冠心病合并COPD的治疗及预后分析

发布时间：2018-05-09 15:28

本文选题：冠心病 + COPD　；参考：《郑州大学》2017年硕士论文

【摘要】：研究背景现如今,随着人们摄入高盐高脂等食物的增多,工作压力的增大,生活方式的不规律,使得患有高血压、糖尿病、肥胖等疾病的人越来越多,在加上吸烟、酗酒等不良习惯,共同导致了患冠心病(冠状动脉硬化型心脏病)的人也在逐年增加。同时环境污染严重,汽车尾气、雾霾、吸烟等因素严重影响人们呼吸道健康,造成患慢性阻塞性肺疾病(COPD)的人数增多。而且我国是人口大国,正处于人口老龄化阶段,高龄是患冠心病和COPD的又一个原因。因此临床上患有冠心病合并COPD的病人也越来越多。COPD的慢性缺氧可加快冠心病的发展进程,冠心病的患者由于冠脉长期处于缺血状态,容易出现心力衰竭,可阻碍COPD患者的肺循环,促进肺动脉高压的形成。二者相互影响,相互加重。研究目的探讨冠心病合并COPD患者的临床特点和预后。研究方法选取2015年1月到2015年11月,在我院(夏邑县人民医院)收入院治疗的冠心病合并COPD患者89人,作为研究资料,其中,男性患者54例,女性患者35例,年龄区间为61-89岁,平均年龄为(74. 51 ±2. 22)岁,住院治疗时间为14-21天,平均住院治疗时间(17. 21±3. 11)天,其中,合并肥胖症的病人35例,合并糖尿病的病人29例,合并高血压的病人25例,合并有急性心肌梗死的病人16例,患有频发早博的病人39例,患有陈旧性心肌梗死的病人34例,经心脏彩超检查,左心室扩大的病人36例,右心室扩大的病人32例,全心扩大的病人12例,心肌酶明显增高的病人19例。病例的纳入标准:(1)所有入选的患者,他们的临床症状和检查结果都符合《缺血性心脏病的命名和诊断标准》与《慢性阻塞性疾病诊治指南》的相关诊断标准;(2)患有典型与不典型的发作心绞痛史,经服用药物硝酸甘油片治疗后显示有效的患者;(3)心电图显示:各个导联出现缺血型的ST-T段的改变,并且在发病时与不发病时有明显的改变,未因COPD发作期的治疗而消除病状;(4)发生的持续性、频发性的室性期前收缩,未在发作期的治疗后,消除病状;(5)经过X线的检查,存在有左室的增大、全心的增大,排除风湿性的心脏病、心肌病、高血压性的心脏病导致的;(6)所有的患者均是自愿参与的本次研究,同时在参与的治疗研究前,签署了知情同意书。患者入院后立即给予他们氧气吸入、抗菌药物、解痉、平喘、化痰及常规的水电解质之间平衡治疗,同时给予他们扩冠、抗凝、抗血小板聚集、降压、降糖、利尿、营养心肌等一般治疗,必要时使用溶栓、急诊PCI等治疗。观察的指标:对两组的患者进行治疗前后所做的用力肺活量(FVC)、第一秒的用力呼气容积(FEV1)、FEV1所占预计值的百分比(FEV1%)、6钟的步行距离(6MWD)、症状的改善、心电图的变化等能进行的对比分析。疗效判定标准:显效:经过治疗后,患者心率的变化范围在每分钟60 - 90次,静息时的心电图显示为正常或无动态改变,患者的步行距离增加500m以上;有效:经过治疗后,患者心率出现的变化范围在每分钟90 - 110次,偶尔有发生过心脏早搏,心电图的ST段下移在0.02mv以内,患者的步行距离增加500m以内;无效:经治疗后,患者的临床症状、疾病体征及影像学检查结果均无明显变化,甚至治疗无效死亡。统计学方法本研究所有数据均采用SPSS13.0统计软件进行数据统计,计量资料用(x±s)进行表示,采用配对T检验;计数资料用%表示,采用X2检验,P0. 05表示差异具有统计学意义。结果对所有的患者进行的临床治疗显示的有效率来分析:这其中的89例患者(冠心病合并COPD),通过综合治疗,显效的病人有53例,所占比例是59.55%,有效的病人有35例,所占比例是39.33%,无效的病人有1例,所占比例是1.12%,临床上治疗的有效率是98. 88%。结论冠心病及COPD是临床上非常常见的疾病和多发的疾病,在进行抗感染、平喘和祛痰基础之上增加氧疗、纠正水电解质的紊乱、抗凝、抗血小板的聚集、降脂、扩张血管、戒烟、限酒、生活规律、提高运动量等综合的规范化的治疗,能明显提升冠心病合并COPD的患者在生存质量和肺功能方面的指标。
[Abstract]:Research background now, with the increase of high salt and high fat food, the increase of work stress and irregular lifestyle, more and more people with high blood pressure, diabetes, obesity and other diseases have been added to the habit of smoking and drinking and other bad habits, and the people with coronary artery disease (coronary artery disease) are also coming from year by year. At the same time, environmental pollution is serious, automobile exhaust, smog, smoking and other factors seriously affect people's respiratory health, and the number of people with chronic obstructive pulmonary disease (COPD) is increasing. Moreover, China is a large population and is in the aging stage of population. The elderly are another cause of coronary heart disease and COPD. Therefore, there are coronary heart disease and C in clinical. OPD patients also more and more chronic hypoxia in.COPD can accelerate the development of coronary heart disease. Patients with coronary heart disease are prone to heart failure due to long-term coronary artery ischemia, which can obstruct the pulmonary circulation of COPD patients and promote the formation of pulmonary hypertension. The two people interact and aggravate each other. The purpose of this study is to explore the patients with coronary heart disease combined with COPD. The clinical characteristics and prognosis were selected from January 2015 to November 2015. 89 patients with coronary heart disease combined with COPD were treated in the income Hospital of our hospital (Xiaye County People's Hospital). Among them, there were 54 male patients, 35 female patients and 61-89 years of age. The average age was (74.51 + 2.22) years and the hospitalization time was 14-21. The average duration of hospitalization was (17.21 + 3.11) days, including 35 patients with obesity, 29 patients with diabetes, 25 patients with hypertension, 16 patients with acute myocardial infarction, 39 patients with frequent premature beats, 34 patients with old myocardial infarction, color Doppler echocardiography, and enlarged left ventricle. 