加味小苦辛汤辩证加减治疗22例儿童闭塞性细支气管炎临床研究

发布时间：2019-03-06 14:46

【摘要】：儿童闭塞性细支气管炎(Bronchiolit is Obliterans, BO)是临床中相对少见而严重的与小气道炎症性损伤相关的慢性气流阻塞综合征,以不可逆性细支气管及其周围炎症和纤维化导致管腔的部分或完全的闭塞为病理特征,主要的临床表现为反复或持续的气促、喘息或咳嗽,运动耐性差,肺部听诊有湿性Up音和喘鸣音,对支气管扩张剂无反应,肺部高分辨CT(HRCT)特征为马赛克灌注征。现代医学治疗儿童BO疗效不确定,感染后BO的总体疗效不佳。一项关于儿童B0的前瞻性研究观察发现9.7%的B0儿童在3.5年内死亡,67.7%的B0儿童呼吸道症状、体征持续存在。目的：观察徐荣谦教授运用加味小苦辛汤治疗小儿闭塞性细支气管炎的临床疗效,进而探讨小儿闭塞性细支气管炎的病因病机、治则和治法。方法：目前尚未形成统一的儿童BO的中医病证诊断疗效标准及喘息控制评分标准,现参照1995年国家中医药管理局发布的《中医病证诊断疗效标准·中医儿科学病证诊断标准》拟定儿童BO的临床疗效观察表和判定标准；依据哮喘测试控制评分标准(ACT)拟定B0喘息测试控制评分表和评定标准,每例B0患儿服用加味小苦辛汤至少3个月,然后对临床观察表与B0喘息测试控制评分表分别进行治疗前与治疗后对比,以分析加味小苦辛汤在儿童B0疾病进程中的临床疗效。结果：经加味小苦辛汤辩证治疗后22例BO患儿的临床观察表及喘息测试控制评分中各项指标较治疗前均有不同程度的改善,经加味小苦辛汤辩证治疗后22例B0患儿中有7例(31.8%)喘息完全控制,12例(54.5%)喘息得到良好控制,3例(13.6%)喘息控制不良,22例B0患儿临床治疗总有效率为86.4%,其中显著效率50%(11例),有效率36.4%(8例),无效率13.6%(3例),临床痊愈率为0(0例)。结论：加味小苦辛汤辨证加减治疗儿童闭塞性细支气管炎可获得较好的临床疗效。徐荣谦教授认为儿童BO基本病机为正虚气郁,治疗小儿BO急性发作期以辛开苦降,涤痰开闭为治疗原则,以加味小苦辛汤加减辩证治疗贯穿始终。
[Abstract]:Childhood bronchiolitis occlusive bronchiolitis (Bronchiolit is Obliterans, BO) is a relatively rare and severe chronic airflow obstruction syndrome associated with small airway inflammation injury. Characterized by partial or complete occlusion of the lumen caused by irreversible bronchiole and its surrounding inflammation and fibrosis, the main clinical manifestations are repeated or persistent shortness of breath, wheezing or cough, and poor exercise tolerance. Lung auscultation had wet Up tone and wheezing tone and had no response to bronchodilator. High-resolution CT (HRCT) was characterized by mosaic perfusion. The efficacy of modern medicine in the treatment of BO in children is uncertain, and the overall curative effect of BO after infection is not good. A prospective study of B0 in children found that 9.7% of B0 children died within 3.5 years, and 67.7% of B0 children suffered respiratory symptoms and signs persisted. Objective: to observe the clinical efficacy of professor Xu Rongqian in the treatment of infantile bronchiolitis obliterans with modified Xiao Kuxin decoction, and to explore the etiology, pathogenesis, treatment and treatment of infantile bronchiolitis obliterans. Methods: at present, there has not been a unified standard for the diagnosis and treatment of BO in children, and the score standard of wheezing control has not been established. According to the Diagnostic Standard of traditional Chinese Medicine and Pediatrics Syndrome published by the State Administration of traditional Chinese Medicine in 1995, the observation table and judging standard of clinical curative effect of BO in children were drawn up according to the Diagnostic Standard of traditional Chinese Medicine and Pediatric Syndrome. According to the Asthma Test Control score Standard (ACT), the B0 wheezing test control scale and the evaluation standard were drawn up. Each B0 child was given Jiawei Xiaokongxin decoction for at least 3 months. Then the clinical observation table and the B0 wheezing test control scale were compared before and after treatment to analyze the clinical efficacy of Jiawei Xiaokongxin decoction in the course of B0 disease in children. Results: after treatment with Jiawei Xiaokuxin decoction, the clinical observation table and the control score of wheezing test in 22 children with BO were improved to some extent compared with those before treatment, and the clinical observation table and the control score of wheezing test were improved to some extent. After treatment with modified Xiaokuxin decoction, 7 cases (31.8%) had complete control of wheeze, 12 cases (54.5%) had good control of wheeze, 3 cases (13.6%) had poor wheezing control, 7 cases (31.8%) had complete control of wheeze, 3 cases (13.6%) had poor wheezing control. The total effective rate of clinical treatment in 22 patients with B0 was 86.4%, among which the effective rate was 50% (11 cases), the effective rate was 36.4% (8 cases), the ineffective rate was 13.6% (3 cases), and the clinical cure rate was 0 (0 cases). Conclusion: the treatment of bronchiolitis obliterans with Jiawei Xiaokuxin decoction can obtain better clinical effect. Professor Xu Rongqian believes that the basic pathogenesis of BO in children is Qi depression due to deficiency of qi. In the acute attack period of children with BO, the principle of treatment is Xinkai Kushi, the principle of eliminating phlegm and opening and closing, and the dialectical treatment of adding and decreasing modified Xiaokunxin decoction throughout the whole process.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R272

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