扶正祛邪法治疗多重耐药细菌性肺炎的临床研究

发布时间：2018-02-13 00:13

  本文关键词： 多重耐药菌 肺炎 扶正祛邪法 临床研究　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过随机对照试验的方法,观察扶正祛邪法治疗多重耐药细菌性肺炎的有效性和安全性,探讨扶正祛邪法治疗多重耐药细菌性肺炎的理论基础,为扶正祛邪法治疗该病提供理论基础。方法：1.理论研究：回顾中医学关于“喘病”、“咳嗽”、“肺热病”等类似疾病的研究和认识,总结其与现代医学多重耐药细菌性肺炎的联系。探讨中医学关于多重耐药细菌性肺炎的理论认识,探讨扶正祛邪法治疗多重耐药性细菌性肺炎的理论和实践基础。2.临床研究：选择2014年01月至2016年02月在成都中医药大学附属医院EICU、急诊科、呼吸科及老年病科的住院病人,随机分为试验组与对照组；对照组按肺炎及多重耐药预防和控制相关指南予以西医治疗,试验组在对照组的基础上加用扶正祛邪法中药汤剂治疗。以治疗前和治疗第3、7、14天作为评价时间点,观察炎症反应指标：血常规、C-反应蛋白(CRP)、降钙素原(PCT)；肺损伤指标：临床肺部感染评分(CPIS)；器官功能障碍指标：急性生理和慢性健康评分(APACHEⅡ)和全身性感染相关器官功能衰竭评分(SOFA评分)；14日病死率；有创机械通气发生率；耐药病原菌清除率；中医疗效及中医症状积分等指标情况。结果：1.基线分析：两组患者基线资料比较,差异均无统计学意义(P0.05)。2.安全性指标：试验组和对照组在治疗过程中的不良反应发生率分别为12.5%和7.5%,差异无统计学意义(P0.05)。3.疗效性指标：治疗第14天,两组患者中医疗效率分别为87.2%与66.7%,耐药菌清除率分别为53.8%与30.8%,有创机械通气发生率分别为10.3%与30.8%,组间差异比较具有统计学意义(P0.05)；两组患者死亡率分7.7%与15.4%,差异不具有统计学意义(P0.05)。两组患者中医症状积分、炎症反应(WBC、NEUT%、CRP、PCT)指标、肺损伤指标(CPIS)评分及器官功能指标评分(APACHE II评分、SOFA评分)比较,治疗前及治疗第3天,差异无统计学意义(P0.05),治疗第7天及第14天差异具有统计学意义(P0.05)。结论：1扶正祛邪法的理论适合临床治疗多重耐药细菌性肺炎,根据扶正祛邪法拟定的理法方药符合中医学基本理论；基于扶正祛邪法拟定的中药方剂安全可靠,不良反应少。2与对照组相比,联合扶正祛邪法的中西医结合治疗方案能有效提高多重耐药细菌性肺炎患者的中医疗效及多重耐药菌株清除率；能有效降低该患者的炎症反应水平、肺损伤评分、器官功能衰竭评分及有创机械通气发生率等指标,具有疗效优势。
[Abstract]:Objective: to observe the efficacy and safety of the method of nourishing qi and dispelling evil in the treatment of multidrug resistant bacterial pneumonia by randomized controlled trial, and to explore the theoretical basis for the treatment of multidrug resistant bacterial pneumonia with the method of nourishing qi and dispelling evil. Methods: 1. Theoretical study: review of the traditional Chinese medicine about "asthma", "cough", "lung fever" and other similar diseases research and understanding, To summarize its relationship with multidrug resistant bacterial pneumonia in modern medicine, and to explore the theoretical understanding of multidrug resistant bacterial pneumonia in traditional Chinese medicine. To explore the theoretical and practical basis of Fuzheng dispelling pathogenic method in the treatment of multidrug resistant bacterial pneumonia. 2. Clinical study: select the inpatients from January 2014 to February 2016 in EICU, emergency, respiratory and geriatric departments, affiliated hospitals of Chengdu University of traditional Chinese Medicine. The patients in the control group were treated with western medicine according to the guidelines for the prevention and control of pneumonia and multidrug resistance. On the basis of the control group, the experimental group was treated with traditional Chinese medicine decoction of the method of nourishing qi and dispelling evil. The inflammatory response indexes were: blood routine C-reactive protein (CRPN), procalcitonin (PCT); lung injury: clinical pulmonary infection score (CPISN); organ dysfunction: acute physiological and chronic health score (Apache 鈪，

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