本文選題：支氣管哮喘 + 心率變異性　； 參考：《昆明醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的 (1)采用動(dòng)態(tài)心電圖分析軟件中的心率變異性的定量指標(biāo)(LF、HF、SDANN、 pNN50)來觀察支氣管哮喘(bronchial asthma,簡稱哮喘)患者與健康對照組自主神經(jīng)功能的變化,探討哮喘患者是否存在著自主神經(jīng)功能紊亂。 (2)使用長效抗膽堿能藥物噻托溴銨治療哮喘患者6周,再次使用心率變異性(HRV)中的定量指標(biāo)(LF、HF、SDANN、pNN50)分析患者的自主神經(jīng)功能變化,與用藥前對比是否有統(tǒng)計(jì)學(xué)意義,同時(shí)觀察肺功能中的FEV1、FEV1%指標(biāo),用藥后每日使用短效p2-受體激動(dòng)劑(沙丁胺醇?xì)忪F劑)的次數(shù),日間、夜間哮喘癥狀評分等相關(guān)指標(biāo),探討長效抗膽堿能藥物噻托溴銨能否從神經(jīng)調(diào)節(jié)機(jī)制上安全、有效的用于哮喘的治療,為哮喘防治提供一種新思路。 方法 (1)以非急性發(fā)作期的30-45歲之間的45例中度持續(xù)哮喘隨機(jī)分為B、C、D三組,B組為ICS+LAMA;C組為ICS+LABA;D組為ICS+LAMA+LABA；選用三組中任意的一組B組和15例健康對照組即A組對比研究,運(yùn)用動(dòng)態(tài)心電圖監(jiān)測得出心率變異性的定量分析指標(biāo)LF、HF、SDANN、pNN50同時(shí)使用肺功能儀肺功能計(jì)量器(Ms-PFT;Jaeger:Analyzer,Unit)測定其第一秒用力呼氣容積(forced expiratory volume in one second, FEV1)、第一秒用力呼氣容積占預(yù)計(jì)值的百分比(forced expiratory volume in one second/predicated value, FEV1%);根據(jù)哮喘癥狀評分表得出哮喘患者的日間、夜間哮喘癥狀評分及每日使用短效β2-受體激動(dòng)劑的次數(shù)。 (2)C、D兩組哮喘患者同樣運(yùn)用上述(1)中方法得出心率變異性的定量分析指標(biāo)LF.HF.SDANN.pNN50；肺功能FEV1、FEV1%:日間、夜間哮喘癥狀評分及每日使用短效p2-受體激動(dòng)劑的次數(shù)。 (3)B、C、D三組哮喘患者(B組為ICS+LAMA:C組為ICS+LABA:D組為ICS+LAMA+LABA)按照治療方案給予6周治療后,再次運(yùn)用動(dòng)態(tài)心電圖監(jiān)測得出治療后的心率變異性定量分析指標(biāo)LF.HF.SDANN.pNN50；同時(shí)使用肺功能儀肺功能計(jì)量器測定其治療后的FEV1、FEV1%;根據(jù)哮喘癥狀評分表得出哮喘患者治療后的日間、夜間哮喘癥狀評分及每日使用短效β2-受體激動(dòng)劑的次數(shù)。 (4)ICS—丙氟酸氟替卡松氣霧劑(商品名：輔舒酮,葛蘭素史克公司生產(chǎn),規(guī)格：125微克)每天2次,早晚各2次吸入；ICS+LABA—沙美特羅替卡松干粉劑(商品名：舒利迭,葛蘭素史克公司生產(chǎn),規(guī)格50/250微克)每天2次,早晚各1次吸入：LAMA—噻托溴銨粉吸入劑(浙江仙琚制藥公司生產(chǎn),規(guī)格：18微克)吸入,每日一次；硫酸沙丁胺醇?xì)忪F劑(商品名：萬托林,葛蘭素史克公司生產(chǎn),規(guī)格：100微克)按需使用。 結(jié)果 1、支氣管哮喘患者與健康對照組比較,即B組與A組,反映副交感神經(jīng)的HF、pNN50增高,反映交感神經(jīng)的LF、SDANN降低,與正常對照組有差異性(P0.05)。2、B、C、D三組哮喘患者使用藥物治療6周后,B組的HF、pNN50降低,與用藥前對比差異有統(tǒng)計(jì)學(xué)意義,LF、SDANN增高,差異無統(tǒng)計(jì)學(xué)意義；C組HF、pNN50降低,LF、SDANN增高,但與用藥前對比差異均無統(tǒng)計(jì)學(xué)意義；D組HF、pNN50降低,LF、SDANNB增高,與用藥前對比差異均有統(tǒng)計(jì)學(xué)意義。三組的日間、夜間癥狀評分較用藥前有所降低,使用短效p2-受體激動(dòng)劑的次數(shù)減少,肺功能中的FEV1、FEV1%較用藥前改善,三組與治療前對比差異均有統(tǒng)計(jì)學(xué)意義。 