kimantawa na asibiti game da tasirin katifa mai hana rashin lafiyan sutura a cikin marasa lafiya tare da matsakaicin matsakaicin matsakaicin asma da rashin lafiyar kurar gida: nazarin binciken makafi biyu bazuwar.

Bayani: Amfani
Katifa mai rashin lafiyan rufewa a cikin marasa lafiya na asma na iya haifar da raguwa mai yawa a matakin ƙurar ƙurar gida a samfuran ƙura.
Bugu da ƙari, nama amine-induced raguwar hawan hawan iska, akwai ƙananan bayanai don nuna tasirin katifa a kan ingancin asibiti da ingancin rayuwa a marasa lafiya tare da matsakaici zuwa matsananciyar asma.
Hanyoyi: An yi nazarin marasa lafiya talatin da ciwon asma da rashin lafiyar kura kurar gida a cikin bazuwar, makafi biyu, binciken sarrafa wuribo.
Kafin da kuma bayan amfani
Murfin alerji na shekara 1 yana tattara ƙura daga katifa don ƙayyade yawan dermat a cikin Gidan (Der p 1)
An auna yawan karfin hawan iska da ingancin rayuwa.
Mai haƙuri ya zana alamun (huhu da hanci)
, Safiya da maraice kololuwar ƙima, maganin ceto 14 kwanaki kafin da bayan sa baki.
Sakamako: idan aka kwatanta da pre-jiyya, ƙaddamar da Der p1 a cikin ƙurar da aka tattara ta katifa a cikin rukunin jiyya mai aiki ya ragu sosai bayan shekara 1;
Ba a sami canje-canje a rukunin placebo ba.
A cikin jiyya mai aiki da ƙungiyoyin placebo, babu wani ci gaba mai mahimmanci a cikin PC20 tissue amin.
Ingancin rayuwa a cikin ƙungiyoyin biyu ya inganta haka.
A cikin ƙungiyoyin biyu, babu wani canji mai mahimmanci a cikin alamar alamar ƙananan iska.
Idan aka kwatanta da riga-kafi, alamar alamun hanci na ƙungiyar jiyya mai aiki ya ragu sosai, amma babu wani babban bambanci tsakanin ƙungiyoyin biyu.
Babu ɗayan ƙungiyoyin da suka sami canje-canje a cikin ƙimar ƙimar kololuwar safiya da maraice, kololuwar canjin kwarara, da amfani da magungunan ceto.
Kammalawa: Yi amfani da juriya
Rashin lafiyar katifa yana haifar da raguwa sosai a cikin tattarawar Der p1 a cikin ɗakunan dakunan da ba su da kafet.
Duk da haka, a cikin marasa lafiya tare da matsakaici zuwa matsananciyar asma, wannan tasiri mai tasiri na rashin lafiyar jiki ba zai shafi hyperresponsiveness na iska da sigogi na asibiti ba.
Hanyoyin daga Janairu 1996 zuwa Disamba 1998, marasa lafiya 38 masu shekaru 11-44 tare da tarihin asma da rashin lafiyar kura gida an dauki su daga asibitin asma a hilverum, Netherlands.
An samu izini daga majiyyaci ko daga iyayensa ko ta.
An zaɓi waɗannan marasa lafiya bisa la'akari da karuwar amsawar hanyar iska zuwa shakar amine nama (
PC20 1 μg Der p 1/g kura).
Fiye da 60% na duk marasa lafiya (ƙimar Hasashen).
Marasa lafiya ba su da tarihin cututtukan numfashi a cikin makonni 6 da suka gabata kuma ba su da mummunan harin asma a cikin watanni 6 da suka gabata.
A cikin watanni shidan da suka gabata, babu wanda ya sami maganin steroid na baka.
Duk marasa lafiya sun sanar da izini.
Kwamitin da'a na likitanci na Asthmacenter heuvel ya amince da binciken.
Ƙirar nazarin wannan binciken ya kasance bazuwar, mai sarrafa wuribo, makafi biyu, ƙirar rukuni-rukuni wanda idan aka kwatanta tasirin marufi marasa shigar alerji akan katifa, matashin kai, da murfin gado a cikin shekara 1 da madaidaicin marufi na placebo.
