本文選題：低分子肝素　切入點(diǎn)：布地奈德福莫特羅　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease簡(jiǎn)稱COPD)是呼吸系統(tǒng)常見的一種慢性氣道炎癥反應(yīng)性疾病,近年來,COPD發(fā)病率逐年增加,其病死率和致殘率均較高,嚴(yán)重影響患者生活質(zhì)量,主要臨床表現(xiàn)為肺功能下降,呼吸困難,機(jī)體運(yùn)動(dòng)耐力差。主要治療目的為消除氣道炎癥、改善呼吸困難等臨床癥狀、改善肺氣體交換,延緩疾病進(jìn)展。呼吸康復(fù)訓(xùn)練可以增加機(jī)體有氧代謝能力,提高運(yùn)動(dòng)耐力,進(jìn)而改善患者肺功能和血?dú)庵笜?biāo),提高生活質(zhì)量。目的本研究旨在探討肝素輔助布地奈德福莫特羅聯(lián)合呼吸康復(fù)訓(xùn)練治療COPD的臨床效果,分析其對(duì)患者肺功能、血?dú)庵笜?biāo)、凝血功能、血流變指標(biāo)及炎性因子的影響。方法選取COPD患者164例,根據(jù)治療方法不同分為對(duì)照組(n=50)、治療組(n=55)和康復(fù)組(n=59)。3組患者均給予常規(guī)綜合治療,其中:(1)對(duì)照組:僅給予常規(guī)治療。(2)治療組:在常規(guī)治療的基礎(chǔ)上給予布地奈德福莫特羅吸入聯(lián)合小劑量低分子肝素治療。(3)康復(fù)組:在治療組基礎(chǔ)上增加呼吸康復(fù)訓(xùn)練。(4)觀察及分析指標(biāo):(1)比較3組治療后臨床療效;(2)比較3組患者治療前后BODE指數(shù)(body mass index,airflow obstruction,dyspnea,and exercise capacity index)評(píng)分、改良醫(yī)學(xué)研究會(huì)呼吸困難指數(shù)(mMRC)評(píng)分、變化的呼吸困難指數(shù)(TDI)評(píng)分;(3)比較3組患者治療前后肺功能、血?dú)庵笜?biāo)、凝血功能、血流變指標(biāo)、炎性因子指標(biāo);(4)比較3組患者治療前后治療前后運(yùn)動(dòng)耐力和生活質(zhì)量。結(jié)果(1)治療后康復(fù)組總有效率治療組對(duì)照組,3組間總有效率比較差異顯著(P0.01)。(2)治療后BODE總分康復(fù)組治療組對(duì)照組(P0.01),治療后mMRC評(píng)分康復(fù)組治療組對(duì)照組(P0.01),治療后TDI總分康復(fù)組治療組對(duì)照組(P0.01)。(3)治療后各組肺功能、血?dú)庵笜?biāo)、凝血功能、炎性因子指標(biāo)均有改善,且改善程度康復(fù)組治療組對(duì)照組(P0.01)。治療后對(duì)照組各項(xiàng)血流變指標(biāo)均無明顯變化(P0.05),治療組和康復(fù)組各項(xiàng)血流變指標(biāo)均明顯降低(P0.05或P0.01),且3組間差異顯著(P0.05或P0.01)。(4)治療后3組患者6 MWD康復(fù)組治療組對(duì)照組(P0.01),治療后SQRG總分康復(fù)組治療組對(duì)照組(P0.01)。結(jié)論小劑量低分子肝素輔助布地奈德福莫特羅吸入治療COPD,輔以適當(dāng)?shù)暮粑祻?fù)訓(xùn)練可以明顯提高臨床有效率,改善患者呼吸困難等臨床癥狀,降低COPD患者血清炎性因子,減輕氣道炎癥反應(yīng),改善患者肺功能,增強(qiáng)呼吸肌肌力和運(yùn)動(dòng)耐力,提高生活質(zhì)量,且還可以改善COPD患者凝血功能,血?dú)庵笜?biāo),有效預(yù)防靜脈血栓栓塞的發(fā)生。
[Abstract]:Background chronic obstructive pulmonary disease is a common chronic airway inflammatory disease in respiratory system. In recent years, the incidence of chronic obstructive pulmonary disease (COPD) is increasing year by year, and its mortality and disability rate are both high, which seriously affects the quality of life of patients. The main clinical manifestations are decreased lung function, dyspnea and poor exercise endurance. The main purpose of treatment is to eliminate airway inflammation, improve respiratory difficulties and other clinical symptoms, and improve lung gas exchange. Respiratory rehabilitation training can increase aerobic metabolism, improve exercise endurance, and then improve patients' lung function and blood gas index. Objective to investigate the clinical effect of heparin assisted with budesonide formoterol combined with respiratory rehabilitation training in the treatment of COPD, and to analyze the effects of heparin on pulmonary function, blood gas index and coagulation function. Methods 164 patients with COPD were divided into two groups: control group (n = 55) and rehabilitation group (n = 59.3). Control group: routine treatment. 2) treatment group: budesonide formoterol inhalation combined with low dose low molecular weight heparin therapy. 3) rehabilitation group: increase respiratory rehabilitation on the basis of treatment group. Exercise 4) observing and analyzing index: 1) comparing the clinical curative effect after treatment in three groups (2) comparing the BODE index and exercise capacity index before and after treatment in the three groups, and comparing the scores of exercise capacity and BODE index before and after treatment. The mMRC score and the TDII score of dyspnea index were compared between the three groups before and after treatment, such as lung function, blood gas index, coagulation function, hemorheological index. Results the total effective rate of rehabilitation group before and after treatment was significantly different from that of control group. The total effective rate of treatment group was significantly higher than that of control group (P < 0.01) and the total score of BODE after treatment was higher than that of control group (P < 0.05). In the rehabilitation group, the control group was treated with P0.01A, the mMRC score after the treatment, the control group with P0.01A, the TDI total score with the control group, the control group, the control group, and the pulmonary function after the treatment. Blood gas index, coagulation function, inflammatory factor index were all improved. After treatment, there was no significant change in the hemorheological indexes of the control group, but the hemorheological indexes in the treatment group and the rehabilitation group were significantly decreased by P0.05 or P0.01A, and the difference among the three groups was significant (P0.05 or P0.01U. 4). The patients in the last 3 groups were treated with P0.01C for 6 MWD rehabilitation group and the control group with SQRG total score after treatment. Conclusion low dose low molecular weight heparin and inhaled budesonide formoterol can be used to treat the patients with proper respiratory rehabilitation training. In order to significantly improve the clinical effective rate, It can improve the clinical symptoms, such as dyspnea, reduce serum inflammatory factors, alleviate airway inflammation, improve pulmonary function, enhance respiratory muscle strength and exercise endurance, improve quality of life, and also improve coagulation function of COPD patients. Blood gas index can effectively prevent the occurrence of venous thromboembolism.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

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