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    長期氧療對矽肺病人的效果觀察
    關鍵字:觀察,效果,病人,長期,CD,EF,GH,AB,yz,uv, 發布時間:2011-08-21

    長期氧療對矽肺病人的效果觀察 孫曉林嚴文魁 214155江蘇無錫市惠山區陽山社區衛生 服務中心 關鍵詞矽肺氧療肺功能 doi:10.3969/j.iasn.1007—614x.2010. 25.030 矽肺是職業危害中最為特殊的一種 職業病例,由于它導致肺纖維化,形成硬 結、團塊,使肺功能嚴蘑破壞,這種對人體 肺組織的破壞過程是逐漸加重的。我們 對我院20例接受長期氧療的矽肺病人進 行了為期6年跟蹤觀察,現報告如下。 資料與方法 2003—2009年住院病人,其診斷均 按GB70—2009{塵肺診斷標準及處理原 則》職業病診斷標準。病例均為男性,接 觸粉塵種類均為石英塵,年齡60—85歲。 其中I期矽肺5例,Ⅱ期矽肺28例,Ⅲ期 矽肺7例。將病人隨機分為治療組和對 照組。20例矽肺病人為治療組,年齡72 ±12.5歲,接塵工齡12.3±3.40年,其中 I期2例、Ⅱ期15例、Ⅲ期3例;另2l例 矽肺為對照組,對象為種種原因如居家等 不規范吸氧的病人,年齡71.5士13歲,接 塵工齡13.6±2.8年,I期3例、Ⅱ期14 例、m期4例。兩組在年齡、接塵工齡、病 情程度、合并癥等方面差異均無統計學意 義(P>0.05),合并感染情況。 方法:經過抗感染、解痙平喘等治療 后,治療組于緩解期進行氧療。病人均使 用醫院中心供氧配減壓表和濕化瓶,予鼻 導管給氧,每日吸氧15~20小時,低氧流 量1.0~3.OL/分。對照組由于經常居家 等隨臨床表現臨時氧療。 合并癥診斷:根據胸部x線攝片、胸 部CT片、痰結核菌結果、肺功能,結合臨 床咳嗽、咯痰、發熱等表現進行診斷。 觀察指標:全部病人于緩解期治療前 進行1次肺功能、全胸片檢查。以后每年 定期檢查4次。治療l一6年后觀察兩組 病人6年生存率。 統計與處理:統計數據用(X±|s)表 示,組間比較采用t檢驗;生存率分析采 用∥檢驗。 結果 全胸片變化:治療組和與對照組1— 6年,全胸片均沒有明顯改變,無統計學 意義。 兩組肺功能比,見表1。 治療組與對照組用力呼氣肺活量 (FVC)無明顯變化,1秒鐘用力呼氣容積 (FVEl)治療組2年內有明顯提高,與基 礎值比較差異有統計學意義(P<0.01)。 對照組FEVl呈進行性下降,1-6年兩組 間比較差異有統計學意義(P<0.01)。 兩組6年牛存率比較,見表2。 衰2治療組及對照組生存率比較《偽} Z 絲型生查墨主全竺查壟蘭!蘭2. 治療組1462070 翌墨塾!!!!!翌. , ≥ 治療組6年生存率為90.2%,對照組為 45.6%;5年生存率治療組顯著高于對照 組(∥=7.452,P<O.01)。 討論 矽肺是塵肺中最為常見的一種類型, 因長期吸人含有游離二氧化硅粉塵所致, 表現為肺部廣泛的結節性纖維化,部分肺 泡融合成肺大泡,部分肺泡塌陷,肺毛血 管床受損而減少,肺的通氣和換氣功能下 降,長期的低氧血癥刺激腎臟產生促紅細 胞生成因子(FEO),致繼發性紅細胞增加。 同時,缺氧性酸中毒可使血管內皮細胞釋放 花生四烯酸及PGE-2,使血小板聚集增加。 臨床表現有3種形式:慢性矽肺、急性矽肺 和介于兩者之間的加速性矽肺,這兩種臨床 表現形式與接觸粉塵濃度、矽肺含量與接塵 年限有顯著關系,臨床以慢性矽肺最為常 見。氣促通常較早出現,呈進行性加重。早 期常感胸悶、胸痛,胸痛較輕微,為脹痛、隱 痛或刺痛,與呼吸、體體位及勞動無關。早 期由于吸入矽塵可出現刺激性咳嗽,并發感 染或吸煙者可有咳痰,少數患者有血痰,合 并肺結核、肺癌或支氣管擴張時可反復或大 量咯血,患者尚町有頭昏、乏力、失眠、心悸、 胃納不佳等癥狀。 矽肺病人免疫力較差,經常發生反復 肺部感染,血液中免疫球蛋白IgG、IgM及 纖維蛋白原增高,前者吸附于紅細胞表 面,使其電荷掩蓋,相互間極性排斥下降 而易聚集,同時缺氧也使紅細胞變應性下 降,上述因素可使血液黏度增加。同時, 矽肺病人呼吸道黏膜損傷合并支氣管炎, 呼吸道分泌物增加,長期的慢性炎癥和機 械刺激使呼吸系統自凈功能下降,極易發 生并發癥和腫瘤。長期持續氧療可使體 內PaO:可長時間維持較高水平,通過提 高氧合血紅蛋白的濃度增加氧化的物質 輸送,防止和逆轉缺氧所致的組織損傷和 血管功能障礙,因而能改善生活質量,提 高生存率。對于矽肺病病人特別足伴有 慢性呼吸衰竭者,應低流最持續給氧,一 般控制在1—3L/分,每日氧療至少15一 18小時。矽肺慢性呼吸衰竭通過長期氧 療能提高慢性呼吸衰竭病人PaO:,增加 組織供氧,改善心腦肺功能,降低肺動脈 壓、紅細胞和血黏度,減輕水鈉潴留,改善 呼吸困難和睡眠。因此,通過長期氧療有 效影響矽肺血液流變學指標,降低了血液 黏度,對于改善矽肺病人紅細胞的帶氧能 力和呼吸系統功能、減少并發癥、提高矽 肺病人的生活質量有重要意義。 參考文獻 1王展.塵肺患者133例胸片小陰影X線分 析[J].職業與健康,2009:25(15). 2 陳灝珠.實用內科學[M].北京:人民衛生 出版社。1997:719. 襲1治療組殛對照緝FVC、F吖l潞窀 一 ”~‘~ 一” ”“ ……—錫 i演:④聹閩比較(p<O.05);②組闋鼬技(P《O。01)。 ,???,.?,,娩 中國社區醫師?醫學專業2010年第為期(第12卷總剪250期)35 萬方數據 換頁

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