83例中重度慢性持续期支气管哮喘患者临床治疗观察

发布时间：2018-04-15 05:06

  本文选题：哮喘 + 信必可都保　； 参考：《郑州大学》2017年硕士论文

【摘要】：哮喘是一种以不同程度气道痉挛、气道高反应性、粘液分泌和慢性炎症为特征的异质性疾病。这种慢性炎症与气道高反应性相关,通常出现广泛多变的可逆性气流受限,并引起反复发作的喘息、气急、胸闷或者咳嗽等症状,通常在夜间或者清晨发作或加剧,多数患者可以自行缓解,或者是经过治疗缓解。哮喘在世界范围内影响约3亿人口,每年死亡人数更是高达25万[1]。而当哮喘得到有效控制后,多数患者很少出现哮喘急性发作,严重哮喘发作更是少见。全球哮喘负担数据表明,尽管控制哮喘的花费似乎稍高,但是不规范的治疗可以导致哮喘反复发作,治疗费用会更高。2016年版的全球哮喘防治倡议(Global initiative for asthma,GINA),推荐吸入糖皮质激素/长效β2受体激动剂(Inhaled corticosteroids/long-actingβ2-agonists,ICS/LABA)复合制剂用于中至重度持续哮喘患者的长期治疗[2],吸入糖皮质激素(Inhaled corticosteroids,ICS)和长效β2受体激动剂(long-actingβ2-agonists,LABA)具有协同作用,抗炎平喘作用大大加强,相当于获得加倍剂量的ICS的疗效,并且可以增加患者的依从性,同时减少大剂量ICS的不良反应,而且低剂量的布地奈德/福莫特罗还可以作为哮喘发作时的缓解使用药物[3]。目前在我国临床上经常应用的复合制剂有各种不同规格的布地奈德/福莫特罗干粉吸入剂、氟替卡松/沙美特罗干粉吸入剂以及倍氯米松/福莫特罗气雾剂。白三烯调节剂(leukotriene receptor antagonists,LTRA),包括半胱氨酰白三烯调节剂和5-脂氧合酶抑制剂,是除了ICS之外,唯一可以单独应用的长效控制性药物,它既可以作为轻度哮喘的替代治疗药物,也可以作为中重度哮喘的联合用药[4]。目前在我国国内主要应用的是半胱氨酰白三烯受体拮抗剂。ltra可以减轻哮喘症状、改善肺功能、延缓并减少哮喘的恶化,但是其抗炎作用并不如ics[5]。抗胆碱药物:主要是吸入性抗胆碱药物,如短效的抗胆碱药物(short-actinganticholinergics,sama)异丙托溴铵和长效的抗胆碱药物(long-actinganticholinergics,lama)噻托溴铵,具有一定的支气管舒张作用,但是较β2-受体激动剂而言,作用稍弱,起效时间也较慢[5]。短效的抗胆碱药物可以通过气雾剂和雾化溶液给药,而长效的抗胆碱药物则主要通过干粉剂和软雾剂给药。抗胆碱药物与β2-受体激动剂联合应用具有互补作用[6]。但是妊娠早期妇女、青光眼患者以及前列腺肥大患者要慎用此类药物。对于中重度慢性持续性哮喘,联合用药受到了越来越多的重视,并且在临床上取得了理想的疗效。在一些国家,甚至已经将联合用药纳入一线治疗方案里。本研究遵循平行、对照、开放的原则,观察使用布地奈德/福莫特罗联合孟鲁司特钠与布地奈德/福莫特罗联合噻托溴铵和单纯吸入布地奈德/福模特罗1个月和3个月对慢性持续性哮喘的临床疗效,为中重度慢性持续性哮喘的治疗提供新思路。目的评价信必可都保联合孟鲁司特钠与信必可都保联合噻托溴铵及单纯吸入信必可都保治疗中重度哮喘的临床疗效方法本研究选取2015年3月到2016年3月来郑州大学第一附属医院就诊的哮喘患者,符合纳入标准者83例,分为a、b、c三组,a组28例给予信必可都保联合孟鲁司特钠治疗,b组28例给予信必可都保联合噻托溴铵治疗,c组27例给予信必可都保单药治疗,治疗3个月,观察患者治疗前,治疗后1个月和3个月哮喘控制问卷改善状况、肺功能变化及血液中嗜酸粒细胞变化状况。结果1.三组患者治疗前性别、年龄、病程、fev1及pef等指标组间分布情况基本一致,差异无统计学意义(P0.05)。2.三种治疗方案在治疗1月及3月后均较治疗前在哮喘控制水平上显著改善(P0.05),A、B、C三组间比较差异无统计学意义(P0.05)。3.三种治疗方案在治疗1月及3月后均较治疗前在肺功能指标FEV1%pred上显著改善(P0.05),且A、B两组间差异无统计学意义(P0.05),A、C两组间差异有统计学意义(P0.05),B、C两组间差异有统计学意义(P0.05)。4.A、B、C三组治疗后1月外周静脉血中嗜酸性粒细胞(Eos)计数与治疗前相比,差异无统计学意义(P0.05),治疗3月后与治疗前相比,差异有统计学意义(P0.05),A、B、C三组间比较差异无统计学意义(P0.05)。结论1.信必可都保联合孟鲁司特和信必可都保联合噻托溴铵较单纯吸入信必可都保短期内在哮喘控制和改善肺功能方面都有更好的效果。2.信必可都保联合孟鲁司特和信必可都保联合噻托溴铵在短期内临床疗效相当。
[Abstract]:Asthma is a heterogeneous disease characterized by varying degrees of airway spasm , airway hyperresponsiveness , mucus secretion , and chronic inflammation . This chronic inflammation is associated with airway hyperresponsiveness , usually with a wide variety of reversible airflow limitations , and causes recurrent episodes of asthma , shortness of breath , chest distress , or cough , often at night or early in the morning , with most patients being able to respond spontaneously or by treatment . Asthma affects about 300 million people worldwide , with an annual toll of 250,000 . Global asthma burden data indicate that although the cost of controlling asthma seems to be slightly higher , the global asthma burden data suggests that although the cost of controlling asthma seems to be slightly higher , the treatment costs may be higher . The 2016 version of Global Asthma for asthma , GINA , recommends inhaled corticosteroids / long - acting 尾2 - agonists ( ICS / LABA ) complex formulations for moderate to severe persistent asthma , and increases patient compliance while reducing the adverse effects of large doses of ICS , and the low dose of Buchenne / Formoterol can also be used as a relief drug for asthma attacks . In addition to the ICS , a long - acting control drug which can be used alone can be used as an alternative treatment drug for mild asthma , but also can be used as a combined drug for moderate and severe asthma . At present , it is mainly used in our country , which can reduce the symptoms of asthma , improve pulmonary function , delay and reduce the deterioration of asthma , but its anti - inflammatory effect is not inferior to that of ics . Anti - cholinergic drugs : mainly inhaled anti - cholinergic drugs , such as short - acting anticholinermis ( s ) and long - acting anti - cholinergic drugs ( long - actinganticholinertly , ibuprofen ) tiotropium bromide , have a certain bronchorelaxation effect , but the effect is slightly weaker than the beta2 - receptor agonists , and the onset time is also slower . Short - acting anti - cholinergic drugs can be administered by aerosol and atomized solutions , while long - acting anticholinertiagents are administered primarily through dry powder and soft - fog agents . The combination of anti - cholinergic drugs with 尾2 - receptor agonists has a complementary action . In the treatment of moderate and severe chronic persistent asthma , there was no significant difference between the two groups ( P0.05 ) .

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25
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本文编号：1752628