龙丹理肺汤治疗慢性阻塞性肺疾病急性加重期（痰热瘀肺证）的临床研究

发布时间：2018-05-20 00:46

本文选题：慢性阻塞性肺疾病 + 痰热瘀肺证　；参考：《南京中医药大学》2017年硕士论文

【摘要】：慢性阻塞性肺疾病(COPD)在我国的发病人数众多。不完全可逆的气流受限是其主要特征。临床多呈反复发作,并逐渐加重。患者长期反复住院,多接受西药抗生素和糖皮质激素的治疗,日久容易出现细菌耐药和激素依赖等不良反应,同时伴有患者生活质量的下降和沉重的经济负担,对社会医疗资源也造成极大的浪费。导师申春悌教授临床工作40余年,多采用中西医结合的方法辨治COPD,取得较好的治疗效果。导师发现,在COPD急性加重期(AECOPD)D组患者中,痰热瘀肺证是最常见的证型,并对该证型采用龙丹理肺汤加减进行治疗,取得了较好的疗效。为了进一步证实该方的临床疗效,本研究在西医常规治疗的基础上加用龙丹理肺汤,进行了简单随机和对照的临床研究。目的:观察龙丹理肺汤对治疗AECOPD(D组)痰热瘀肺证的临床疗效,并进一步明确其是否具有改善中医症状、肺功能、血粘度及协同抗感染的作用。方法:本研究采用加载性临床试验的方法。选取AECOPD(D组)痰热瘀肺证的患者作为研究对象。共选取南京中医药大学附属武进中医医院肺病科住院患者42例,根据入院日期的奇偶数进行简单随机,其中对照组21例,治疗组21例。对照组采用常规西医治疗:抗感染(哌拉西林他唑巴坦钠静滴)、化痰(盐酸氨溴索静推)、解痉平喘(多索茶碱静滴、布地奈德和硫酸特布他林雾化吸入),病情较重时予口服强的松3-5天抗炎平喘,同时予氧疗,维持水、电解质平衡等辅助治疗。治疗组在对照组常规治疗的基础上加用龙丹理肺汤中药免煎颗粒剂,每日1剂,分两次服。7天为1疗程,共观察14天。记录治疗初期和1周后两组患者的临床疗效、血常规、血粘度、肺功能、血气分析等相关指标。整理数据,采用SPSS19.0对数据进行分析。结果:1.治疗后两组疗效比较有差异。治疗组:显效率(57.14%),有效率(38.10%);对照组:显效率(19.05%),有效率(76.19%)。经χ 2检验两组总的有效率存在统计学差异,治疗组的临床疗效更优于对照组(P0.05)。2.两组治疗后临床主症的比较有差异。经过一周治疗后,两组临床主症均较同组治疗前有明显好转(P0.01),但是组间比较无统计学差异。随访至第二周,进行组间比较,治疗组咳痰和喘息好转的情况优于对照组(P0.05)。3.两组治疗前后感染性指标的比较有差异。两组治疗前后白细胞数、中性粒细胞数和hCRP的变化均具有统计学差异(P0.05)。组间比较,治疗组hCRP下降得更明显(P0.05)。4.两组治疗前后血气指标的比较有差异。两组治疗前后PaO2和SaO2的变化均具有统计学差异(P0.05)。组间比较,治疗组PaO2的升高更明显(P0.05)。5.两组治疗前后肺功能指标的比较有差异。两组治疗前后FVC和FEV1的变化均具有统计学意义(P0.05)。组间比较,治疗组FVC和FEV1均升高得更明显(P0.05)。6.两组治疗前后血液流变学指标的比较无差异。两组治疗后全血粘度(低切、中切、高切)、血浆粘度和血沉均较治疗前无明显变化(P0.05)。结论:在常规AECOPD(D组)痰热瘀肺证的治疗过程中联合使用龙丹理肺汤可以协助抗感染、改善缺氧和二氧化碳潴留,从而能提高临床的治疗效果。长期使用该方药,还可以减轻患者的呼吸道症状。
[Abstract]:Chronic obstructive pulmonary disease (COPD) has a large number of patients in China. Incomplete and reversible airflow limitation is its main feature. The clinical symptoms are repeated episodes and gradually aggravated. Patients who have been hospitalized for a long time, receive more western medicine antibiotics and glucocorticoid treatment, and are likely to have adverse reactions such as bacterial resistance and hormone dependence, and are accompanied by a long time. The decline in the quality of life and the heavy economic burden of the patients have also caused great waste to the social medical resources. Professor Shen Chun FTI has been working for more than 40 years, using the method of combining traditional Chinese and Western medicine to distinguish COPD, and obtain better therapeutic effect. The teacher found that in the patients with acute exacerbation of COPD (AECOPD), the syndrome of phlegm and blood stasis is the most common. In order to further confirm the clinical curative effect of this prescription, in order to further confirm the clinical curative effect of this prescription, we added the long Danli lung soup on the basis of conventional treatment of Western medicine, and carried out a simple randomized and controlled clinical study. The clinical effect of the syndrome of stasis of lung and whether it has the effect of improving the symptoms of traditional Chinese medicine, lung function, blood viscosity and synergistic anti infection. Methods: This study adopts the method of loading clinical test. Select the patients of AECOPD (group D) phlegm and blood stasis lung syndrome as the research object. The lung disease of Wujin Affiliated Hospital of Nanjing University of Chinese Medicine is selected. 