本文選題：冠心病 + COPD��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：研究背景現(xiàn)如今,隨著人們攝入高鹽高脂等食物的增多,工作壓力的增大,生活方式的不規(guī)律,使得患有高血壓、糖尿病、肥胖等疾病的人越來越多,在加上吸煙、酗酒等不良習(xí)慣,共同導(dǎo)致了患冠心病(冠狀動脈硬化型心臟病)的人也在逐年增加。同時環(huán)境污染嚴(yán)重,汽車尾氣、霧霾、吸煙等因素嚴(yán)重影響人們呼吸道健康,造成患慢性阻塞性肺疾病(COPD)的人數(shù)增多。而且我國是人口大國,正處于人口老齡化階段,高齡是患冠心病和COPD的又一個原因。因此臨床上患有冠心病合并COPD的病人也越來越多。COPD的慢性缺氧可加快冠心病的發(fā)展進(jìn)程,冠心病的患者由于冠脈長期處于缺血狀態(tài),容易出現(xiàn)心力衰竭,可阻礙COPD患者的肺循環(huán),促進(jìn)肺動脈高壓的形成。二者相互影響,相互加重。研究目的探討冠心病合并COPD患者的臨床特點(diǎn)和預(yù)后。研究方法選取2015年1月到2015年11月,在我院(夏邑縣人民醫(yī)院)收入院治療的冠心病合并COPD患者89人,作為研究資料,其中,男性患者54例,女性患者35例,年齡區(qū)間為61-89歲,平均年齡為(74. 51 ±2. 22)歲,住院治療時間為14-21天,平均住院治療時間(17. 21±3. 11)天,其中,合并肥胖癥的病人35例,合并糖尿病的病人29例,合并高血壓的病人25例,合并有急性心肌梗死的病人16例,患有頻發(fā)早博的病人39例,患有陳舊性心肌梗死的病人34例,經(jīng)心臟彩超檢查,左心室擴(kuò)大的病人36例,右心室擴(kuò)大的病人32例,全心擴(kuò)大的病人12例,心肌酶明顯增高的病人19例。病例的納入標(biāo)準(zhǔn):(1)所有入選的患者,他們的臨床癥狀和檢查結(jié)果都符合《缺血性心臟病的命名和診斷標(biāo)準(zhǔn)》與《慢性阻塞性疾病診治指南》的相關(guān)診斷標(biāo)準(zhǔn);(2)患有典型與不典型的發(fā)作心絞痛史,經(jīng)服用藥物硝酸甘油片治療后顯示有效的患者;(3)心電圖顯示:各個導(dǎo)聯(lián)出現(xiàn)缺血型的ST-T段的改變,并且在發(fā)病時與不發(fā)病時有明顯的改變,未因COPD發(fā)作期的治療而消除病狀;(4)發(fā)生的持續(xù)性、頻發(fā)性的室性期前收縮,未在發(fā)作期的治療后,消除病狀;(5)經(jīng)過X線的檢查,存在有左室的增大、全心的增大,排除風(fēng)濕性的心臟病、心肌病、高血壓性的心臟病導(dǎo)致的;(6)所有的患者均是自愿參與的本次研究,同時在參與的治療研究前,簽署了知情同意書�；颊呷朐汉罅⒓唇o予他們氧氣吸入、抗菌藥物、解痙、平喘、化痰及常規(guī)的水電解質(zhì)之間平衡治療,同時給予他們擴(kuò)冠、抗凝、抗血小板聚集、降壓、降糖、利尿、營養(yǎng)心肌等一般治療,必要時使用溶栓、急診PCI等治療。觀察的指標(biāo):對兩組的患者進(jìn)行治療前后所做的用力肺活量(FVC)、第一秒的用力呼氣容積(FEV1)、FEV1所占預(yù)計(jì)值的百分比(FEV1%)、6鐘的步行距離(6MWD)、癥狀的改善、心電圖的變化等能進(jìn)行的對比分析。療效判定標(biāo)準(zhǔn):顯效:經(jīng)過治療后,患者心率的變化范圍在每分鐘60 - 90次,靜息時的心電圖顯示為正�；驘o動態(tài)改變,患者的步行距離增加500m以上;有效:經(jīng)過治療后,患者心率出現(xiàn)的變化范圍在每分鐘90 - 110次,偶爾有發(fā)生過心臟早搏,心電圖的ST段下移在0.02mv以內(nèi),患者的步行距離增加500m以內(nèi);無效:經(jīng)治療后,患者的臨床癥狀、疾病體征及影像學(xué)檢查結(jié)果均無明顯變化,甚至治療無效死亡。統(tǒng)計(jì)學(xué)方法本研究所有數(shù)據(jù)均采用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì),計(jì)量資料用(x±s)進(jìn)行表示,采用配對T檢驗(yàn);計(jì)數(shù)資料用%表示,采用X2檢驗(yàn),P0. 05表示差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果對所有的患者進(jìn)行的臨床治療顯示的有效率來分析:這其中的89例患者(冠心病合并COPD),通過綜合治療,顯效的病人有53例,所占比例是59.55%,有效的病人有35例,所占比例是39.33%,無效的病人有1例,所占比例是1.12%,臨床上治療的有效率是98. 88%。結(jié)論冠心病及COPD是臨床上非常常見的疾病和多發(fā)的疾病,在進(jìn)行抗感染、平喘和祛痰基礎(chǔ)之上增加氧療、糾正水電解質(zhì)的紊亂、抗凝、抗血小板的聚集、降脂、擴(kuò)張血管、戒煙、限酒、生活規(guī)律、提高運(yùn)動量等綜合的規(guī)范化的治療,能明顯提升冠心病合并COPD的患者在生存質(zhì)量和肺功能方面的指標(biāo)。
[Abstract]:Research background now, with the increase of high salt and high fat food, the increase of work stress and irregular lifestyle, more and more people with high blood pressure, diabetes, obesity and other diseases have been added to the habit of smoking and drinking and other bad habits, and the people with coronary artery disease (coronary artery disease) are also coming from year by year. At the same time, environmental pollution is serious, automobile exhaust, smog, smoking and other factors seriously affect people's respiratory health, and the number of people with chronic obstructive pulmonary disease (COPD) is increasing. Moreover, China is a large population and is in the aging stage of population. The elderly are another cause of coronary heart disease and COPD. Therefore, there are coronary heart disease and C in clinical. OPD patients also more and more chronic hypoxia in.COPD can accelerate the development of coronary heart disease. Patients with coronary heart disease are prone to heart failure due to long-term coronary artery ischemia, which can obstruct the pulmonary circulation of COPD patients and promote the formation of pulmonary hypertension. The two people interact and aggravate each other. The purpose of this study is to explore the patients with coronary heart disease combined with COPD. The clinical characteristics and prognosis were selected from January 2015 to November 2015. 89 patients with coronary heart disease combined with COPD were treated in the income Hospital of our hospital (Xiaye County People's Hospital). Among them, there were 54 male patients, 35 female patients and 61-89 years of age. The average age was (74.51 + 2.22) years and the hospitalization time was 14-21. The average duration of hospitalization was (17.21 + 3.11) days, including 35 patients with obesity, 29 patients with diabetes, 25 patients with hypertension, 16 patients with acute myocardial infarction, 39 patients with frequent premature beats, 34 patients with old myocardial infarction, color Doppler echocardiography, and enlarged left ventricle. 