肝素辅助布地奈德福莫特罗联合呼吸康复训练治疗慢性阻塞性肺疾病的效果分析

发布时间：2018-03-17 11:40

本文选题：低分子肝素　切入点：布地奈德福莫特罗　出处：《新乡医学院》2017年硕士论文　论文类型：学位论文

【摘要】：背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease简称COPD)是呼吸系统常见的一种慢性气道炎症反应性疾病,近年来,COPD发病率逐年增加,其病死率和致残率均较高,严重影响患者生活质量,主要临床表现为肺功能下降,呼吸困难,机体运动耐力差。主要治疗目的为消除气道炎症、改善呼吸困难等临床症状、改善肺气体交换,延缓疾病进展。呼吸康复训练可以增加机体有氧代谢能力,提高运动耐力,进而改善患者肺功能和血气指标,提高生活质量。目的本研究旨在探讨肝素辅助布地奈德福莫特罗联合呼吸康复训练治疗COPD的临床效果,分析其对患者肺功能、血气指标、凝血功能、血流变指标及炎性因子的影响。方法选取COPD患者164例,根据治疗方法不同分为对照组(n=50)、治疗组(n=55)和康复组(n=59)。3组患者均给予常规综合治疗,其中:(1)对照组:仅给予常规治疗。(2)治疗组:在常规治疗的基础上给予布地奈德福莫特罗吸入联合小剂量低分子肝素治疗。(3)康复组:在治疗组基础上增加呼吸康复训练。(4)观察及分析指标:(1)比较3组治疗后临床疗效;(2)比较3组患者治疗前后BODE指数(body mass index,airflow obstruction,dyspnea,and exercise capacity index)评分、改良医学研究会呼吸困难指数(mMRC)评分、变化的呼吸困难指数(TDI)评分;(3)比较3组患者治疗前后肺功能、血气指标、凝血功能、血流变指标、炎性因子指标;(4)比较3组患者治疗前后治疗前后运动耐力和生活质量。结果(1)治疗后康复组总有效率治疗组对照组,3组间总有效率比较差异显著(P0.01)。(2)治疗后BODE总分康复组治疗组对照组(P0.01),治疗后mMRC评分康复组治疗组对照组(P0.01),治疗后TDI总分康复组治疗组对照组(P0.01)。(3)治疗后各组肺功能、血气指标、凝血功能、炎性因子指标均有改善,且改善程度康复组治疗组对照组(P0.01)。治疗后对照组各项血流变指标均无明显变化(P0.05),治疗组和康复组各项血流变指标均明显降低(P0.05或P0.01),且3组间差异显著(P0.05或P0.01)。(4)治疗后3组患者6 MWD康复组治疗组对照组(P0.01),治疗后SQRG总分康复组治疗组对照组(P0.01)。结论小剂量低分子肝素辅助布地奈德福莫特罗吸入治疗COPD,辅以适当的呼吸康复训练可以明显提高临床有效率,改善患者呼吸困难等临床症状,降低COPD患者血清炎性因子,减轻气道炎症反应,改善患者肺功能,增强呼吸肌肌力和运动耐力,提高生活质量,且还可以改善COPD患者凝血功能,血气指标,有效预防静脉血栓栓塞的发生。
[Abstract]:Background chronic obstructive pulmonary disease is a common chronic airway inflammatory disease in respiratory system. In recent years, the incidence of chronic obstructive pulmonary disease (COPD) is increasing year by year, and its mortality and disability rate are both high, which seriously affects the quality of life of patients. The main clinical manifestations are decreased lung function, dyspnea and poor exercise endurance. The main purpose of treatment is to eliminate airway inflammation, improve respiratory difficulties and other clinical symptoms, and improve lung gas exchange. Respiratory rehabilitation training can increase aerobic metabolism, improve exercise endurance, and then improve patients' lung function and blood gas index. Objective to investigate the clinical effect of heparin assisted with budesonide formoterol combined with respiratory rehabilitation training in the treatment of COPD, and to analyze the effects of heparin on pulmonary function, blood gas index and coagulation function. Methods 164 patients with COPD were divided into two groups: control group (n = 55) and rehabilitation group (n = 59.3). Control group: routine treatment. 2) treatment group: budesonide formoterol inhalation combined with low dose low molecular weight heparin therapy. 3) rehabilitation group: increase respiratory rehabilitation on the basis of treatment group. Exercise 4) observing and analyzing index: 1) comparing the clinical curative effect after treatment in three groups (2) comparing the BODE index and exercise capacity index before and after treatment in the three groups, and comparing the scores of exercise capacity and BODE index before and after treatment. The mMRC score and the TDII score of dyspnea index were compared between the three groups before and after treatment, such as lung function, blood gas index, coagulation function, hemorheological index. Results the total effective rate of rehabilitation group before and after treatment was significantly different from that of control group. The total effective rate of treatment group was significantly higher than that of control group (P < 0.01) and the total score of BODE after treatment was higher than that of control group (P < 0.05). In the rehabilitation group, the control group was treated with P0.01A, the mMRC score after the treatment, the control group with P0.01A, the TDI total score with the control group, the control group, the control group, and the pulmonary function after the treatment. Blood gas index, coagulation function, inflammatory factor index were all improved. After treatment, there was no significant change in the hemorheological indexes of the control group, but the hemorheological indexes in the treatment group and the rehabilitation group were significantly decreased by P0.05 or P0.01A, and the difference among the three groups was significant (P0.05 or P0.01U. 4). The patients in the last 3 groups were treated with P0.01C for 6 MWD rehabilitation group and the control group with SQRG total score after treatment. Conclusion low dose low molecular weight heparin and inhaled budesonide formoterol can be used to treat the patients with proper respiratory rehabilitation training. In order to significantly improve the clinical effective rate, It can improve the clinical symptoms, such as dyspnea, reduce serum inflammatory factors, alleviate airway inflammation, improve pulmonary function, enhance respiratory muscle strength and exercise endurance, improve quality of life, and also improve coagulation function of COPD patients. Blood gas index can effectively prevent the occurrence of venous thromboembolism.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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