影响婴幼儿喘息预后相关因素的回顾性分析

发布时间：2018-09-07 20:51

【摘要】：目的：总结现代医学及中医对婴幼儿喘息的研究现状,通过回顾性分析导师门诊婴幼儿喘息患儿病例,研究婴幼儿喘息患儿痊愈或缓解的年龄分布,分析痊愈及缓解集中年龄段的中西医症状特点及规律,探讨运用中医临床表现结合哮喘预测指数预测婴幼儿喘息预后转归的可行性,为婴幼儿喘息的临床治疗提供一定理论支撑。方法：分为理论研究和临床研究两部分。理论研究部分：对目前中西医关于婴幼儿喘息的研究进行归纳总结,提出婴幼儿喘息研究的问题,为临床研究提供基础。临床研究部分：采用回顾性分析方法,根据导师门诊收集的婴幼儿喘息病例进行临床资料收集并判定每例病例哮喘预测指数,记录其喘息控制的主要措施、中医临床症状、治疗方法、危险因素等,通过电话回访方式,记录目前控制情况(如已治愈,则记录其治愈年龄)等,将上述信息输入计算机,使用统计软件统计其痊愈各年龄段的分布情况,分析哮喘预测指数的准确度、治疗干预对喘息的影响,研究痊愈集中年龄段的病情特点、中医证型分布等,得出结论。结果： (1)痊愈年龄主要集中在3岁左右、6-8岁、11-14岁年龄段； (2)503例哮喘预测指数阴性患儿中,痊愈患儿356例,占70.77%；147例在14岁后仍有哮喘症状,占29.22%；329例哮喘预测指数阳性患儿中298例发展为哮喘,占90.58%；痊愈患儿31例,占9.42%。说明哮喘预测指数的准确性较高。 (3)中医症状及疾病史与婴幼儿喘息预后的相关性分析：经R×C表卡方检验,首次喘息后年喘息次数、哮喘家族史、吸入过敏史、反复呼吸道感染史、喘嗽、痰液、汗出、面色、饮食、大便、小便这几个方面的P值均小于0.05,有统计学意义。说明中医症状及疾病史在痊愈集中年龄段分布存在差异,根据中医症状及疾病史预测婴幼儿喘息的预后有一定的可行性,值得进一步研究。 (4)中医证型：在y≤3岁年龄段中医证型分布以肺脾气虚证为主。在6岁≤y8岁年龄段肺脾气虚证和脾肾阳虚证例数较多,占总例数的37.61%和35.78%,肺肾阴虚证相对较少,占总例数的26.61%。在11岁y≤14岁年龄段中,脾肾阳虚例数较多,占总例数的38.28%,肺脾气虚和肺肾阴虚相对例数较少,分别占总例数的28.13%和33.59%。说明三个痊愈集中年龄段中中医证型分布有区别,根据中医证型预测婴幼儿喘息患儿预后有一定的可行性。 (5)中医、中西医结合及西医三种治疗方法对婴幼儿喘息痊愈影响分析,经卡方检验,P0.05,有统计学意义。三种治疗方法之间两两比较,除中医治疗与中西医结合治疗比较外,P均0.05,有统计学意义。是否长期规范治疗对婴幼儿喘息痊愈的影响,经卡方检验,P0.05,无统计学意义。说明中医治疗及中西医结合治疗在婴幼儿喘息痊愈方面要优于单纯西医治疗,是否长期规范治疗不能影响婴幼儿喘息的痊愈。 (6)未愈患儿喘息控制的主要相关因素及措施是及时对症治疗、避免感冒,分别占96.18%和90.11%；说明及时对症治疗及避免感冒有助于喘息的控制。 (7)中医、中西医结合及西医治疗三种治疗手段在病情控制上,经Ridit分析,95%置信区间有重叠,说明三种治疗手段均可控制喘息发作,但控制程度差别不明显。长期规范治疗与未长期规范治疗对病情控制上,经Ridit分析,95%置信区间无重叠,尚可认为是否规范治疗在病程控制情况上不同,说明长期规范治疗有利于病情的控制。结论： (1)婴幼儿喘息患儿的痊愈与年龄存在相关性,主要集中在3岁、7岁、13岁左右； (2)哮喘预测指数具有较高的准确率,对婴幼儿喘息的预后有指导意义； (3)根据中医临床症状和证型结合哮喘预测指数预测婴幼儿喘息患儿预后有一定的可行性,能为指导中西医结合的临床治疗提供参考,值得进一步研究。 (4)及时的中医、中西医结合及西医治疗对病情控制均有较好的疗效,坚持长期规范治疗优于未长期规范治疗,说明及时的对症治疗和坚持长期规范治疗对哮喘患儿是非常必要的。
[Abstract]:Objective: To summarize the research status of modern medicine and traditional Chinese medicine on infantile wheezing, retrospectively analyze the cases of infantile wheezing in tutor's clinic, study the age distribution of recovery or remission of infantile wheezing, analyze the characteristics and regularity of traditional Chinese and Western Medicine symptoms in the period of recovery and remission, and explore the application of clinical manifestations of traditional Chinese medicine combined with asthma. The feasibility of asthma prediction index in predicting the prognosis of infantile asthma provides theoretical support for the clinical treatment of infantile asthma.
Methods: It is divided into two parts: theoretical research and clinical research. Theoretical research part: Summarize and summarize the current research on infantile asthma in Chinese and Western medicine, put forward the problem of infantile asthma research, and provide the basis for clinical research. Clinical data were collected to determine the predictive index of asthma in each case. The main measures of asthma control, clinical symptoms, treatment methods and risk factors of TCM were recorded. The current control situation (if cured, the age of cure) was recorded by telephone return visit. The above information was input into the computer and statistically analyzed by statistical software. Distribution of different age groups, analysis of the accuracy of asthma prediction index, treatment intervention on the impact of asthma, study of the characteristics of the disease in the age group, distribution of TCM syndromes, etc., draw conclusions.
Result:
(1) the age of recovery is mainly in the age of 3, 6-8 and 11-14.
(2) Among 503 children with negative predictive index of asthma, 356 (70.77%) were cured, 147 (29.22%) still had asthma symptoms after 14 years old, 298 (90.58%) of 329 children with positive predictive index of asthma developed asthma, and 31 (9.42%) were cured.