A farkon binciken, wata ƙwararriyar ma'aikaciyar jinya ta numfashi ta ziyarci majiyyaci, ta tattara samfuran ƙura daga katifar majinyacin don ma'aunin Der p1, kuma ta rubuta matakan gujewa allergen da suka rigaya a gida.
Duk marasa lafiya da aka haɗa a cikin binciken suna da benayen ɗakuna masu santsi.
An umurci mai haƙuri don tsaftace zanen gado a 60 ° C a mako guda
Baya ga marufi na katifa, ba a ɗauki wasu matakan don guje wa allergens ba.
A karshen binciken, ma'aikaciyar jinyar ta sake ziyartar gidajen don kwashe ƙura daga gadajen gado.
An haɗa mai haƙuri a duk shekara;
Lokacin haɗawa shine shekaru 2.
An gwada marasa lafiya da rashin lafiyar pollen a wajen lokacin pollen.
A ziyarar farko, an tantance mai haƙuri a asibiti.
Ƙarfin rayuwa (VC)
An auna ma'auni, an yi gwajin fata, kuma an kimanta PC20 tissue Amine.
Dakatar da shan kwayoyi kafin lokacin binciken: Inhaled steroids da sodium acetate don mako 1 kafin gwajin motsa jiki na trachea tissue amine;
Kafin gwajin, maganin theophylline, magungunan beta 2 adrenaline na baka, magungunan beta 2 adrenaline da aka yi amfani da su na dogon lokaci, da maganin antihistatine sun dau tsawon sa'o'i 48, kuma shakar magungunan beta 2 adrenaline na gajeren lokaci ya dauki tsawon sa'o'i 6.
Tattara da hakar ƙurar gida kafin, watanni 4 da 8 na sa baki kuma a ƙarshen saƙon ana tattara shi ta hanyar injin tsabtace gida ɗaya (
Philips Vitall 377,1300 Watt, Philips, Eindhoven, Netherlands)
Yi amfani da na'urar tacewa ta musamman daga dukkan katifa a cikin mintuna 2 (
ALK in Holsham, Denmark).
A farkon binciken, tattara ƙura kai tsaye daga katifa;
A ƙarshen binciken, an tara ƙura a saman sansanin.
Ana adana tacewa a cikin firiji a-20 ° C har sai an yi bincike a ƙarshen binciken.
Ƙaddamar da Der P1 antigen ta elisa (ELISA).
Monoclonal antibody da Der p1 an gyara shi a farantin rijiyar 96.
Bayan shiryawa tare da tsattsauran ƙura, mataki na biyu an haɗa shi tare da antibody-valent multi-valent.
Sunflower a kan-enzyme.
Bayan an ƙara 1, 2-
Don diamine HCl (OPD)
A matsayin substrate, an auna sha a 490 nm ta amfani da mai karanta ELISA.
Tissue amin phosphate mafita (
Hankali biyu daga 0. 25 zuwa 32 mg/ml)
Ana gudanarwa ta De Vilbiss 646 nebulizer tare da fitowar 0. 13 mg/ml.
An ɗora nebulizer akan akwatin bawul tare da tace aerosol.
Lokacin atomization shine 30 seconds lokacin da aka umurci majiyyaci ya yi numfashi a hankali.
An fara wannan gwajin tare da shakar phosphate buffer aerosol.
VC guda uku da ma'aunin fev kafin inhalation (
Masterscreen).
An auna V1 bayan kowane taro.
PC20 tissue amin an samo shi ta hanyar haɗin kai tsaye.
An nannade katifa, matashin kai da katifa na ƙungiyar masu shiga tsakani a cikin LID da Carla c\'air ta bayar (
Allergy Control AC btm Velserbroek, Netherlands).
Kamfani ɗaya ne ya yi madaidaicin murfin placebo.
Sansanin, wanda ma'aikaciyar jinya ta bincike ta shirya, ya zauna a wurin har tsawon shekara 1.
