小柴胡汤加减治疗上气道咳嗽综合征的临床研究

发布时间：2018-04-12 19:19

本文选题：小柴胡汤 + 上气道咳嗽综合征　；参考：《西南医科大学》2016年硕士论文

【摘要】：目的:上气道咳嗽综合征(upper airway cough syndrome,UACS)是慢性咳嗽的常见病因。本研究通过《伤寒论》小柴胡汤加减结合常规西医治疗UACS的疗效观察,探讨该中西医结合治疗方案的疗效,为进一步提高治疗UACS临床疗效提供依据。方法:按照《咳嗽的诊断与治疗指南》(2009版)[1]上气道咳嗽综合征的诊断标准及《中医诊断与鉴别诊断学》确定邪客少阳证患者实际有意义102例,治疗组与对照组各51例完成研究。对照组西医常规治疗包括:依巴斯汀片10mg 1次/d,复方甘草口服溶液10 m L 3次/d;7天为1个疗程,观察1-2个疗程。治疗组经中医辨证为少阳证,在上述西医治疗基础上用小柴胡汤加减治疗,基本药物组成:柴胡12g,黄芩15g,党参12g,半夏15g,甘草6g,杏仁15g,桔梗15g,前胡15 g,蜜麻黄5-8g,五味子6-10g。每天1剂,水煎3次,分三次服,7天为1个疗程,观察1-2个疗程。分别观察两组患者治疗前,治疗后3天、7天、14天临床疗效,症状积分,疗程结束后2周随访与疗程结束时临床情况对比,治疗前、后的肝功能(AST、ALT),肾功能(BUN、Cr)情况,用SPSS17.0统计软件进行统计分析。结果:⑴临床疗效:治疗后第3天,治疗组有效率72.5%%,对照组有效率58.8%%;治疗后第7天,治疗组有效率86.2%,对照组78.4%;治疗后第14天,治疗组有效率达到90.19%,对照组为82.3%;三个时间段两组比较,经卡方检验差异有统计学意义(P0.05)。⑵症状积分:治疗前后两组症状积分均值对比显示,治疗组(P0.01),差异明显,有统计学意义;对照组(P0.05),差异有统计学意义,但不如治疗组明显。⑶疗程结束后2周随访:治疗组总有效率为92.1%,对照组总有效率80.3%,与疗程结束时临床情况比较,差异不大,P值0.05,没有统计学意义。⑷两组患者治疗时间比较:治疗组在治疗后第3天即有显著效果,愈显率(痊愈率+显效率)分别是治疗组41.1%、对照组13.7%,两组差距达到27.4%;治疗后第7天,愈显率分别是治疗组72.5%、对照组47.0%,两组差距达到25.5%;治疗后第14天,愈显率分别是治疗组78.4%、对照组64.7%,愈显率差值为13.7%;三个时间段愈显率经卡方检验,P值都0.01,但差距在依次递减。说明中西医结合组疗效不仅高于单纯西药治疗,还可缩短病程时间。⑸治疗前后肝、肾功能:经t检验及秩和检验比较,结果提示差异均无统计学意义(p0.05)。结论:⑴对于上气道综合征,中医辨证属少阳证患者,用小柴胡汤加减配合常规西医治疗临床疗效优于西药治疗;⑵小柴胡汤加减配合常规西医治疗UACS,临床症状改善优于西药治疗;⑶小柴胡汤加减配合常规西医治疗UACS,治疗时间缩短,疗效稳定。⑷该治疗方案对肝功、肾功无影响,安全性好。
[Abstract]:Objective: upper airway cough syndrome is a common cause of chronic cough.In this study, the therapeutic effect of Xiaochaihu decoction combined with conventional western medicine on UACS was observed, and the curative effect of this scheme was discussed, which provided the basis for further improving the clinical efficacy of UACS.Methods: according to the diagnostic criteria of upper airway cough syndrome and the diagnosis and differential diagnosis of TCM, 102 patients with Shaoyang syndrome were confirmed according to the guidelines for the diagnosis and treatment of cough (2009 edition). The treatment group and control group (51 cases each) completed the study.The routine treatment of western medicine in the control group included: Ebastin tablet 10mg 1 / d, compound liquorice oral solution 10 mL / 3 / d for 7 days as a course of treatment, observe 1-2 courses of treatment.1 dose per day, 3 times of decoction, divided into 3 times for 7 days as a course of treatment, observe 1-2 courses of treatment.The clinical curative effect, symptom score, two weeks follow-up after treatment and the clinical situation at the end of the course of treatment were observed before and 3 days after treatment and 3 days after treatment. The liver function before and after treatment was compared with that at the end of the course of treatment. The liver function and renal function were compared before and after treatment.SPSS17.0 statistical software was used for statistical analysis.Results: on the third day after treatment, the effective rate of the treatment group was 72.5 and the effective rate of the control group was 58.8. On the 7th day after treatment, the effective rate of the treatment group was 86.2 and that of the control group was 78.4. on the 14th day after treatment, the effective rate of the treatment group was 86.2 and the control group was 78.4.The difference was statistically significant in the control group (P 0.05), but was not as good as that in the treatment group 2 weeks after the end of the course of treatment. The total effective rate in the treatment group was 92. 1%, and the total effective rate in the control group was 80. 3%, which was compared with the clinical situation at the end of the course of treatment.The difference was not significant (P = 0.05). There was no significant difference between the two groups in the treatment time: the treatment group had significant effect on the 3rd day after treatment.The effective rate of healing was 41.1 in the treatment group, 13.7in the control group, the difference between the two groups was 27.44.On the 7th day after treatment, the effective rate was 72.5 in the treatment group, and 47.0 in the control group, the difference between the two groups reached 25.5. on the 14th day after treatment,The effective rates were 78.4% in the treatment group and 64.7% in the control group, respectively, and the difference was 13.7.The significant recovery rates in the three periods were all 0.01 by chi-square test, but the difference was decreasing in turn.The results showed that the curative effect of TCM combined with western medicine was not only higher than that of western medicine alone, but also could shorten the course of disease before and after treatment. The function of liver and kidney: t test and rank sum test, the results showed that there was no significant difference between the two groups (P 0.05).Conclusion for the patients with upper airway syndrome, Xiao Chai Hu decoction combined with routine western medicine is superior to western medicine in treating the patients with Shaoyang syndrome according to syndrome differentiation of traditional Chinese medicine.2Xiaochaihu decoction combined with routine western medicine to treat UACS.The clinical symptom improvement was better than that of Xiaoxiaochaihu decoction combined with routine western medicine in UACS.The treatment time was shortened, and the curative effect was stable. 4. The treatment plan had no effect on liver function and renal function.Good safety.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.1

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