日常监测呼气峰流速对哮喘病情控制水平的影响及降低哮喘急性发作的风险

发布时间：2018-08-24 18:01

【摘要】：目的：支气管哮喘（简称哮喘）是一种气道慢性炎症性疾病，其发病率和病死率均呈逐年上升趋势，目前已经成为全球日益关注的公共卫生问题。然而，当前全球哮喘控制现状并不容乐观。如何更好地控制哮喘及降低哮喘发作风险？2009年GINA指南（全球哮喘防治创议，Global Initiative for Asthma)提出哮喘治疗的目标是达到并维持哮喘控制。呼气峰流速（Peak expiratory flow，简称PEF）作为客观的肺功能简易指标，及其变异率（Peak expiratory flow rate，简称PEFR）均是临床上用来评估与监测哮喘控制水平的重要指标，，并指导哮喘治疗方案的调整。本研究目的是探讨日常监测PEF对哮喘病情控制水平的影响及降低哮喘急性发作的风险。方法：选取2010年11月至2011年5月在大连医科大学附属第一医院住院及哮喘门诊就诊的21例哮喘患者，规范化治疗1年以上，男性10例（47.62%），女性11例（52.38%），平均年龄（36.38±10.21）岁，平均病程（9.67±5.35）年，接受面对面问卷调查，并日常监测PEF一年，如实填写哮喘日记、哮喘控制测试（ACT）评分。将监测PEF前后各1年哮喘控制水平、哮喘急性发作次数、因哮喘急性加重住院、到急诊就诊及误工情况进行比较，PEF测定结果与ACT测试结果进行比较，并评价哮喘未来发作的风险。结果：监测PEF一年后达到GINA指南完全控制和部分控制的患者比例分别为47.62%和33.33%,显著高于监测PEF前状况(P＜0.05)。监测PEF一年中因哮喘急性加重住院、看急诊及误工率分别为9.52%、14.29%、19.05%，显著低于监测PEF前状况(P＜0.05)。绿区组的ACT分值显著高于红区组，黄区组ACT分值也显著高于红区组（P＜0.05）；绿区组的ACT分值与黄区组比较无显著差异（P=0.221）。部分控制组的PEF%pred明显高于未控制组(P＜0.05),部分控制组监测PEF1年中哮喘急性发作次数明显低于未控制组(P＜0.05)。结论：1.日常监测PEF可以有效提高哮喘患者的病情控制水平。 2.在ACT问卷的同时动态监测PEF，有助于更加准确地反映哮喘患者真实的病情情况。 3.日常监测PEF可以降低哮喘未来急性发作的风险。
[Abstract]:Objective: bronchial asthma (Asthma) is a chronic inflammatory disease of airway. Its morbidity and mortality are increasing year by year. However, the current global asthma control situation is not optimistic. How to better Control Asthma and reduce the risk of Asthma attack? the 2009 GINA guidelines (Global Initiative for Asthma) for Asthma Prevention and treatment set out the goal of asthma treatment to achieve and maintain asthma control). Peak expiratory flow rate (PEF) is an objective simple index of pulmonary function and its variation rate (Peak expiratory flow rate, (PEFR) is an important index to evaluate and monitor asthma control level in clinic and guide the adjustment of asthma treatment plan. The aim of this study was to investigate the effect of routine monitoring of PEF on asthma control and to reduce the risk of acute asthma attack. Methods: from November 2010 to May 2011, 21 asthmatic patients, 10 males (47.62%) and 11 females (52.38%), were enrolled in the first affiliated Hospital of Dalian Medical University. The average age was (36.38 卤10.21) years. The average course of disease was (9.67 卤5.35) years. Face to face questionnaire was conducted, PEF was monitored daily for one year, asthma diary was filled out truthfully, and (ACT) score of asthma control test was measured. The control level of asthma before and after PEF, the frequency of acute asthma attack, the hospitalization for acute exacerbation of asthma, the emergency visit and the delayed work were compared. The results were compared with the results of ACT test. The risk of future asthma attack was evaluated. Results: the percentage of patients who achieved complete and partial control of GINA after one year of monitoring PEF was 47.62% and 33.33% respectively, which was significantly higher than that before monitoring PEF (P < 0. 05). The acute exacerbation of asthma in monitoring PEF in one year, the emergency treatment rate and delayed work rate were 9.52, 14.29 and 19.05, respectively, which were significantly lower than those before monitoring PEF (P < 0. 05). The ACT score of the green area group was significantly higher than that of the red area group, and the ACT score of the yellow area group was significantly higher than that of the red area group (P < 0. 05), but the ACT score of the green area group was not significantly different from that of the yellow area group (P0. 221). The PEF%pred of partial control group was significantly higher than that of uncontrolled group (P < 0. 05), and that of partial control group was significantly lower than that of uncontrolled group (P < 0. 05). Conclusion 1. Daily monitoring of PEF can effectively improve the disease control level of asthmatic patients. 2. 2. Dynamic monitoring of PEF, at the same time as ACT questionnaire can more accurately reflect the true condition of asthmatic patients. Routine monitoring of PEF can reduce the risk of future acute asthma attacks.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R562.25

【共引文献】