【摘要】：目的：總結(jié)現(xiàn)代醫(yī)學及中醫(yī)對嬰幼兒喘息的研究現(xiàn)狀,通過回顧性分析導師門診嬰幼兒喘息患兒病例,研究嬰幼兒喘息患兒痊愈或緩解的年齡分布,分析痊愈及緩解集中年齡段的中西醫(yī)癥狀特點及規(guī)律,探討運用中醫(yī)臨床表現(xiàn)結(jié)合哮喘預測指數(shù)預測嬰幼兒喘息預后轉(zhuǎn)歸的可行性,為嬰幼兒喘息的臨床治療提供一定理論支撐。 方法：分為理論研究和臨床研究兩部分。理論研究部分：對目前中西醫(yī)關(guān)于嬰幼兒喘息的研究進行歸納總結(jié),提出嬰幼兒喘息研究的問題,為臨床研究提供基礎。臨床研究部分：采用回顧性分析方法,根據(jù)導師門診收集的嬰幼兒喘息病例進行臨床資料收集并判定每例病例哮喘預測指數(shù),記錄其喘息控制的主要措施、中醫(yī)臨床癥狀、治療方法、危險因素等,通過電話回訪方式,記錄目前控制情況(如已治愈,則記錄其治愈年齡)等,將上述信息輸入計算機,使用統(tǒng)計軟件統(tǒng)計其痊愈各年齡段的分布情況,分析哮喘預測指數(shù)的準確度、治療干預對喘息的影響,研究痊愈集中年齡段的病情特點、中醫(yī)證型分布等,得出結(jié)論。 結(jié)果： (1)痊愈年齡主要集中在3歲左右、6-8歲、11-14歲年齡段； (2)503例哮喘預測指數(shù)陰性患兒中,痊愈患兒356例,占70.77%；147例在14歲后仍有哮喘癥狀,占29.22%；329例哮喘預測指數(shù)陽性患兒中298例發(fā)展為哮喘,占90.58%；痊愈患兒31例,占9.42%。說明哮喘預測指數(shù)的準確性較高。 (3)中醫(yī)癥狀及疾病史與嬰幼兒喘息預后的相關(guān)性分析：經(jīng)R×C表卡方檢驗,首次喘息后年喘息次數(shù)、哮喘家族史、吸入過敏史、反復呼吸道感染史、喘嗽、痰液、汗出、面色、飲食、大便、小便這幾個方面的P值均小于0.05,有統(tǒng)計學意義。說明中醫(yī)癥狀及疾病史在痊愈集中年齡段分布存在差異,根據(jù)中醫(yī)癥狀及疾病史預測嬰幼兒喘息的預后有一定的可行性,值得進一步研究。 (4)中醫(yī)證型：在y≤3歲年齡段中醫(yī)證型分布以肺脾氣虛證為主。在6歲≤y8歲年齡段肺脾氣虛證和脾腎陽虛證例數(shù)較多,占總例數(shù)的37.61%和35.78%,肺腎陰虛證相對較少,占總例數(shù)的26.61%。在11歲y≤14歲年齡段中,脾腎陽虛例數(shù)較多,占總例數(shù)的38.28%,肺脾氣虛和肺腎陰虛相對例數(shù)較少,分別占總例數(shù)的28.13%和33.59%。說明三個痊愈集中年齡段中中醫(yī)證型分布有區(qū)別,根據(jù)中醫(yī)證型預測嬰幼兒喘息患兒預后有一定的可行性。 (5)中醫(yī)、中西醫(yī)結(jié)合及西醫(yī)三種治療方法對嬰幼兒喘息痊愈影響分析,經(jīng)卡方檢驗,P0.05,有統(tǒng)計學意義。三種治療方法之間兩兩比較,除中醫(yī)治療與中西醫(yī)結(jié)合治療比較外,P均0.05,有統(tǒng)計學意義。是否長期規(guī)范治療對嬰幼兒喘息痊愈的影響,經(jīng)卡方檢驗,P0.05,無統(tǒng)計學意義。說明中醫(yī)治療及中西醫(yī)結(jié)合治療在嬰幼兒喘息痊愈方面要優(yōu)于單純西醫(yī)治療,是否長期規(guī)范治療不能影響嬰幼兒喘息的痊愈。 (6)未愈患兒喘息控制的主要相關(guān)因素及措施是及時對癥治療、避免感冒,分別占96.18%和90.11%；說明及時對癥治療及避免感冒有助于喘息的控制。 (7)中醫(yī)、中西醫(yī)結(jié)合及西醫(yī)治療三種治療手段在病情控制上,經(jīng)Ridit分析,95%置信區(qū)間有重疊,說明三種治療手段均可控制喘息發(fā)作,但控制程度差別不明顯。長期規(guī)范治療與未長期規(guī)范治療對病情控制上,經(jīng)Ridit分析,95%置信區(qū)間無重疊,尚可認為是否規(guī)范治療在病程控制情況上不同,說明長期規(guī)范治療有利于病情的控制。 結(jié)論： (1)嬰幼兒喘息患兒的痊愈與年齡存在相關(guān)性,主要集中在3歲、7歲、13歲左右； (2)哮喘預測指數(shù)具有較高的準確率,對嬰幼兒喘息的預后有指導意義； (3)根據(jù)中醫(yī)臨床癥狀和證型結(jié)合哮喘預測指數(shù)預測嬰幼兒喘息患兒預后有一定的可行性,能為指導中西醫(yī)結(jié)合的臨床治療提供參考,值得進一步研究。 (4)及時的中醫(yī)、中西醫(yī)結(jié)合及西醫(yī)治療對病情控制均有較好的療效,堅持長期規(guī)范治療優(yōu)于未長期規(guī)范治療,說明及時的對癥治療和堅持長期規(guī)范治療對哮喘患兒是非常必要的。
[Abstract]:Objective: To summarize the research status of modern medicine and traditional Chinese medicine on infantile wheezing, retrospectively analyze the cases of infantile wheezing in tutor's clinic, study the age distribution of recovery or remission of infantile wheezing, analyze the characteristics and regularity of traditional Chinese and Western Medicine symptoms in the period of recovery and remission, and explore the application of clinical manifestations of traditional Chinese medicine combined with asthma. The feasibility of asthma prediction index in predicting the prognosis of infantile asthma provides theoretical support for the clinical treatment of infantile asthma.