(3) Correlation analysis between symptoms and disease history of TCM and prognosis of wheezing in infants and young children: the number of wheezes in the first year after wheezing, family history of asthma, history of inhalation allergy, history of recurrent respiratory tract infection, wheezing, sputum, sweating, complexion, diet, stool, urination, P values of these aspects are less than 0.05, with statistical significance. The distribution of symptoms and disease history is different in the age group with concentrated recovery. It is feasible to predict the prognosis of infantile wheezing according to the symptoms and disease history of traditional Chinese medicine.
(4) TCM syndromes: lung-spleen-qi deficiency syndrome was the main type of TCM syndromes in the age of Y < 3 years old. There were more cases of lung-spleen-qi deficiency syndrome and spleen-kidney Yang deficiency syndrome in the age of 6 < y 8 years old, accounting for 37.61% and 35.78% of the total cases, while lung-kidney Yin deficiency syndrome was relatively small, accounting for 26.61% of the total cases. 38.28%. The relative cases of deficiency of lung-spleen-qi and deficiency of lung-kidney-yin were less, accounting for 28.13% and 33.59% of the total cases respectively.
(5) Chinese medicine, integrated traditional Chinese and Western medicine and Western medicine three treatment methods of infant asthma healing effect analysis, chi-square test, P 0.05, there is statistical significance. Chi-square test, P 0.05, no statistical significance, indicating that the treatment of traditional Chinese medicine and integrated Chinese and Western medicine in infants and young children with asthma healing is superior to western medicine alone, whether long-term standardized treatment can not affect the recovery of infants and young children with asthma.
(6) Timely symptomatic treatment and avoidance of colds accounted for 96.18% and 90.11% respectively, indicating that timely symptomatic treatment and avoidance of colds contributed to the control of wheezing.
(7) By Ridit analysis, 95% confidence intervals overlap among the three treatments, indicating that the three treatments can control wheezing attacks, but the degree of control is not significantly different. It can be considered whether the standard treatment is different in the course of disease control, indicating that long-term standardized treatment is conducive to disease control.
Conclusion:
(1) the recovery of infants with wheezing is related to age, mainly in 3, 7 and 13 years old.
(2) the asthma predictive index has a high accuracy rate, which is of guiding significance for the prognosis of wheezing in infants.
(3) It is feasible to predict the prognosis of infantile wheezing patients according to the clinical symptoms and syndromes of TCM combined with asthma prediction index, which can provide a reference for guiding the clinical treatment of integrated Chinese and Western medicine and is worthy of further study.
(4) Timely traditional Chinese medicine, integrated traditional Chinese and Western medicine and Western medicine have a good effect on the condition control. Persisting in long-term standardized treatment is better than non-long-term standardized treatment. It shows that timely symptomatic treatment and long-term standardized treatment are very necessary for children with asthma.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R272

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