36 cases of patients, 32 cases of enlarged right ventricle, 12 cases of full heart enlargement, 19 patients with significantly increased myocardial enzymes. The inclusion criteria of cases were: (1) all the patients were selected, their clinical symptoms and results were consistent with the diagnosis and diagnosis of ischemic heart disease and the diagnosis of chronic obstructive disease. Standard; (2) a history of typical and atypical episodes of angina pectoris, which showed an effective patient after taking a drug Nitroglycerin Tablets; (3) the electrocardiogram showed a change in the ST-T segment of the blood type in each lead, and a significant change during the onset of the onset of the disease, without the treatment of the COPD attack; (4) the duration of the occurrence of the disease. Sex, frequent ventricular premature contraction, and no symptoms after the treatment of the episodes; (5) the X-ray examination revealed that the left ventricle increased, the heart increased, the rheumatic heart disease, the cardiomyopathy, the hypertensive heart disease were excluded; (6) all the patients were voluntarily participated in this study, and before the participation of the treatment study, The patients were given an informed consent form. The patients were given oxygen inhalation, antispasmodic, antispasmodic, antispasmodic, phlegm and conventional water and electrolyte balance treatment immediately after admission, and gave them general treatment of crowns, anticoagulants, anti platelet aggregation, depressurization, hypoglycemic, diuresis, and nutritional myocardium, with thrombolytic and emergency PCI treatment when necessary. Index: the forced vital capacity (FVC), the first second forced expiratory volume (FEV1), the percentage (FEV1%) of the expected value of FEV1, the 6 clock walk distance (6MWD), the improvement of the symptoms, the changes of the electrocardiogram, and so on. The criterion of the curative effect: the change of heart rate after treatment: after treatment. 60-90 times a minute, the resting electrocardiogram showed normal or no dynamic changes, the patient's walking distance increased by more than 500m; effective: after treatment, the patient's heart rate changes were 90-110 times per minute, the occasional cardiac premature beat, the ST segment of electrocardiography below 0.02mv, and the patient's walking distance increased. In addition to 500m, null and void: after treatment, the clinical symptoms, signs and imaging results of the patients had no obvious changes, even the death of the treatment. All the data were statistically analyzed by SPSS13.0 software, the measurement data were expressed with (x + s), and the paired T test was used, and the count data were expressed with%, Using X2 test, P0. 05 indicated that the difference was statistically significant. Results the effective rate of clinical treatment for all patients was analyzed: 89 of them (coronary heart disease combined with COPD), through comprehensive treatment, 53 cases of the effective patients were 59.55%, the effective patients had 35 cases, the proportion was 39.33%, invalid patients. 1 cases, the proportion is 1.12%, the effective rate of clinical treatment is 98. 88%. conclusion coronary heart disease and COPD is a very common disease and multiple diseases, on the basis of anti infection, antiasthmatic and expectorant on the basis of oxygen therapy, correction of water and electrolyte disorders, anticoagulant, anti blood plate aggregation, lipid lowering, dilatation of blood vessels, smoking cessation, alcohol limit, life Regular and standardized treatment can significantly improve the quality of life and pulmonary function in patients with coronary heart disease complicated with COPD.

【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】：R541.4;R563.9

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本文編號：1866549