Ingantacciyar rayuwa ta hanyar ingancin tambayoyin rayuwa don cututtukan numfashi (QoL-RIQ). 17 QUL-
RIQ tambaya ce ta ƙayyadaddun yanayin cutar ga marasa lafiya da ke fama da asma da kuma na yau da kullun, wanda ya ƙunshi abubuwa 55, an raba shi zuwa yankuna bakwai: matsalolin numfashi (abubuwa 9)
Matsalolin jiki (Abu 9), motsin rai (Abu 9)
, Haɓaka / haɓaka yanayin matsalolin numfashi (abubuwa 7)
Ayyukan gama gari (Abubuwa 4)
Ayyukan yau da kullun da na gida (abubuwa 10)
Ayyukan zamantakewa, hulɗar juna da jima'i (abubuwa 7).
Domin a mai da hankali kan matsalar a kan ƙwarewar majiyyaci, aikin ya dogara ne akan "yawancin matsala" da suka fuskanta daga alamomin da ke sama ko motsin rai.
Dangane da ayyukan da suka shafi ayyuka, tambayar ita ce \" nawa aka hana su gudanar da wannan takamaiman aiki \".
An tambayi marasa lafiya su ba da amsoshinsu akan ma'aunin Likert mai maki 70, daga \"ba kwata-kwata" zuwa "mafi tsanani" damuwa ko toshewa. Dogara (gwaji-
Sake jarrabawa, daidaiton ciki)
Kuma ya tabbatar da ingancinsa.
17 sigogi na asibiti a cikin kwanakin 14 kafin shiga tsakani da kuma a ƙarshen watanni 12 na busassun fata na buƙatar marasa lafiya don yin rikodin katunan diary don ciwon fuka da alamun hanci, ƙima mai girma, da rikodin magani sau biyu a rana.
Alamomin asma sun hada da wahalar numfashi, tari, tari da numfashi.
Alamomin hanci sun haɗa da cunkoson hanci, atishawa da ƙaiƙayi.
An raba kowane abu daga maki 0 (babu alamomi) zuwa 4 (Alamomi masu tsanani).
An horar da marasa lafiya don yin aikin motsa jiki kololuwa ta amfani da ƙananan kayan aikin Wright.
An umurce su da su yi karatu uku da rubuta mafi girman darajar idan sun tashi da safe da kuma kafin su kwanta da dare.
An nemi majiyyata da su ci gaba da maganin shaka na yau da kullun da kuma yin rikodin ƙarin maganin ceto idan suna buƙatarsa.
An yi nazarin bayanai da ƙididdigar ƙididdiga tare da SPSS.
Kwatancen rukuni (
Kafin da kuma bayan sa baki)
An yi tare da bitar sa hannun Wilcoxon.
Yi nazarin bayanan log ta amfani da gwaje-gwajen alamomi. Da Mann-
Anyi amfani da gwajin Whitney U don kwatanta ƙungiyoyin ƙungiyoyi. p darajar 0. 5)
A cikin ƙungiyar kulawa da ƙungiyar placebo, akwai maki 18 don matsalolin numfashi, matsalolin jiki da ke hade da matsalolin ƙirji, faɗakarwa / haɓakawa, da jimlar ƙima.
Kodayake babu wani bambanci mai mahimmanci a cikin haɓakar haɓakawa tsakanin ƙungiyoyin biyu, haɓakawa a cikin rukunin jiyya yana da mahimmanci.
Babu wani muhimmin bambanci a cikin ƙimar asali na sigogi na asibiti don maki alamun asma tsakanin ƙungiyoyi (tebur 2).
Makin alamar huhu na tsakiya na ƙungiyoyin biyu bai canza sosai a cikin shekara 1 ba.
Makin alamar alamun hanci na rukunin jiyya ya ragu sosai (p=0. 04)
Amma ba a cikin rukunin placebo ba.
Bambancin da ke tsakanin ƙungiyoyin biyu ba shi da mahimmanci.
Ƙimar asali (ef)
Safiya da maraice)
Ƙungiyoyin biyu suna kama da juna (tebur na 3).
Bayan shekara 1 na shiga tsakani, babu wani canji mai mahimmanci a safiya da maraice ef, kololuwar sauye-sauye ko amfani da magungunan ceto a cikin ƙungiyoyin marasa lafiya biyu.
