本文關(guān)鍵詞：長(zhǎng)期吸入布地奈德對(duì)哮喘幼兒骨代謝及骨密度的影響　出處：《承德醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 哮喘 吸入糖皮質(zhì)激素 布地奈德 骨代謝 血鈣 血磷 血堿性磷酸酶 骨密度

【摘要】：支氣管哮喘(下文簡(jiǎn)稱哮喘)是兒童時(shí)期常見(jiàn)的呼吸道慢性疾病之一,近二十余年來(lái)多次調(diào)查顯示兒童哮喘患病率呈逐年上升趨勢(shì)。哮喘的發(fā)病機(jī)制十分復(fù)雜,目前認(rèn)為哮喘的本質(zhì)是氣道慢性炎癥反應(yīng)。這種氣道慢性炎癥增加了氣道痙攣---氣道高反應(yīng)---暴露于刺激物之中的惡性循環(huán)。其中氣道高反應(yīng)是哮喘的基本特征之一,它是指氣道對(duì)多種多樣的刺激因素,如過(guò)敏原、物理因素、化學(xué)因素、運(yùn)動(dòng)等出現(xiàn)高度敏感的狀態(tài),可以在一定的程度上表示出氣道慢性炎癥的嚴(yán)重情況。哮喘的臨床表現(xiàn)特點(diǎn)是間歇性發(fā)作,表現(xiàn)為反復(fù)發(fā)作的喘息、咳嗽、胸悶、呼吸急促等,通常易出現(xiàn)在夜間及劇烈運(yùn)動(dòng)期間,這些癥狀與廣泛多變的可逆性氣流阻塞有密切關(guān)系,可以經(jīng)過(guò)有效治療或者自行緩解。但若哮喘不經(jīng)有效治療,易出現(xiàn)反復(fù)發(fā)作并進(jìn)行性加重,嚴(yán)重時(shí)會(huì)出現(xiàn)哮喘危重狀態(tài),表現(xiàn)為呼吸困難,大汗淋漓,煩躁不安,甚至?xí)霈F(xiàn)端坐呼吸,意識(shí)障礙及呼吸循環(huán)衰竭,進(jìn)而危及到患兒的生命安全。因此,哮喘反復(fù)發(fā)作,嚴(yán)重影響了患兒的身心健康發(fā)展。目前,隨著哮喘研究進(jìn)展及炎癥學(xué)說(shuō)的確定,糖皮質(zhì)激素(GC)已被作為治療哮喘的第一線藥物。全身應(yīng)用GC已經(jīng)產(chǎn)生了明顯的全身不良反應(yīng),而吸入性糖皮質(zhì)激素(ICS)因其療效好、直接作用于氣道黏膜,全身副作用少而得到廣泛推廣。但是同時(shí),ICS的療程長(zhǎng),吸入種類、頻次及劑量不同,在兒科醫(yī)生及患兒家屬中廣泛存在著安全性的爭(zhēng)議。布地奈德(BUD)是最常用的一種ICS,它能有效的消除氣道炎癥從而降低氣道高反應(yīng)性,進(jìn)而達(dá)到治療哮喘的目的。長(zhǎng)期吸入BUD是否會(huì)對(duì)哮喘患兒的骨代謝和骨密度產(chǎn)生影響,是兒科醫(yī)生及患兒家屬關(guān)注的焦點(diǎn)。本研究通過(guò)觀察60例哮喘幼兒持續(xù)吸入BUD對(duì)其骨代謝指標(biāo)和骨密度的影響,了解長(zhǎng)期應(yīng)用ICS治療哮喘的安全性。目的:通過(guò)檢測(cè)哮喘幼兒持續(xù)吸入布地奈德后骨代謝生化指標(biāo)---血鈣(Ca)、血磷(P)、血堿性磷酸酶(ALP)以及骨密度(BMD)的變化情況,探究長(zhǎng)期吸入bud對(duì)哮喘患兒骨代謝及骨密度指標(biāo)的影響,了解是否有可能引起骨量丟失,進(jìn)而指導(dǎo)哮喘患兒應(yīng)用霧化吸入gc來(lái)預(yù)防和治療哮喘發(fā)作。方法:收集2014年1月至2015年10月,于我院門(mén)診及住院部診治的支氣管哮喘幼兒60例。所選患兒均規(guī)律吸入bud(1mg/d)≥3個(gè)月。調(diào)查所選患兒在用藥期間能夠影響骨代謝和骨密度的三個(gè)常見(jiàn)因素---飲食因素、體育活動(dòng)、日照時(shí)間,以了解這些因素的均衡分布情況。于用藥前、用藥1個(gè)月、用藥3個(gè)月三個(gè)時(shí)間窗,對(duì)所選患兒分別進(jìn)行血ca、血p、血alp及bmd的測(cè)定。所有數(shù)據(jù)應(yīng)用excel錄入,使用spss19.0統(tǒng)計(jì)軟件進(jìn)行分析,首先進(jìn)行一般資料的頻數(shù)分布描述,然后進(jìn)行各指標(biāo)均數(shù)差別的檢驗(yàn)(χ2檢驗(yàn)或方差分析)。結(jié)果:1患兒一般情況分析:所選患兒平均年齡為2.17±0.62歲,其中1周歲至2周歲之間占45%(27),2周歲到3周歲之間占55%(33);男、女各占56.7%(34)和43.3%(26)。分析所選患兒在治療過(guò)程中影響骨代謝指標(biāo)和骨密度的三種因素。飲食因素:合理膳食且無(wú)偏食為較好,占80%-85%(48-50),三個(gè)時(shí)間段比較差異無(wú)統(tǒng)計(jì)學(xué)意義。體育活動(dòng):活動(dòng)時(shí)間大于2h為較好,占86%-89%(52-53),三個(gè)時(shí)間段比較差異無(wú)統(tǒng)計(jì)學(xué)意義。日照時(shí)間:大于2h為較好,占86%-89%(52-53),三個(gè)時(shí)間段比較差異無(wú)統(tǒng)計(jì)學(xué)意義。2患兒的骨代謝指標(biāo)在三個(gè)時(shí)間點(diǎn)的變化情況:所選患兒于用藥前、用藥1個(gè)月、用藥3個(gè)月這三個(gè)時(shí)間點(diǎn)的血ca、血p、血alp的測(cè)定結(jié)果如下:血ca(mmol/l)分別為2.26±0.16,2.28±0.15,2.27±0.13(p=0.64);血p(mmol/l)分別為1.78±0.18,1.80±0.19,1.82±0.16(p=0.52);血alp(u/l)分別為116.80±20.42,115.15±17.07,115.53±17.04(p=0.87)。各指標(biāo)均數(shù)間比較均為p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。3患兒的骨密度在三個(gè)時(shí)間點(diǎn)的變化情況:所選患兒于用藥前、用藥1個(gè)月、用藥3個(gè)月這三個(gè)時(shí)間點(diǎn)的bmd(z值)分別為0.45±0.28,0.51±0.30,0.50±0.27(p=0.55),三個(gè)均數(shù)之間比較為p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1所選哮喘患兒在吸入布地奈德期間的飲食因素、體育活動(dòng)及日照時(shí)間是均衡的。2所選哮喘患兒三個(gè)時(shí)間點(diǎn)的骨代謝指標(biāo)及骨密度無(wú)明顯改變,表明長(zhǎng)期吸入布地奈德不會(huì)對(duì)哮喘患兒的骨質(zhì)發(fā)育產(chǎn)生影響。
