%) %FEV1.0(%) 50% % (18.0%) (11.8%) (16.0%) (22.9%) (22.1%) (22.6%) (33.1%) (24.6%) (30.3%) 70% (0.0%) (3.9%) (1.2%) (0.7%) (0.5%) (0.7%) (1.4%) (0.0%) (0.9%) Mean * StdDev %FEV1.0(%) Median Min Max Mean StdDev * FEV1.0/FVC(%) Median Min Max Mean StdDev * Median FVC L Min Max * FEV1.0%FEV1.0FEV1.0/FVC FVC ( 19) wash out 276
47 FEV A/126B 16/ /128 14/ FEV (Tr ) ( A/126B) (Tr /128) (Tr ) ( A/126B) (Tr /128) FEV1.0L FEV1.0L LSMean95% LSMean95% FEV FEV L 0.09L 95% L L 6 1 FEV1.0 FEV1.0 95% 6 1 FEV
48 FEV1.0 95% Test Drug LSMean Day Lower Upper P-Value < < / < / < < < ( A/ B < / < ( 19)
49 FEV /128 14/ A/126B 16/ Tio 18mcg Oxitropium Total N (21.8%) 10 (19.6%) 34 (21.1%) / 0 (0.0%) 0 (0.0%) 0 (0.0%) 20 (18.2%) 10 (19.6%) 30 (18.6%) 6 (5.5%) 0 (0.0%) 6 (3.7%) 74 (67.3%) 34 (66.7%) 108 (67.1%) 74 (67.3%) 34 (66.7%) 108 (67.1%) 49 (44.5%) 25 (49.0%) 74 (46.0%) / 0 (0.0%) 0 (0.0%) 0 (0.0%) 31 (28.2%) 13 (25.5%) 44 (27.3%) 18 (16.4%) 12 (23.5%) 30 (18.6%) 11 (10.0%) 10 (19.6%) 21 (13.0%) /128 14/ A/126B 16/17 Tio 18mcg Placebo Total Tio 18mcg Ipratropium Total N (44.9%) 159 (42.9%) 406 (44.1%) 291 (81.7%) 146 (81.6%) 437 (81.7%) / 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.6%) 1 (0.2%) 239 (43.5%) 148 (39.9%) 387 (42.0%) 286 (80.3%) 145 (81.0%) 431 (80.6%) 31 (5.6%) 34 (9.2%) 65 (7.1%) 31 (8.7%) 19 (10.6%) 50 (9.3%) 123 (22.4%) 94 (25.3%) 217 (23.6%) 58 (16.3%) 27 (15.1%) 85 (15.9%) 123 (22.4%) 94 (25.3%) 217 (23.6%) 58 (16.3%) 27 (15.1%) 85 (15.9%) 546 (99.3%) 368 (99.2%) 914 (99.2%) 149 (41.9%) 70 (39.1%) 219 (40.9%) / 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 546 (99.3%) 368 (99.2%) 914 (99.2%) 139 (39.0%) 66 (36.9%) 205 (38.3%) 4 (0.7%) 8 (2.2%) 12 (1.3%) 14 (3.9%) 7 (3.9%) 21 (3.9%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 279
50 18.6% 42.0% 80.6% 67.1% 23.6% 15.9% % 99.2% 38.3% FEV1.0 FEV p=
51 FEV1.0 95% p= Placebo / /15 Tiotropium p= Ipratropium A/126B /17 Tiotropium p= Oxitropium Tiotropium Placebo / /15 Tiotropium Ipratropium A/126B /17 Tiotropium Oxitropium Tiotropium Placebo / /15 Tiotropium Ipratropium A/126B /17 Tiotropium Oxitropium Tiotropium p= p= p= p= p= p=
52 FEV A/126B 16/ /128 14/ FEV1.0 FEV
1. 1) Gross NJ; Co E; Skorodin MS. Cholinergic bronchomotor tone in COPD: estimates of its amount in comparison with that in normal subjects. Chest 19
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デスフルラン時代の周術期管理 岡山大学麻酔科蘇生科森松博史 デスフルランの特徴!!! 岡山大学での現状 本日のお話 デスフルランの特徴 3 Eger et al. Anesth Analg 1998; 86: 414-21 デスフルランの特徴 2 つのメタアナリシス 2005 Macario et al. Am J Health Syst Pharm!! 2010 Dexter et al.
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Suzuki R, et al 慢性閉塞性肺疾患患者の日常生活動作に対するプロカテロール頓用の効果 Effects of the supplementary use of the short-acting β 2 stimulant procaterol on the daily physical
慢性閉塞性肺疾患患者の日常生活動作に対するプロカテロール頓用の効果 Effects of the supplementary use of the short-acting β 2 stimulant procaterol on the daily physical activity of patients with chronic obstructive pulmonary disease 鈴木涼子
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29 7 IT 27 339 5,199 464 40-74 100cm 2 100cm 2 BMI25kg/m 2 85cm90cm 85cm90cm BMI25kg/m 2 130mmHg 140mmHg 85mmHg 90mmHg 150mg/dL 300mg/dL HDL 39mg/dL 34mg/dL LDL 120mg/dL 140mg/dL 100mg/dL 126mg/dL HbA1c
卒業論文
Y = ax 1 b1 X 2 b2...x k bk e u InY = Ina + b 1 InX 1 + b 2 InX 2 +...+ b k InX k + u X 1 Y b = ab 1 X 1 1 b 1 X 2 2...X bk k e u = b 1 (ax b1 1 X b2 2...X bk k e u ) / X 1 = b 1 Y / X 1 X 1 X 1 q YX1
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28 6 IT 26 1 326 4,499 433 40-74 100cm 2 100cm 2 BMI25kg/m 2 85cm90cm 85cm90cm BMI25kg/m 2 130mmHg 140mmHg 85mmHg 90mmHg 150mg/dL 300mg/dL HDL 39mg/dL 34mg/dL LDL 120mg/dL 140mg/dL 100mg/dL 126mg/dL HbA1c