本文選題：哮喘 + 信必可都保��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：哮喘是一種以不同程度氣道痙攣、氣道高反應(yīng)性、粘液分泌和慢性炎癥為特征的異質(zhì)性疾病。這種慢性炎癥與氣道高反應(yīng)性相關(guān),通常出現(xiàn)廣泛多變的可逆性氣流受限,并引起反復(fù)發(fā)作的喘息、氣急、胸悶或者咳嗽等癥狀,通常在夜間或者清晨發(fā)作或加劇,多數(shù)患者可以自行緩解,或者是經(jīng)過治療緩解。哮喘在世界范圍內(nèi)影響約3億人口,每年死亡人數(shù)更是高達(dá)25萬[1]。而當(dāng)哮喘得到有效控制后,多數(shù)患者很少出現(xiàn)哮喘急性發(fā)作,嚴(yán)重哮喘發(fā)作更是少見。全球哮喘負(fù)擔(dān)數(shù)據(jù)表明,盡管控制哮喘的花費(fèi)似乎稍高,但是不規(guī)范的治療可以導(dǎo)致哮喘反復(fù)發(fā)作,治療費(fèi)用會更高。2016年版的全球哮喘防治倡議(Global initiative for asthma,GINA),推薦吸入糖皮質(zhì)激素/長效β2受體激動劑(Inhaled corticosteroids/long-actingβ2-agonists,ICS/LABA)復(fù)合制劑用于中至重度持續(xù)哮喘患者的長期治療[2],吸入糖皮質(zhì)激素(Inhaled corticosteroids,ICS)和長效β2受體激動劑(long-actingβ2-agonists,LABA)具有協(xié)同作用,抗炎平喘作用大大加強(qiáng),相當(dāng)于獲得加倍劑量的ICS的療效,并且可以增加患者的依從性,同時(shí)減少大劑量ICS的不良反應(yīng),而且低劑量的布地奈德/福莫特羅還可以作為哮喘發(fā)作時(shí)的緩解使用藥物[3]。目前在我國臨床上經(jīng)常應(yīng)用的復(fù)合制劑有各種不同規(guī)格的布地奈德/福莫特羅干粉吸入劑、氟替卡松/沙美特羅干粉吸入劑以及倍氯米松/福莫特羅氣霧劑。白三烯調(diào)節(jié)劑(leukotriene receptor antagonists,LTRA),包括半胱氨酰白三烯調(diào)節(jié)劑和5-脂氧合酶抑制劑,是除了ICS之外,唯一可以單獨(dú)應(yīng)用的長效控制性藥物,它既可以作為輕度哮喘的替代治療藥物,也可以作為中重度哮喘的聯(lián)合用藥[4]。目前在我國國內(nèi)主要應(yīng)用的是半胱氨酰白三烯受體拮抗劑。ltra可以減輕哮喘癥狀、改善肺功能、延緩并減少哮喘的惡化,但是其抗炎作用并不如ics[5]。抗膽堿藥物:主要是吸入性抗膽堿藥物,如短效的抗膽堿藥物(short-actinganticholinergics,sama)異丙托溴銨和長效的抗膽堿藥物(long-actinganticholinergics,lama)噻托溴銨,具有一定的支氣管舒張作用,但是較β2-受體激動劑而言,作用稍弱,起效時(shí)間也較慢[5]。短效的抗膽堿藥物可以通過氣霧劑和霧化溶液給藥,而長效的抗膽堿藥物則主要通過干粉劑和軟霧劑給藥�？鼓憠A藥物與β2-受體激動劑聯(lián)合應(yīng)用具有互補(bǔ)作用[6]。但是妊娠早期婦女、青光眼患者以及前列腺肥大患者要慎用此類藥物。對于中重度慢性持續(xù)性哮喘,聯(lián)合用藥受到了越來越多的重視,并且在臨床上取得了理想的療效。在一些國家,甚至已經(jīng)將聯(lián)合用藥納入一線治療方案里。本研究遵循平行、對照、開放的原則,觀察使用布地奈德/福莫特羅聯(lián)合孟魯司特鈉與布地奈德/福莫特羅聯(lián)合噻托溴銨和單純吸入布地奈德/福模特羅1個(gè)月和3個(gè)月對慢性持續(xù)性哮喘的臨床療效,為中重度慢性持續(xù)性哮喘的治療提供新思路。目的評價(jià)信必可都保聯(lián)合孟魯司特鈉與信必可都保聯(lián)合噻托溴銨及單純吸入信必可都保治療中重度哮喘的臨床療效方法本研究選取2015年3月到2016年3月來鄭州大學(xué)第一附屬醫(yī)院就診的哮喘患者,符合納入標(biāo)準(zhǔn)者83例,分為a、b、c三組,a組28例給予信必可都保聯(lián)合孟魯司特鈉治療,b組28例給予信必可都保聯(lián)合噻托溴銨治療,c組27例給予信必可都保單藥治療,治療3個(gè)月,觀察患者治療前,治療后1個(gè)月和3個(gè)月哮喘控制問卷改善狀況、肺功能變化及血液中嗜酸粒細(xì)胞變化狀況。結(jié)果1.三組患者治療前性別、年齡、病程、fev1及pef等指標(biāo)組間分布情況基本一致,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.三種治療方案在治療1月及3月后均較治療前在哮喘控制水平上顯著改善(P0.05),A、B、C三組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.三種治療方案在治療1月及3月后均較治療前在肺功能指標(biāo)FEV1%pred上顯著改善(P0.05),且A、B兩組間差異無統(tǒng)計(jì)學(xué)意義(P0.05),A、C兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05),B、C兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.A、B、C三組治療后1月外周靜脈血中嗜酸性粒細(xì)胞(Eos)計(jì)數(shù)與治療前相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05),治療3月后與治療前相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05),A、B、C三組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.信必可都保聯(lián)合孟魯司特和信必可都保聯(lián)合噻托溴銨較單純吸入信必可都保短期內(nèi)在哮喘控制和改善肺功能方面都有更好的效果。2.信必可都保聯(lián)合孟魯司特和信必可都保聯(lián)合噻托溴銨在短期內(nèi)臨床療效相當(dāng)。