[Abstract]:Bronchial asthma (hereinafter referred to as asthma) is one of the most common childhood chronic respiratory disease in recent twenty years, many surveys show that the prevalence of childhood asthma increased year by year. The pathogenesis of asthma is very complicated, now that the nature of asthma is a chronic airway inflammation. This chronic airway inflammation increases airway spasm, airway high vicious spiral the reaction - exposure to irritants. Among which the airway hyperresponsiveness is one of the basic features of asthma, it refers to a variety of airway stimuli, such as allergen, physical factors, chemical factors, such as movement appeared highly sensitive state, can show serious chronic airway inflammation in a certain extent. The clinical features of asthma is characterized by repeated episodes of intermittent episodes of wheezing, coughing, chest tightness, shortness of breath, usually at night and prone to violent movement During the start period, there is a close relationship between these symptoms and a wide variety of reversible airflow obstruction can be relieved or after effective treatment. But if asthma without effective treatment, prone to recurrent and progressive, there will be serious severe asthma, showed dyspnea, sweating, irritability, and even there orthopnea, disturbance of consciousness and respiratory failure, and endanger the children's safety. Therefore, repeated attacks of asthma, serious impact on children's physical and mental health development. At present, with the research progress and the inflammation theory of asthma, Glucocorticoid (GC) has been used as first-line drugs for the treatment of asthma in the body. The application of GC has produced obvious systemic adverse reactions, and inhaled corticosteroids (ICS) because of its good curative effect, directly on the airway mucosa, with fewer side effects and spread. But at the same time, I The CS long course of treatment, inhalation of different types, frequency and dose in the family and children, pediatricians exists widely in the security dispute. Budesonide (BUD) is one of the most commonly used ICS, which can effectively eliminate airway inflammation and reduce airway hyperresponsiveness, which can cure asthma. The long-term inhalation of BUD children with asthma will affect bone metabolism and bone density, is the focus of the family and children's pediatrician. In this study, through the observation of 60 cases of asthmatic children inhaled the effect of BUD on bone metabolism and bone mineral density, should understand the long-term safety of ICS for the treatment of asthma. Objective: to detect the budesonide inhalation asthma children after the biochemical indexes of bone metabolism, serum calcium (Ca), phosphorus (P), serum alkaline phosphatase (ALP) and bone mineral density (BMD) changes, to explore the long-term inhalation of bud on bone metabolism in children with asthma and bone density index To find out whether there is influence, may cause the loss of bone mass, and then guide the application of atomization inhalation on children with asthma GC for the prevention and treatment of asthma. Methods: from January 2014 to October 2015, in our hospital outpatient and inpatient diagnosis and treatment of bronchial asthma in children 60 cases. The selected patients were regular inhalation of bud (1mg/d) is more than 3 months of investigation. The children can choose three common factors, dietary factors, bone metabolism and bone density in use during sports activities, sunshine time, in order to understand the equilibrium distribution of these factors. In the 1 months before the medication, medication, medication for 3 months the three time window, the selected patients were blood Ca, blood p, serum ALP and BMD. All the data input by Excel, were analyzed using spss19.0 statistical software, describes the frequency distribution of the first general inspection data, then each index mean difference (x ~ 2 test or analysis of variance). 鏋，

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