何钦, 刘永泉, 王智, 李艳文, 容开萍. 汉防己甲素联合改良缩唇呼吸对矽肺合并稳定期慢性阻塞性肺疾病患者的效果观察[J]. 环境与职业医学, 2021, 38(3): 282-287. DOI: 10.13213/j.cnki.jeom.2021.20275
引用本文: 何钦, 刘永泉, 王智, 李艳文, 容开萍. 汉防己甲素联合改良缩唇呼吸对矽肺合并稳定期慢性阻塞性肺疾病患者的效果观察[J]. 环境与职业医学, 2021, 38(3): 282-287. DOI: 10.13213/j.cnki.jeom.2021.20275
HE Qin, LIU Yongquan, WANG Zhi, LI Yanwen, RONG Kaiping. Effects of tetrandrine combined with modified pursed lip breathing on silicosis patients complicated with stable chronic obstructive pulmonary disease[J]. Journal of Environmental and Occupational Medicine, 2021, 38(3): 282-287. DOI: 10.13213/j.cnki.jeom.2021.20275
Citation: HE Qin, LIU Yongquan, WANG Zhi, LI Yanwen, RONG Kaiping. Effects of tetrandrine combined with modified pursed lip breathing on silicosis patients complicated with stable chronic obstructive pulmonary disease[J]. Journal of Environmental and Occupational Medicine, 2021, 38(3): 282-287. DOI: 10.13213/j.cnki.jeom.2021.20275

汉防己甲素联合改良缩唇呼吸对矽肺合并稳定期慢性阻塞性肺疾病患者的效果观察

Effects of tetrandrine combined with modified pursed lip breathing on silicosis patients complicated with stable chronic obstructive pulmonary disease

  • 摘要: 背景

    矽肺合并慢性阻塞性肺疾病(COPD)的治疗尚无特效药物。

    目的

    探究汉防己甲素联合改良缩唇呼吸对矽肺合并COPD稳定期患者血氧水平、呼吸功能及生活自理能力的影响。

    方法

    以2018年6月—2020年1月江西省职业病防治研究院门诊部收治的矽肺合并COPD稳定期患者81例为研究对象,采用随机数字表法将其分为药物治疗组(40例)和联合治疗组(41例),药物治疗组仅给予汉防己甲素治疗,联合治疗组给予汉防己甲素联合改良缩唇呼吸治疗。分别检测两组患者治疗前、后动脉血气指标动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、肺功能指标用力肺活量(FVC)、第1秒用力呼气容积占预测值的百分比(FEV1百分比)、肺最大通气量占预测值的百分比(MVV百分比)和FEV1/FVC、呼吸频率、6 min步行距离、改良版英国医学研究理事会(mMRC)评分、日常生活活动能力(ADL),并比较治疗前后指标变化。

    结果

    本研究纳入的81例矽肺合并COPD稳定期患者均为男性。药物治疗组和联合治疗组的年龄、体重指数、矽肺病程、COPD病程以及矽肺临床分期分布差异无统计学意义。治疗前,两组动脉血气指标和肺功能指标等观察指标差异也均无统计学意义。治疗后药物治疗组PaCO2、mMRC、呼吸频率分别为(43.99±5.01)mmHg、(1.97±0.21)分、(23.09±2.02)次·min-1,联合治疗组分别为(38.09±3.04)mmHg、(1.52±0.19)分、(17.99±1.05)次·min-1,均较治疗前降低,且联合治疗组低于药物治疗组(P < 0.05)。治疗后药物治疗组SaO2、PaO2、FVC、FEV1百分比、MVV百分比、FEV1/FVC分别为(86.69±8.57)%、(70.57±7.17)mmHg、(2.59±0.30)L、(77.69±7.47)%、(69.17±7.02)%、(56.24±5.69)%,联合治疗组分别为(98.49±9.15)%、(80.02±8.59)mmHg、(3.15±0.35)L、(86.29±8.05)%、(80.02±8.09)%、(63.01±6.52)%,较治疗前升高,且联合治疗组高于药物治疗组(P < 0.05)。治疗后药物治疗组6 min步行距离为(337.65±35.41)m,联合治疗组为(388.29±39.05)m,联合治疗组较药物治疗组延长(P < 0.05);药物治疗组呼吸频率、mMRC评分为(23.09±2.02)m、1.97±0.21,联合治疗组为(17.99±1.05)m、1.52±0.19,且联合治疗组低于药物治疗组(P < 0.05)。治疗3、6、9个月后药物治疗组ADL评分分别为(55.34±5.57)、(65.14±6.57)、(80.11±7.99)分,联合治疗组分别为(59.14±6.02)、(71.38±7.05)、(89.24±9.42)分,不同时间点两组ADL评分比较差异有统计学意义,均较治疗前升高,且联合治疗组高于药物治疗组(P < 0.05)。

