矿难患者肺功能评估及其影响因素研究

发布时间：2018-05-17 19:02

本文选题：肺功能检测 + 饥饿　；参考：《山西医科大学》2013年硕士论文

【摘要】：目的回顾性研究“3.28”王家岭透水事故获救工人肺通气功能及小气道功能检查结果,分析影响肺功能的因素及其与血清电解质变化的关系,探讨饥饿状态下肺功能改变的机制及饥饿后再进食补充电解质作用。方法入选46例“3.28”王家岭矿山透水事件的获救工人为实验组,51例健康体检者为对照组,两组年龄、性别、身高、体重均匹配。收集所有患者入院1-3天的静脉血液样本,进行电解质、胆红素、尿酸、前蛋白浓度、C反应蛋白、纤维蛋原等指标的测定。所有患者在入院后第6-8天行肺功能检查,采用实测值占预测值百分比来表示结果。采用SPSS16.0统计学软件建立数据库,将上述研究指标录入数据库并进行统计学分析：①对实验组和对照组肺功能检测结果进行比较。②小气道功能改变的影响因素分析：因变量为实验组小气道功能,自变量为吸烟史、电解质、上呼吸道感染、血尿酸、血胆红素、前白蛋白、C反应蛋白、纤维蛋白原。③相关性分析：分析血清电解质与小气道功能的相关性。结果 1.两组肺功能检测结果肺功能检测结果中,实验组肺功能各项指标与对照组相比均降低。其中FVC、FEV1、FEV1/FVC值低于对照组(t=2.903,2.401,3.325,均P0.05),PEF、FEF25值显著低于对照组(t=8.692,9.912,均P0.001),差异有统计学意义。小气道功能检测结果中,实验组与对照组相比,小气道功能FEF50、FEF75、MMEF明显低于对照组(t=7.529,t=7.181,t=7.707,均P0.001),差异有统计学意义。FEF50与FEF75异常率较高,小气道功能异常29(46)例,两组间异常率差异有统计学意义。 2.影响因素本研究调查了8个影响因素,共有5个因素进入回归方程：吸烟史、电解质紊乱、上呼吸道感染为危险因素。排除其他因素的混杂作用外,危险性分别增加19.844、14.861、28.925倍。高尿酸血症,高胆红素血症为保护因素。排除其他因素的混杂作用外,危险性分别是对照组的6.2%与2.3%。 3.血清电解质与小气道功能变化的相关性血清钾、钠、钙的浓度与小气道功能的变化无相关性；血清磷、镁浓度的变化分别与FEF50、FEF75有线性回归关系,由标准化回归系数可以看出,镁对FEF50、FEF75的影响最大(r=0.887,r=0.879,均p0.001)。结论 1.饥饿、脱水状态可影响肺通气功能,以小气道功能降低较为明显,FEF50与FEF75是判断小气道功能的敏感指标。 2.电解质紊乱及上呼吸道感染是引起小气道病变的危险因素。 3.合理补充电解质,特别是血清磷、镁对饥饿所致肺功能紊乱有重要的临床意义。 4.饥饿、脱水状态下血清胆红素及尿酸升高可能是机体的一种保护性适应反应。
[Abstract]:Purpose The pulmonary ventilation function and small airway function of the workers rescued from the "3.28" Wangjialing water permeation accident were studied retrospectively. The factors affecting the pulmonary function and the relationship between the pulmonary function and the changes of serum electrolytes were analyzed. To investigate the mechanism of lung function change in starvation and the role of supplementation of electrolytes after starvation. Method A total of 46 rescued workers in Wangjialing mine were selected as control group. The two groups were matched in age, sex, height and weight. Venous blood samples of all patients were collected for the determination of electrolyte, bilirubin, uric acid, proprotein concentration, C-reactive protein and fibrinogen. Lung function tests were performed on the 6-8 th day after admission, and the results were expressed as a percentage of the predicted values. SPSS16.0 statistical software was used to establish the database. The results of lung function test in experimental group and control group were compared with that of control group. 2 factors influencing the change of small airway function were analyzed: dependent variable was small airway function in experimental group. The independent variables were smoking history, electrolyte, upper respiratory tract infection, serum uric acid, serum bilirubin, prealbumin C-reactive protein and fibrinogen. 3. The correlation between serum electrolyte and small airway function was analyzed. Result 1. Compared with the control group, the indexes of pulmonary function in the experimental group were lower than those in the control group. The FVC value of FEV1 / FEV1 / FVC was lower than that of the control group (2.903 / 2.401 / 3.325), and the FEF25 value was significantly lower than that of the control group (P0.05, P = 8.692or 9.912, respectively), and the difference was statistically significant. In the small airway function test results, compared with the control group, the MMEF of small airway function FEF50 / FEF75 was significantly lower in the experimental group than that in the control group (P 0.001), and the difference was statistically significant. The abnormal rate of FEF50 and FEF75 was higher in the experimental group than that in the control group. The small airway function was abnormal in 2946 cases. There was significant difference in abnormal rate between the two groups. 2. In this study, 8 influential factors were investigated. Five factors entered the regression equation: smoking history, electrolyte disturbance, upper respiratory tract infection as risk factors. Excluding the mixed effects of other factors, the risk increased by 19.844 ~ 14.861U 28.925 times, respectively. Hyperuricemia and hyperbilirubinemia were protective factors. Excluding the mixed effect of other factors, the risk was 6.2% and 2.3% of the control group, respectively. 3. Correlation between serum electrolytes and small airway function concentration of serum potassium, sodium and calcium have no correlation with changes of small airway function, serum phosphorus and magnesium concentrations have linear regression relationship with FEF50 and FEF75, which can be seen from the standardized regression coefficient. The effect of magnesium on FEF50 and FEF75 was the most significant (P 0.001). Conclusion 1. Starvation and dehydration can affect pulmonary ventilation function. FEF50 and FEF75 are sensitive indexes to judge small airway function. 2. Electrolyte disturbance and upper respiratory tract infection are risk factors for small airway disease. 3. The reasonable supplement of electrolytes, especially serum phosphorus and magnesium, has important clinical significance for the lung dysfunction caused by starvation. 4. Elevated serum bilirubin and uric acid may be a protective adaptive response to starvation and dehydration.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563

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