36 cases of patients, 32 cases of enlarged right ventricle, 12 cases of full heart enlargement, 19 patients with significantly increased myocardial enzymes. The inclusion criteria of cases were: (1) all the patients were selected, their clinical symptoms and results were consistent with the diagnosis and diagnosis of ischemic heart disease and the diagnosis of chronic obstructive disease. Standard; (2) a history of typical and atypical episodes of angina pectoris, which showed an effective patient after taking a drug Nitroglycerin Tablets; (3) the electrocardiogram showed a change in the ST-T segment of the blood type in each lead, and a significant change during the onset of the onset of the disease, without the treatment of the COPD attack; (4) the duration of the occurrence of the disease. Sex, frequent ventricular premature contraction, and no symptoms after the treatment of the episodes; (5) the X-ray examination revealed that the left ventricle increased, the heart increased, the rheumatic heart disease, the cardiomyopathy, the hypertensive heart disease were excluded; (6) all the patients were voluntarily participated in this study, and before the participation of the treatment study, The patients were given an informed consent form. The patients were given oxygen inhalation, antispasmodic, antispasmodic, antispasmodic, phlegm and conventional water and electrolyte balance treatment immediately after admission, and gave them general treatment of crowns, anticoagulants, anti platelet aggregation, depressurization, hypoglycemic, diuresis, and nutritional myocardium, with thrombolytic and emergency PCI treatment when necessary. Index: the forced vital capacity (FVC), the first second forced expiratory volume (FEV1), the percentage (FEV1%) of the expected value of FEV1, the 6 clock walk distance (6MWD), the improvement of the symptoms, the changes of the electrocardiogram, and so on. The criterion of the curative effect: the change of heart rate after treatment: after treatment. 60-90 times a minute, the resting electrocardiogram showed normal or no dynamic changes, the patient's walking distance increased by more than 500m; effective: after treatment, the patient's heart rate changes were 90-110 times per minute, the occasional cardiac premature beat, the ST segment of electrocardiography below 0.02mv, and the patient's walking distance increased. In addition to 500m, null and void: after treatment, the clinical symptoms, signs and imaging results of the patients had no obvious changes, even the death of the treatment. All the data were statistically analyzed by SPSS13.0 software, the measurement data were expressed with (x + s), and the paired T test was used, and the count data were expressed with%, Using X2 test, P0. 05 indicated that the difference was statistically significant. Results the effective rate of clinical treatment for all patients was analyzed: 89 of them (coronary heart disease combined with COPD), through comprehensive treatment, 53 cases of the effective patients were 59.55%, the effective patients had 35 cases, the proportion was 39.33%, invalid patients. 1 cases, the proportion is 1.12%, the effective rate of clinical treatment is 98. 88%. conclusion coronary heart disease and COPD is a very common disease and multiple diseases, on the basis of anti infection, antiasthmatic and expectorant on the basis of oxygen therapy, correction of water and electrolyte disorders, anticoagulant, anti blood plate aggregation, lipid lowering, dilatation of blood vessels, smoking cessation, alcohol limit, life Regular and standardized treatment can significantly improve the quality of life and pulmonary function in patients with coronary heart disease complicated with COPD.

【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】：R541.4;R563.9

【参考文献】