Duba wannan tebur: Duba layi Duba tebur mai fafutuka 2 alamar alama kafin da bayan sa baki (
Rijistar matsakaici a cikin kwanaki 14)
Duba wannan tebur: Duba layin kan layi Duba tebur mai fafutuka 3 ƙimar zirga-zirga mafi girma kafin da bayan sa baki (
Rijistar matsakaici a cikin kwanaki 14)
Manufar wannan binciken shine yin karatu
A cikin kunshin katifa mai rashin lafiyan a cikin ɗakin kwana marar kafet, wanda aka fallasa zuwa Der p1 akan gado, rashin lafiyar kurar gida a cikin marasa lafiya masu matsakaici zuwa asma mai tsanani.
Mun sami raguwa mai yawa a cikin tattarawar Der p1 a cikin ƙurar da aka tattara ta katifa a cikin rukunin jiyya mai aiki idan aka kwatanta da ƙungiyar placebo.
PC20 tissue Amine bai inganta ba yayin sa baki na shekara 1.
Ko da yake an sami ci gaba mai mahimmanci a cikin alamun hanci da ingancin rayuwa kawai a cikin ƙungiyar kulawa mai aiki, ba mu sami wani bambanci mai mahimmanci tsakanin ƙungiyar placebo da ƙungiyar kulawa mai aiki a cikin canje-canje a cikin huhu da bayyanar cututtuka na hanci, ingancin rayuwa, ƙimar ƙimar girma, da amfani da magungunan ceto.
Nazarin farko da aka yi amfani da nau'ikan marufin katifa iri-iri kuma ya nuna raguwar bayyanar Der p1 a saman katifa (tebu na 4).
Duk da haka, wasu nazarin ba su nuna raguwa a cikin tattarawar Der p1 ba, kuma a cikin waɗannan nazarin ba a cire kafet a cikin ɗakin kwana ba.
21,22 mun ware batun cutar Der p1 daga bene na 13 ta hanyar haɗawa kawai marasa lafiya waɗanda ba su da kafet a cikin ɗakin kwana.
Wannan na iya haifar da gaskiyar cewa, kodayake ƙaddamarwarmu ta Der p1 ta fi girma fiye da sauran karatun, za mu iya raguwa sosai a cikin rukunin da ake bi da su.
22, 23 raguwa a cikin ƙaddamarwar allergen ya kai bayan watanni 4 kuma ya kasance ba canzawa a duk lokacin nazarin.
Dubi wannan tebur: Duba cikin layi Duba tebur mai tasowa 4 Takaitacciyar sakamako da saitunan katifa mai kulawa da ke rufe binciken ko da yake an rage yawan maida hankali na Der p1 a cikin rukunin jiyya mai aiki idan aka kwatanta da ƙungiyar placebo, ba mu sami raguwa mai yawa a cikin hyperresponsiveness na iska ba.
Sauran nazarin kuma sun kasa nuna ci gaba a cikin karfin hawan iska.
Nazarin guda biyu 22, 23, 10, 11, 22 ba su sami raguwa mai yawa a cikin ƙwayar allergen a cikin ƙura ba, wanda ya bayyana rashin ingantawa a cikin hyperreactivity na iska.
Frederick et al ya ce duk marasa lafiya suna da kulawa da kyau a cikin maganin rigakafi na yau da kullum, don haka babu wani canji ko canji a cikin sigogi na asibiti.
Ko da Cloosterman da abokan aikinsa, 11 mutanen da suka yi ƙoƙari su guje wa wannan sakamako na warkewa ta hanyar kawai ciki har da marasa lafiya waɗanda ba su yi amfani da steroids ba ko kuma sun iya dakatar da su, ba su sami ci gaba mai mahimmanci a cikin hyperresponsiveness na iska ba, babu wani ci gaba mai mahimmanci a cikin kowane nau'i na asibiti da aka yi amfani da su, irin su alamun alamun, ef variability, da kuma sake dawowa na F1.
Ta yaya za mu daidaita waɗannan ra'ayoyin?
Duk da ƙarancin ƙwayar cortisol mai inhaled, marasa lafiya da ke cikin bincikenmu suna da hyperreactivity (> 800 μg)
Sabanin haka, PC20