Methods: It is divided into two parts: theoretical research and clinical research. Theoretical research part: Summarize and summarize the current research on infantile asthma in Chinese and Western medicine, put forward the problem of infantile asthma research, and provide the basis for clinical research. Clinical data were collected to determine the predictive index of asthma in each case. The main measures of asthma control, clinical symptoms, treatment methods and risk factors of TCM were recorded. The current control situation (if cured, the age of cure) was recorded by telephone return visit. The above information was input into the computer and statistically analyzed by statistical software. Distribution of different age groups, analysis of the accuracy of asthma prediction index, treatment intervention on the impact of asthma, study of the characteristics of the disease in the age group, distribution of TCM syndromes, etc., draw conclusions.
Result:
(1) the age of recovery is mainly in the age of 3, 6-8 and 11-14.
(2) Among 503 children with negative predictive index of asthma, 356 (70.77%) were cured, 147 (29.22%) still had asthma symptoms after 14 years old, 298 (90.58%) of 329 children with positive predictive index of asthma developed asthma, and 31 (9.42%) were cured.
(3) Correlation analysis between symptoms and disease history of TCM and prognosis of wheezing in infants and young children: the number of wheezes in the first year after wheezing, family history of asthma, history of inhalation allergy, history of recurrent respiratory tract infection, wheezing, sputum, sweating, complexion, diet, stool, urination, P values of these aspects are less than 0.05, with statistical significance. The distribution of symptoms and disease history is different in the age group with concentrated recovery. It is feasible to predict the prognosis of infantile wheezing according to the symptoms and disease history of traditional Chinese medicine.
(4) TCM syndromes: lung-spleen-qi deficiency syndrome was the main type of TCM syndromes in the age of Y < 3 years old. There were more cases of lung-spleen-qi deficiency syndrome and spleen-kidney Yang deficiency syndrome in the age of 6 < y 8 years old, accounting for 37.61% and 35.78% of the total cases, while lung-kidney Yin deficiency syndrome was relatively small, accounting for 26.61% of the total cases. 38.28%. The relative cases of deficiency of lung-spleen-qi and deficiency of lung-kidney-yin were less, accounting for 28.13% and 33.59% of the total cases respectively.
(5) Chinese medicine, integrated traditional Chinese and Western medicine and Western medicine three treatment methods of infant asthma healing effect analysis, chi-square test, P 0.05, there is statistical significance. Chi-square test, P 0.05, no statistical significance, indicating that the treatment of traditional Chinese medicine and integrated Chinese and Western medicine in infants and young children with asthma healing is superior to western medicine alone, whether long-term standardized treatment can not affect the recovery of infants and young children with asthma.
(6) Timely symptomatic treatment and avoidance of colds accounted for 96.18% and 90.11% respectively, indicating that timely symptomatic treatment and avoidance of colds contributed to the control of wheezing.
(7) By Ridit analysis, 95% confidence intervals overlap among the three treatments, indicating that the three treatments can control wheezing attacks, but the degree of control is not significantly different. It can be considered whether the standard treatment is different in the course of disease control, indicating that long-term standardized treatment is conducive to disease control.
Conclusion:
(1) the recovery of infants with wheezing is related to age, mainly in 3, 7 and 13 years old.
(2) the asthma predictive index has a high accuracy rate, which is of guiding significance for the prognosis of wheezing in infants.
(3) It is feasible to predict the prognosis of infantile wheezing patients according to the clinical symptoms and syndromes of TCM combined with asthma prediction index, which can provide a reference for guiding the clinical treatment of integrated Chinese and Western medicine and is worthy of further study.
(4) Timely traditional Chinese medicine, integrated traditional Chinese and Western medicine and Western medicine have a good effect on the condition control. Persisting in long-term standardized treatment is better than non-long-term standardized treatment. It shows that timely symptomatic treatment and long-term standardized treatment are very necessary for children with asthma.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R272

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