3、B、C、D三組哮喘患者使用藥物治療6周后,組間對比得出心率變異性的定量分析指標(biāo)(HF、pNN50、LF、SDANN),B組與C組、C組與D組差異有統(tǒng)計(jì)學(xué)意義,B組與D組差異無統(tǒng)計(jì)學(xué)意義；肺功能中的FEV1、FEV1%顯示B組與C組差異無統(tǒng)計(jì)學(xué)意義,而B組與D組、C組與D組差異均有統(tǒng)計(jì)學(xué)意義；日間、夜間癥狀評分、使用短效p2-受體激動(dòng)劑的次數(shù)顯示B組與C組差異無統(tǒng)計(jì)學(xué)意義,B組與D組、C組與D組差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論 (1)非急性發(fā)作期的中度持續(xù)支氣管哮喘患者存在自主神經(jīng)功能紊亂,表現(xiàn)為反映副交感神經(jīng)興奮性的HF、PNN50增加,反映交感神經(jīng)興奮性的LF、SDANN降低。 (2)長效抗膽堿能藥物噻托溴銨粉吸入劑聯(lián)合糖皮質(zhì)激素組可以降低HF、PNN50,使副交感神經(jīng)興奮性降低；在改善自主神經(jīng)功能紊亂方面,抗膽堿能藥物聯(lián)合糖皮質(zhì)激素組優(yōu)于長效β2-受體激動(dòng)劑聯(lián)合糖皮質(zhì)激素組；在減輕哮喘癥狀方面及改善肺功能方面二者效果相當(dāng)；以上三種藥物聯(lián)合使用在改善肺功能、降低心率變異性、降低哮喘癥狀評分及使用短效β2-受體激動(dòng)劑次數(shù)等方面均表現(xiàn)出更加優(yōu)越的臨床療效。
[Abstract]:objective
(1) the quantitative indexes of heart rate variability (LF, HF, SDANN, pNN50) in the dynamic electrocardiogram analysis software were used to observe the changes of autonomic nervous function in the patients with bronchial asthma (bronchial asthma) and the healthy control group, and to explore the existence of autonomic nervous dysfunction in the patients with asthma.
(2) the use of the long effect anticholinergic drug thiotropium bromide in the treatment of asthmatic patients for 6 weeks, again using the quantitative index of heart rate variability (HRV) (LF, HF, SDANN, pNN50) to analyze the changes in autonomic nervous function of the patients, whether there is a statistical significance compared with the pre medication, and observe the FEV1, FEV1% index in the lung function, and use the short acting p2- daily after the drug use. The frequency of the body agonist (Salbutamol Aerosol), the day, and the symptoms of asthma at night are related to the safety of the long effect anticholinergic drug thiotropium bromide from the neuromodulation mechanism, effectively used in the treatment of asthma, and provide a new way of thinking for the prevention and treatment of asthma.
