蒿芩清胆汤加味治疗社区获得性肺炎（湿热内蕴证）的临床观察

发布时间：2018-03-12 10:02

本文选题：社区获得性肺炎　切入点：蒿芩清胆汤　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨蒿芩清胆汤加味对社区获得性肺炎(湿热内蕴证)的临床疗效,通过对比蒿芩清胆汤加味联合西医治疗与单纯西药常规治疗在疾病总疗效、中医证候评分、住院天数及费用、热退时间及炎症性指标的差别,探讨蒿芩清胆汤加味治疗CAP的临床价值。方法:通过选取符合中西医诊断标准、病例纳入标准,不符合排除标准及剔除标准共52例病例,按随机分组原则分为治疗组和对照组各26例。对照组予以西医常规抗感染、止咳化痰及营养支持治疗;治疗组在西药治疗的基础上予以蒿芩清胆汤加味汤剂治疗,总疗程为5天。通过对比两组治疗前、治疗后第3天、治疗后第5天的病情评分、中医证候评分及相关炎症指标等,采用统计学软件SPSS 20.0分析两组相关数据,科学评价蒿芩清胆汤加味在治疗社区获得性肺炎的临床疗效。结果:1.治疗组的疾病总疗效优于对照组(P0.01);2.治疗组平均住院天数5.88±0.95天,对照组平均住院天数7.27±2.44天,差异有统计学意义(P0.05);3.治疗组平均住院费用6802.3±1953.6元,对照组平均住院费用为9326.8±6033.2元,差异有统计学意义(P0.05);4.治疗组平均热退时间33.0±17.1h,对照组平均热退时间63.2±64.9h,差异有统计学意义(P0.05);5.治疗前两组CPIS评分无明显差别;治疗后两组CPIS评分均较前下降,差异均有统计学意义(P0.05);治疗组治疗前后CPIS评分差值下降幅度大于对照组,差异有显著统计学意义(P0.01);治疗后治疗组CPIS评分低于对照组,差异具有统计学意义(P0.05);6.治疗前两组CURB-65评分无明显差别;治疗后两组CUBR-65评分均较前下降,差异均有统计学意义(P0.05);治疗组治疗前后CURB-65评分差值下降幅度与对照组无明显差别,差异不具有统计学意义(P0.05);治疗后治疗组CURB-65评分低于对照组,差异不具有统计学意义(P0.05);7.治疗前两组中医证候评分无明显差别;治疗后两组中医证候评分均较前下降,差异均有统计学意义(P0.05);对于治疗第3天的评分,治疗组的下降幅度大于对照组,差异有显著的统计学意义(P0.01);治疗第3天至第5天,两组证候评分的降低幅度差别无统计学意义(JP0.05);治疗后治疗组中医证候评分低于对照组,差异具有统计学意义(P0.05);8.治疗第3天两组白细胞总数均较前下降,差异均有统计学意义(P0.05);治疗组第3天、第5天白细胞总数均低于对照组,但差异不具有统计学意义(P0.05);9.治疗第3天、第5天两组PCT均较前下降,但差异均不具有统计学意义(P0.05);治疗组第3天、第5天PCT均低于对照组,但差异不具有统计学意义(P0.05);10.治疗第3天、第5天两组CRP均较前下降,差异均有统计学意义(P0.05);治疗组第3天、第5天CRP均低于对照组,差异具有显著统计学意义(P0.01);11.治疗后第3天、第5天两组D-二聚体均较前下降,差异均具有显著统计学意义(P0.01);治疗组第3天、第5天D-二聚体均低于对照组,差异具有统计学意义(P0.05);12.CRP与D-二聚体存在线性相关,相关系数为0.620,P0.01。结论:蒿芩清胆汤加味联合西药治疗在疾病总疗效、中医证候改善、病情严重程度的改善方面均优于单纯西药组;中西医结合治疗CAP可减少住院天数、降低住院费用、缩短退热时间;两组治疗对中医证候改善程度的差异可能主要体现在治疗前3天;治疗后两组降钙素原均较前明显下降,但两组组内、组间比较差别均无统计学意义,可能提示降钙素原在评估非重症CAP疗效上价值有限;治疗后两组白细胞总数、C-反应蛋白、D-二聚体均较前明显下降,差异有统计学意义,且治疗组上述数值低于对照组,提示中西结合治疗对于降低炎症指标及改善凝血指标方面优于单纯西药组;C-反应蛋白与D-二聚体在数值上存在线性相关,提示CAP发生、发展的过程中炎症因子与凝血功能存在相互的作用,其作用机理有待进一步探讨。
[Abstract]:Objective: To investigate the haoqinqingdan Decoction of community-acquired pneumonia (damp heat syndrome) clinical efficacy of Qingdan decoction combined with western medicine and simple western medicine therapy in the treatment of disease by comparing the total effect of Haoqin, TCM syndrome score, hospitalization days and expenses, the duration of fever and inflammatory index difference. Study on the clinical value of haoqinqingdan Decoction for the treatment of CAP. Methods: the selected traditional Chinese medicine and Western medicine diagnostic criteria, inclusion criteria, does not meet the criteria of a total of 52 cases and exclusion criteria excluded cases, were randomly divided into treatment group and control group with 26 cases in each group. The control group was given routine anti infection, cough and phlegm and nutritional support therapy; treatment group on the basis of Western medicine treatment to Hao Qin Qing Dan Tang Decoction, the total course of treatment for 5 days. By comparing the two groups before treatment, third days after treatment, treatment after fifth days of illness score, TCM Syndrome The score and the related inflammatory indicators, using statistical software SPSS 20 analysis of two groups of related data, evaluation of Haoqin Qing Dan Tang clinical science community acquired pneumonia in the treatment of the disease. Results: the total effect is better than the 1. treatment group, control group (P0.01); 2. in the treatment group the average hospitalization was 5.88 + 0.95 days, control the average length of stay was 7.27 + 2.44 days, the difference was statistically significant (P0.05); 3. in the treatment group the average hospitalization expenses of 6802.3 + 1953.6 yuan, the control group the average hospitalization expenses for 9326.8 + 6033.2 yuan, the difference was statistically significant (P0.05); 4. in the treatment group the average duration of fever was 33 + 17.1h, the control group the average duration of fever 63.2 + 64.9h, the difference was statistically significant (P0.05); 5. of the two groups before treatment CPIS score had no significant difference; the two groups after treatment CPIS score decreased than before, the differences were statistically significant (P0.05); the treatment group before and after