中华地方病学杂志
中華地方病學雜誌
중화지방병학잡지
Chinese Journal of Endemiology
2013年
5期
500-503
,共4页
克山病%临床路径%卫生计划实施%治疗结果
剋山病%臨床路徑%衛生計劃實施%治療結果
극산병%림상로경%위생계화실시%치료결과
Keshan disease%Critical pathways%Health plan implementation%Treatment outcome
目的 探索慢型克山病临床路径在病区的初步实施情况及应用效果.方法 2010年,选取陕西省黄陵县及旬邑县2个克山病重病区76例慢型克山病患者作为观察对象,在口服亚硒酸钠的基础上,采用血管紧张素转化酶抑制剂(卡托普利)、β受体阻滞剂(普萘洛尔)、利尿剂(氢氯噻嗪、螺内酯)及强心剂(地高辛)作为固定组方,治疗全部患者4个月.分析治疗前后患者的心功能分级、心胸比值、心电图、左室射血分数(EF)及短轴缩短率(FS)的变化情况,进而评价治疗效果.结果 76例慢型克山病患者中74例完成服药观察.治疗后,心功能改善总有效率达81.1％(60/74)；异位心律消失率为37.5％(9/24),传导阻滞消失率为2.8％ (1/36),ST-T改变消失率为26.9％ (7/26).心功能Ⅱ、Ⅲ、Ⅳ级患者治疗后心胸比值(0.486±0.048、0.538±0.046、0.607±0.048)较治疗前(0.504±0.051、0.572±0.054、0.632±0.063)明显减小(t值分别为2.643、6.641、3.005,P均＜ 0.05),而治疗前后心胸比值差值(0.017±0.029、0.033±0.031、0.024±0.035)比较,差异无统计学意义(F=3.005,P＞ 0.05).EF轻度减低(35％≤EF＜ 50％)及中-重度减低(EF＜35％)患者治疗后EF值[(48.21±10.01)％、(36.57±6.60)％]明显高于治疗前[(43.62±4.58)％、(27.57±3.69)％,t值分别为-2.911、-3.334,P均＜0.05],治疗前后EF差值[(4.59±8.48)％、(9.00±7.14)％]比较,差异无统计学意义(P＞ 0.05);FS减低(FS＜ 25％)患者治疗后FS值[(21.92±5.67)％]较治疗前[(19.75±2.88)％]明显提高(t=-2.297,P＜ 0.05).结论 慢型克山病临床路径在病区可操作性强,固定药物组方疗效显著.
目的 探索慢型剋山病臨床路徑在病區的初步實施情況及應用效果.方法 2010年,選取陝西省黃陵縣及旬邑縣2箇剋山病重病區76例慢型剋山病患者作為觀察對象,在口服亞硒痠鈉的基礎上,採用血管緊張素轉化酶抑製劑(卡託普利)、β受體阻滯劑(普萘洛爾)、利尿劑(氫氯噻嗪、螺內酯)及彊心劑(地高辛)作為固定組方,治療全部患者4箇月.分析治療前後患者的心功能分級、心胸比值、心電圖、左室射血分數(EF)及短軸縮短率(FS)的變化情況,進而評價治療效果.結果 76例慢型剋山病患者中74例完成服藥觀察.治療後,心功能改善總有效率達81.1％(60/74)；異位心律消失率為37.5％(9/24),傳導阻滯消失率為2.8％ (1/36),ST-T改變消失率為26.9％ (7/26).心功能Ⅱ、Ⅲ、Ⅳ級患者治療後心胸比值(0.486±0.048、0.538±0.046、0.607±0.048)較治療前(0.504±0.051、0.572±0.054、0.632±0.063)明顯減小(t值分彆為2.643、6.641、3.005,P均＜ 0.05),而治療前後心胸比值差值(0.017±0.029、0.033±0.031、0.024±0.035)比較,差異無統計學意義(F=3.005,P＞ 0.05).EF輕度減低(35％≤EF＜ 50％)及中-重度減低(EF＜35％)患者治療後EF值[(48.21±10.01)％、(36.57±6.60)％]明顯高于治療前[(43.62±4.58)％、(27.57±3.69)％,t值分彆為-2.911、-3.334,P均＜0.05],治療前後EF差值[(4.59±8.48)％、(9.00±7.14)％]比較,差異無統計學意義(P＞ 0.05);FS減低(FS＜ 25％)患者治療後FS值[(21.92±5.67)％]較治療前[(19.75±2.88)％]明顯提高(t=-2.297,P＜ 0.05).結論 慢型剋山病臨床路徑在病區可操作性彊,固定藥物組方療效顯著.