Method
(1) 45 cases of moderate persistent asthma at the age of 30-45 years were randomly divided into B, C, D three, group B ICS+LAMA, C group ICS+LABA, and D group ICS+LAMA+LABA, three groups of any group of B groups and 15 healthy controls were compared to A group, and the quantitative analysis index of heart rate variability was obtained by dynamic electrocardiogram monitoring. DANN, pNN50 also measured the first second forced expiratory volume (forced expiratory volume in one second, FEV1) using the pulmonary function instrument (Ms-PFT; Jaeger:Analyzer, Unit). The scores of asthmatic patients' daytime, nocturnal asthma symptoms and daily use of short acting beta 2- agonists were obtained.
(2) C, D two groups of asthmatic patients also used the above (1) methods to determine the quantitative index of heart rate variability (LF.HF.SDANN.pNN50); pulmonary function FEV1, FEV1%: day, night asthma symptom score and the number of short acting p2- receptor agonists.
(3) B, C, D three groups of asthmatic patients (group B as ICS+LAMA:C group ICS+LABA:D group ICS+LAMA+LABA) after 6 weeks of treatment in accordance with the treatment program, again using dynamic electrocardiogram monitoring to get the quantitative analysis index of heart rate variability after treatment, and use lung function meter lung function measuring instrument to determine the FEV1, FEV1%, root after the treatment. According to the asthma symptom score, the number of asthmatic patients during daytime, nocturnal asthma symptoms and the daily use of short acting beta 2- agonists were obtained.
(4) ICS - fluticasone fluticasone aerosol (commodity name: coferone, GlaxoSmithKline Co production, specification: 125 micrograms) 2 times a day, 2 times every morning and evening; ICS+LABA - salmeterol carpasone dry powder (commodity name: suletide, GlaxoSmithKline Co production, 50/250 microgram) 2 times a day, every morning and night, each inhalation: LAMA - Thito Ammonium bromide powder inhalation (Zhejiang immortal pharmaceutical company production, specifications: 18 micrograms) inhalation, once a day; Salbutamol Aerosol (commodity name: Wan Tuo Lin, GlaxoSmithKline Co production, specification: 100 micrograms) on demand.
Result
1, the patients with bronchial asthma compared with the healthy control group, that is, group B and A, reflecting the HF and pNN50 of the parasympathetic nerve, reflecting the LF and SDANN of sympathetic nerve, and the difference between the normal control group and the normal control group (P0.05).2, B, C, D three groups of asthmatic patients after 6 weeks of drug treatment. N increased, the difference was not statistically significant, C group HF, pNN50 decreased, LF, SDANN increased, but there was no statistical significance compared with before drug use; D group HF, pNN50 decreased, LF, SDANNB increased, the difference was statistically significant before medication. Three groups of day, night symptom scores were lower than before use of short acting p2- receptor agonists. The decrease of FEV1 and FEV1% in lung function were better than before treatment. The difference between the three groups was statistically significant.
3, B, C, D three groups of asthma patients after 6 weeks of drug treatment, compared with the quantitative analysis index of heart rate variability (HF, pNN50, LF, SDANN), B group and C group, C group and D group have statistical significance, B group and the group difference is not statistically significant. The difference between group D and group C was statistically significant. The times of day, night symptom score and the use of short effect p2- receptor agonists showed no significant difference between group B and group C. There was a significant difference between group B and group D, and that of group C and D group.
conclusion
(1) patients with moderate persistent bronchial asthma in non acute episodes have autonomic nervous dysfunction, showing an increase in HF, PNN50, which reflects the excitability of the parasympathetic nerve, which reflects the LF of sympathetic excitability, and a decrease in SDANN.
(2) the long-acting anticholinergic drug Tiotropium Bromide Powder for Inhalation combined with glucocorticoid can reduce HF, PNN50, and reduce the excitability of parasympathetic nerve; in improving autonomic nervous dysfunction, anticholinergic drugs combined with glucocorticoid group are superior to the long effect beta 2- receptor agonist combined with glucocorticoid group; in alleviating asthma symptoms. The effect of the two groups on improving lung function is quite effective. The combined use of the above three drugs has a better clinical effect in improving lung function, reducing heart rate variability, reducing asthma symptom score and using short effect beta 2- receptor agonist.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R562.25

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相關(guān)期刊論文 前2條

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本文編號：1974636