平喘摩按法治疗儿童哮喘与呼吸音信号分析应用的临床研究

发布时间：2018-06-17 01:18

本文选题：平喘摩按法 + 哮喘　；参考：《北京中医药大学》2015年博士论文

【摘要】：目的：系统评价平喘摩按法在儿童哮喘中的临床疗效,包括急性发作期的平喘效果和慢性持续期预防控制效果,为儿童哮喘提供疗效肯定、简单易行的治疗方法和预防管理选择。对哮喘儿童的呼吸音信号变化进行定量分析,以及对哮喘急性期、慢性持续期和正常儿童的呼吸音信号做定量分析和频谱比较,为临床诊疗提供新的定量监测和记录方法。方法：1.采用自身前后对照的研究方法,纳入60例哮喘急性期的患儿,采用平喘摩按法进行治疗,观察手法前后患儿症状、体征、PEF、FEV1、呼吸音强度和总有效功率的变化情况,评价平喘摩按法在急性期的疗效。2.采用随机、对照的研究方法,纳入140例病例,分为治疗组(手法+中药治疗组)与对照组(单纯中药治疗组),各70例,两组之间进行平行对照。分别在入组当天及每个月随访一次(共随访6次)时观察记录患儿的症状、体征,儿童哮喘控制测试表评分,PEF、FEV1值,呼吸音强度和总有效功率,分析评价平喘摩按法在慢性持续期的疗效。3.采用3MTM Littmann(?)3200电子听诊器分别录取哮喘儿童急性期、哮喘慢性持续期以及正常儿童的呼吸音。用配套软件提取呼吸音相关数据,对呼吸音强度、总有效功率及呼吸音频谱,进行相关定量分析。结果：1.急性期患儿在手法治疗前后相比较,咳嗽、胸闷、憋气、气促、喘息均明显减轻(P0.05)；肺内哮鸣音较手法治疗前明显减轻,部分患儿的哮鸣音甚至消失(P0.05)；呼吸音强度明显降低(P0.05),总有效功率明显减少(P0.05),并且明显提高PEF、FEV1值(P0.05)。手法治疗儿童哮喘急性发作效果显著。2.慢性持续期患儿两组基线一致,具有可比性。从随访6个月观察时间点的统计结果看,全分析集(FAS)与符合方案集(PPS)结果基本一致,研究结果可靠。治疗组比对照组更能有效控制哮喘慢性持续期的症状；两组间的PEF、FEV1变化情况无明显差异(P0.05),但治疗组的均值较对照组高；治疗组比对照组的呼吸音强度、总有效功率降低明显(p0.05)；治疗组的C-ACT评分明显比对照组高(p0.05)。总体分析,治疗组较对照组控制儿童哮喘慢性持续期效果显著,症状反复情况明显减少。3.哮喘急性发作期、慢性持续期的呼吸音强度和总有效功率均比正常儿童的明显升高(p0.05)。哮喘急性发作期患儿呼吸音频谱在各频率段均显示振幅明显升高(p0.05),哮喘慢性持续期的呼吸音频谱与正常儿童的相比较,只在部分特定频率段声音强度更高(p0.05)。结论：1.平喘摩按法能缓解哮喘急性发作的症状,改善肺内通气,治疗儿童哮喘急性发作效果显著。2.对于哮喘慢性持续期的儿童,平喘摩按法能有效控制症状,防止复发,降低气道阻力,改善肺内通气,治疗儿童哮喘慢性持续期效果显著。通过培训,患儿家长能掌握平喘摩按法的操作,参与到患儿的治疗中,降低儿童哮喘对家庭、社会的负担。3.通过对哮喘急性期、慢性持续期的儿童与正常儿童的呼吸音信号进行对比分析,发现呼吸音频谱分析能反应出肺内轻微的改变,呼吸音频谱分析是一种更加灵敏的、客观的检查指标。
[Abstract]:Objective: to systematically evaluate the clinical efficacy of asthmatic asthma in children, including the effect of acute asthma and the effect of chronic persistent period prevention and control, to provide therapeutic affirmative, simple and easy treatment and preventive management choice for children with asthma. In acute, chronic and normal children's respiratory sound signals, quantitative analysis and spectrum comparison are used to provide new quantitative monitoring and recording methods for clinical diagnosis and treatment. Methods: 1. the children of 60 patients with acute asthma were included in the treatment of asthma acute stage by the method of self control, and the symptoms and bodies of the children were observed before and after the treatment. The changes of PEF, FEV1, respiratory sound intensity and total effective power were used to evaluate the effect of antiasthmatic friction on the acute phase of.2.. A randomized, controlled study was adopted in 140 cases, divided into the treatment group (manipulation + Chinese medicine treatment group) and the control group (only the Chinese medicine treatment group), each of the 70 cases and the two groups in parallel control. The symptoms, signs, children's asthma control test table score, PEF, FEV1 value, respiratory sound intensity and total effective power were observed and recorded at one time of follow-up (6 times per month). The efficacy of 3MTM Littmann (?) 3200 electronic stethoscope was applied to the acute period of asthma in children and the asthma was slow. Respiratory sound of normal children and normal children. Correlation quantitative analysis of respiratory sound intensity, total effective power and respiratory audio spectrum were extracted with supporting software. Results: 1. children in acute stage were compared before and after manipulation, cough, chest tightness, suffocation, breath, and wheezing were all significantly reduced (P0.05); lung wheezing sounds were compared. Some children's wheezing sounds even disappeared (P0.05), respiratory sound intensity decreased (P0.05), total effective power decreased significantly (P0.05), and PEF and FEV1 value (P0.05) were obviously improved. The effect of manipulative treatment for children with acute attack of asthma was significant in the two groups of children with chronic persistent period of.2., with a comparable baseline, from a follow-up of 6 The total analysis set (FAS) was consistent with the results of conforming program set (PPS), and the results were reliable. The treatment group could control the symptoms of chronic asthma more effectively than the control group. There was no significant difference in the changes of PEF and FEV1 between the two groups (P0.05), but the mean value of the treatment group was higher than that of the control group; the comparison of the treatment group was higher than that of the control group. The total effective power decreased significantly (P0.05) and the C-ACT score in the treatment group was significantly higher than that of the control group (P0.05). Overall analysis, the treatment group was significantly more effective in controlling the chronic duration of asthma in children than the control group. The recurrent symptoms of the symptoms significantly reduced the acute attack period of the.3. asthma, the respiratory sound intensity and the total effective work in the chronic duration. The rate of respiratory audio spectrum in children with acute asthma was significantly higher than that of normal children (P0.05). The respiratory audio spectrum in the chronic duration of asthma was compared with that of normal children, and the sound intensity was higher only in some specific frequency segments (P0.05). Conclusion: 1. asthma can relieve asthma. The symptoms of acute attack, improvement of pulmonary ventilation, the effect of treatment for acute attack of asthma in children is significant.2. for children with chronic asthma. The treatment of asthma in chronic persistent asthmatic children can effectively control symptoms, prevent recurrence, reduce airway resistance, improve pulmonary ventilation, and improve the effect of chronic asthma in children. Through training, parents can master asthma. The operation of friction and press is involved in the treatment of children, reducing the burden of children's asthma to the family and society.3. through the comparison and analysis of the respiratory sound signals of children and normal children in the acute period of asthma, the children with chronic duration and the normal children. It is found that the respiratory audio spectrum analysis can reflect the slight changes in the lungs, and the respiratory audio spectrum analysis is more sensitive. The objective examination index.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R272

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