목적 탐색만형극산병림상로경재병구적초보실시정황급응용효과.방법 2010년,선취합서성황릉현급순읍현2개극산병중병구76례만형극산병환자작위관찰대상,재구복아서산납적기출상,채용혈관긴장소전화매억제제(잡탁보리)、β수체조체제(보내락이)、이뇨제(경록새진、라내지)급강심제(지고신)작위고정조방,치료전부환자4개월.분석치료전후환자적심공능분급、심흉비치、심전도、좌실사혈분수(EF)급단축축단솔(FS)적변화정황,진이평개치료효과.결과 76례만형극산병환자중74례완성복약관찰.치료후,심공능개선총유효솔체81.1％(60/74)；이위심률소실솔위37.5％(9/24),전도조체소실솔위2.8％ (1/36),ST-T개변소실솔위26.9％ (7/26).심공능Ⅱ、Ⅲ、Ⅳ급환자치료후심흉비치(0.486±0.048、0.538±0.046、0.607±0.048)교치료전(0.504±0.051、0.572±0.054、0.632±0.063)명현감소(t치분별위2.643、6.641、3.005,P균＜ 0.05),이치료전후심흉비치차치(0.017±0.029、0.033±0.031、0.024±0.035)비교,차이무통계학의의(F=3.005,P＞ 0.05).EF경도감저(35％≤EF＜ 50％)급중-중도감저(EF＜35％)환자치료후EF치[(48.21±10.01)％、(36.57±6.60)％]명현고우치료전[(43.62±4.58)％、(27.57±3.69)％,t치분별위-2.911、-3.334,P균＜0.05],치료전후EF차치[(4.59±8.48)％、(9.00±7.14)％]비교,차이무통계학의의(P＞ 0.05);FS감저(FS＜ 25％)환자치료후FS치[(21.92±5.67)％]교치료전[(19.75±2.88)％]명현제고(t=-2.297,P＜ 0.05).결론 만형극산병림상로경재병구가조작성강,고정약물조방료효현저.
Objective This present study explores and evaluates the effect of preliminary implementation in the clinical therapy programs for patients with chronic Keshan disease (CKD) in the disease seriously-affected endemic areas.Methods In 2010,seventy-six CKD patients with heart failure were chosen from Huangling and Xunyi Counties in Shaanxi Province,where incidences of CKD were high.Besides taking sodium selenite,all patients were given treatment with fixed prescription,which included angiotensin-converting enzyme inhibitor (captopril),β-blocker (propranolol),diuretics (hydrochlorothiazide,spironolactone) and cardiac (digoxin) for 4 months.The changes before and after treatment were analyzed,which included the changes of heart function by the United States of America New York Heart Association(NYHA) fractionation,cardiothoracic ratio,electrocardiogram,left ventricular ejection fraction(EF) and fractional shortening(FS).The therapeutic effect was subsequently evaluated.Results Seventy-four cases of the seventy-six CKD patients completed the treatment observation.The improvement rate of heart function was 81.1％ (60/74) after treatment.The elimination rates of ectopic rhythm,conduction block and ST-T changes were 37.5％ (9/24),2.7％ (1/36) and 26.9％ (7/26),respectively.The cardiothoracic ratios of heart function NYHA Ⅱ,Ⅲ and Ⅳ were 0.504 ± 0.051,0.572 ± 0.054 and 0.632 ± 0.063 before treatment.After treatment,the cardiothoracic ratios were 0.486 ± 0.048,0.538 ± 0.046 and 0.607 ± 0.048,which were reduced in all groups (t =2.643,6.641,3.005,all P ＜ 0.05),while the D-value of cardiothoracic ratio changes before and after treatment was not significantly different(F =3.005,P ＞ 0.05).Both the mild reduction group(35％≤EF ＜ 50％) and the moderate-severe group(EF ＜ 35％) EF were (43.62 ± 4.58)％,(27.57 ± 3.69)％ before treatment and were (48.21 ± 10.01)％,(36.57 ± 6.60)％ after treatment,EF were increased in the two groups,while the changes before and after treatment were significantly different(t =-2.911,-3.334,all P＜ 0.05).The EF D-value of the two groups was (4.59 ± 8.48)％ before treatment and was (9.00 ± 7.14)％ after treatment,which were not significantly different(P ＞ 0.05).FS was higher compared with pre-treatment in FS reduction group(FS ＜ 25％) and the changes before and after treatment[(19.75 ± 2.88)％,(21.92 ± 5.67)％] were significantly different(t =-2.297,P ＜ 0.05).Conclusions This study shows that the feasibility of clinical treatment of patients with CKD is very promising.The treatment of fixed prescription is effective.