42 hospitalized patients were randomly selected according to the odd even number of admission dates, including 21 cases in the control group and 21 in the treatment group. The control group was treated with conventional western medicine: anti infection (piperacillin tazobactam sodium), phlegm (ambroxol hydrochloro), antispasmodic antiasthmatic (droxyophylline intravenous drip, budesonide and terbutaline sulfate inhalation). The treatment group was given 3-5 days of antiasthmatic antiasthmatic prednisone, oxygen therapy, maintenance of water and electrolyte balance. The treatment group was treated with long Daniel lung decoction free Decoction on the basis of conventional treatment in the control group, 1 doses per day, two times of.7 days as 1 courses, and a total of 14 days. The clinical records of two groups of patients in the early and 1 weeks after treatment were recorded. Effect, blood routine, blood viscosity, lung function, blood gas analysis and other related indexes. The data were collected and analyzed by SPSS19.0. Results: after 1. treatment, the two groups had different curative effects. The treatment group was effective (57.14%) and effective (38.10%); the control group was effective (19.05%) and effective (76.19%). The total effective rate of two groups was counted by chi chi 2 test. The clinical curative effect of the treatment group was better than that of the control group (P0.05).2. two groups. After one week treatment, the two groups of clinical main symptoms were significantly better than the same group (P0.01), but there was no statistical difference between the groups. The follow-up to second weeks was compared with the treatment group, the expectoration and wheezing improved in the treatment group. Compared with the control group (P0.05).3. two groups, there were differences in the infection index before and after treatment. The changes in the number of leucocytes, neutrophils and hCRP before and after treatment in the two groups were statistically different (P0.05). The comparison between the groups, the hCRP of the treatment group decreased more obviously (P0.05) the comparison of blood gas indexes before and after treatment in the two groups of.4. two groups. The two groups were treated. The changes of PaO2 and SaO2 were statistically different (P0.05). The increase of PaO2 in the treatment group was more obvious (P0.05) and the comparison of lung function indexes before and after treatment in group.5. two was significant. The changes of FVC and FEV1 before and after treatment in the two groups were statistically significant (P0.05). The FVC and FEV1 were increased more obviously in the treatment group (P0.05) two. There was no difference in hemorheological indexes before and after treatment. The whole blood viscosity (low cut, middle cut, high cutting), plasma viscosity and ESR in the two groups had no significant changes (P0.05). Conclusion: in the treatment of conventional AECOPD (group D) phlegm heat and blood stasis syndrome, the combination of dragon Danli lung soup can help anti infection, improve hypoxia and two oxidation. Carbon retention can improve the clinical therapeutic effect. Long term use of this drug can also relieve the respiratory symptoms of patients.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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