    结论

    汉防己甲素联合改良缩唇呼吸治疗可明显改善矽肺合并COPD稳定期患者血氧水平,并有效提高患者的呼吸功能和生活自理能力,具备临床推广应用优势。

     

    Abstract: Background

    Currently, no specific medicine is available for silicosis complicated with chronic obstructive pulmonary disease (COPD).

    Objective

    This study investigates the effects of tetrandrine combined with a modified pursed lip breathing method on the blood oxygen level, respiratory function, and the ability of self care among silicosis patients complicated with COPD.

    Methods

    A total of 81 patients with silicosis and stable COPD admitted to the outpatient department of Jiangxi Province Institute of Occupational Disease Prevention and Control between June 2018 and January 2020 were selected as study subjects and divided into a drug therapy group (40 cases) and a combined treatment group (41 cases) by random number table method. The drug therapy group were treated with tetrandrine only, while the combined treatment group were treated with tetrandrine and a modified pursed lip breathing method. The arterial blood gas indicatorsarterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2), and arterial partial pressure of carbon dioxide (PaCO2), lung function indicatorsforced vital capacity (FVC), the percentage of predicted forced expiratory volume in 1 second (FEV1%), the percentage of predicted maximum ventilatory volume (MVV%), and FEV1/FVC, respiratory rate, 6-minute walking distance, modified Medical Research Council Dyspnea Scale (mMRC) scores, and activities of daily living (ADL) in both groups were detected and compared before and after the assigned treatment.

    Results

    The study included 81 male silicosis patients complicated with stable COPD. No differences were found between the drug therapy group and the combined treatment group in age, body mass index, silicosis duration, COPD duration, and silicosis stages. At baseline, there were also no differences in the observations such as arterial blood gas indicators and lung function indicators. After the designed treatment, the PaCO2 level, mMRC score, and respiratory rate of the drug therapy group were (43.99±5.01) mmHg, 1.97±0.21, and (23.09±2.02) times·min-1, respectively, and those of the combined treatment group were (38.09±3.04) mmHg, 1.52±0.19, and (17.99±1.05) times·min-1, respectively; these indicators were reduced after treatment compared with before, and the combined treatment group showed lower levels than the drug therapy group (P < 0.05). After the treatment, the SaO2, PaO2, FVC, FEV1%, MVV%, and FEV1/FVC of the drug therapy group were (86.69±8.57)%, (70.57±7.17) mmHg, (2.59±0.30) L, (77.69±7.47)%, (69.17±7.02)%, and (56.24±5.69)%, respectively, and those of the combined group were (98.49±9.15)%, (80.02±8.59) mmHg, (3.15±0.35) L, (86.29±8.05)%, (80.02±8.09)%, and (63.01±6.52)%, respectively; these indicators were increased after treatment compared with before, and the combined treatment group showed higher levels than the drug therapy group (P < 0.05). After the treatment, the 6-minute walking distance of the drug therapy group was (337.65±35.41) m, significantly shorter than (388.29±39.05) m of the combined treatment group (P < 0.05); the respiratory rate and the mMRC of the drug therapy group were (23.09±2.02) m and 1.97±0.21, significantly higher than (17.99±1.05) m and 1.52±0.19 of the combined treatment group (P < 0.05). At 3, 6, and 9 months after the treatment, the ADL scores of the drug therapy group were 55.34±5.57, 65.14±6.57, and 80.11±7.99, respectively, and those of the combined treatment group were 59.14±6.02, 71.38±7.05, and 89.24±9.42, respectively; the ADL scores were significantly different between the two groups at different time points after treatment, showing patterns like higher ADL scores after treatment than before, and higher ADL scores in the combined treatment group than in the drug therapy group (P < 0.05).

    Conclusion

    Tetrandrine combined with modified pursed lip breathing can remarkably improve the blood oxygen level in patients with silicosis complicated with stable COPD, as well as their respiratory function and self-care ability; therefore, the combined treatment deserves wide application.

     

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