treatment CPIS score decreased Larger than that of the control group, the difference was statistically significant (P0.01); the CPIS score of treatment group than the control group, the difference was statistically significant (P0.05); 6. of the two groups before treatment CURB-65 score had no significant difference; the two groups after treatment CUBR-65 score decreased than before, the differences were statistically significant (P0.05); the treatment group before and after the CURB-65 score decreased amplitude had no significant difference with the control group, the difference was not statistically significant (P0.05); the CURB-65 score of treatment group than the control group, the difference was not statistically significant (P0.05); 7. for two groups of TCM syndrome score had no significant difference before treatment; the two groups after treatment of TCM syndrome scores decreased, the differences were statistically significant (P0.05); for the third day treatment score, treatment group decreased than that of control group, the difference was statistically significant (P0.01); for third days to fifth days, two groups of syndrome score The reduction of the difference was not statistically significant (JP0.05); after treatment, TCM syndrome score lower than the control group, the difference was statistically significant (P0.05); 8. for third days, two groups of white blood cell counts were decreased, the differences were statistically significant (P0.05); the treatment group for third days, fifth days, the total number of white blood cells are compared with the control group, but the difference was not statistically significant (P0.05); 9. for third days, fifth days and two in group PCT decreased than before, but the difference was not statistically significant (P0.05); the treatment group for third days, Fifth days PCT were lower than the control group, but the difference was not statistically significant (P0.05); 10. for third days, fifth days and two in group CRP decreased than before, the differences were statistically significant (P0.05); the treatment group for third days, fifth days CRP were lower than the control group, the difference was statistically significant (P0.01); third days and 11. days after treatment, the fifth group two D- two dimer decreased than before, the difference all have significant The statistical significance (P0.01); the treatment group for third days, fifth days and two D- dimer were lower than the control group, the difference was statistically significant (P0.05); 12.CRP and D- dimer has two linear correlation, the correlation coefficient was 0.620, P0.01. conclusion: haoqinqingdan decoction combined with western medicine treatment of the disease in the total effect. Improve the TCM syndrome, severity were better than the pure western medicine group; CAP treatment can reduce the hospitalization time of Integrated Chinese and Western medicine, reduce hospitalization costs, shorten the cooling time; two groups of treatment of TCM syndrome improvement is mainly reflected in the 3 day before treatment, the difference in the degree of the two groups after treatment; procalcitonin were decreased significantly, but in the two groups, the differences between the two groups were not statistically significant, suggesting procalcitonin in evaluation of limited value non severe CAP effect; two groups of white blood cell counts after treatment, C- reactive protein, D- two dimers were decreased significantly, the difference There was statistical significance, and the numerical treatment group than the control group, suggesting that the combination of Chinese and Western treatment to reduce inflammation and improve blood coagulation index index is better than pure western medicine group; C- reactive protein and D- dimer has two in numerical linear correlation, suggesting that CAP has occurred, the interaction between inflammation and coagulation function in the process of development further, to explore its mechanism.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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