[Abstract]:Asthma is a heterogeneous disease characterized by varying degrees of airway spasm , airway hyperresponsiveness , mucus secretion , and chronic inflammation . This chronic inflammation is associated with airway hyperresponsiveness , usually with a wide variety of reversible airflow limitations , and causes recurrent episodes of asthma , shortness of breath , chest distress , or cough , often at night or early in the morning , with most patients being able to respond spontaneously or by treatment . Asthma affects about 300 million people worldwide , with an annual toll of 250,000 . Global asthma burden data indicate that although the cost of controlling asthma seems to be slightly higher , the global asthma burden data suggests that although the cost of controlling asthma seems to be slightly higher , the treatment costs may be higher . The 2016 version of Global Asthma for asthma , GINA , recommends inhaled corticosteroids / long - acting 尾2 - agonists ( ICS / LABA ) complex formulations for moderate to severe persistent asthma , and increases patient compliance while reducing the adverse effects of large doses of ICS , and the low dose of Buchenne / Formoterol can also be used as a relief drug for asthma attacks . In addition to the ICS , a long - acting control drug which can be used alone can be used as an alternative treatment drug for mild asthma , but also can be used as a combined drug for moderate and severe asthma . At present , it is mainly used in our country , which can reduce the symptoms of asthma , improve pulmonary function , delay and reduce the deterioration of asthma , but its anti - inflammatory effect is not inferior to that of ics . Anti - cholinergic drugs : mainly inhaled anti - cholinergic drugs , such as short - acting anticholinermis ( s ) and long - acting anti - cholinergic drugs ( long - actinganticholinertly , ibuprofen ) tiotropium bromide , have a certain bronchorelaxation effect , but the effect is slightly weaker than the beta2 - receptor agonists , and the onset time is also slower . Short - acting anti - cholinergic drugs can be administered by aerosol and atomized solutions , while long - acting anticholinertiagents are administered primarily through dry powder and soft - fog agents . The combination of anti - cholinergic drugs with 尾2 - receptor agonists has a complementary action . In the treatment of moderate and severe chronic persistent asthma , there was no significant difference between the two groups ( P0.05 ) .

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25
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本文編號：1752628