天灸干预喘息性支气管炎急性发作期治疗的临床研究

发布时间：2018-05-07 14:50

  本文选题：天灸 + 喘息性支气管炎　； 参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：本次论文选用新疆图木舒克市人民医院内科门诊病人中诊断为慢性喘息性支气管炎急性发作期(喘证：风寒犯肺型)的患者来作为试验的研究对象,观察在西医基础治疗完全一致的标准上施加天灸疗法是否能促进患者症状的缓解或消失,分析该种方法是否在提高临床疗效,改善患者生存质量等方面具有优势。近年来,我国慢性喘息性支气管炎的患病率日趋上涨,其原因可能是人口老龄化速度加快和大气污染日趋加剧,严重影响到人们的日常工作与生活质量。小海子垦区是南疆兵团三师三大垦区之一,属干旱荒漠气候,昼夜温差大,沙尘暴频发,由于常年风沙和寒冷空气影响,慢性喘息性支气管炎已然成为本地常见病之一。因此研究针对本病采用更有效的方法来进行治疗,从而提高对本病的疗效是具有较大意义的,且天灸疗法治疗本病简单易行,无明显毒副作用,颇受好评。方法：本临床研究收集的观察病例100例均来源于新疆图木舒克市人民医院内科门诊病人,经确诊为慢性喘息性支气管炎急性发作期(喘证：风寒犯肺型)且符合科研纳入标准。采用随机对照实验的方法,按照1：1的比例分配,随机将100例慢性喘息性支气管炎患者分别分配至治疗组(天灸组)与对照组(安慰剂组)。两组基础治疗一致：患者口服茶碱缓释胶囊(息川叮),每次0.1g,每日早、晚各服用1次,不间断服用5周。治疗组：在基础治疗上使用天灸疗法。药物组成：天灸膏包含有延胡索、白芥子、细辛、甘遂等药物；药物制备方法：由图木舒克市人民医院药剂科专门负责提供,专人进行配药、清洗、粉碎,将药物制作为粗细度80目筛规格的药粉并均匀混合制成散剂待用；穴位组成： (1)双侧肺俞、胃俞、志室,膻中； (2)双侧风门、脾俞、膏肓俞,天突； (3)双侧定喘、肾俞,心俞,中脘。交替选取三组穴位。操作方法：将生姜汁(生姜去皮绞汁过滤)与已制备成功的天灸药粉均匀调和成药膏(其中药粉与姜汁的重量比例设为3：4),并将药膏切成每个约1cm×1cm×1cm大小的药块,随后让患者取坐位,用镊子将药块放置于约5cm×5cm的透气胶布中央,将胶布准确贴至穴位,嘱受试者在贴够2小时后便可自行撕下。对照组：在基础治疗上加用安慰剂贴敷。药物组成：安慰剂(主要包括天灸散粉、红曲红色素粉,板栗壳棕色素粉、荞麦粉,比例为1：1：3：6)药物制备方法：将一般市场上买来的荞麦粉、板栗壳棕色素粉、红曲红色素粉及天灸散粉这四种粉末均匀混合制成散剂代用。穴位组成：与治疗组一致。操作方法：用水稀释少量生姜汁(生姜汁与水的比例设为1：10),将安慰剂药粉均匀调和成为与天灸膏外观、质地较为相似的药膏,并切块成每个约1cm×1cm×1cm大小的药块,随后让患者取坐位,用镊子将药块放置于约5cm×5cm的透气胶布中央,将胶布准确贴至穴位,嘱受试者在贴够2小时后便可自行撕下。以上两组受试者每周治疗3次,总共治疗5周时间,即共计15次,每次贴药时间为2小时,每次治疗间隔时间需≥148小时,治疗完成12次以上(含12次)视为治疗完成。在治疗前、第9次治疗后、疗程结束时评估两组患者的中医证候总评分以及喘息性支气管炎生存质量量表(Asthmatic bronchitis quality of life questionnaire, AQLQ)的积分变化,疗程结束时评价两组临床疗效,计算有效率,并随时记录研究过程中发生的不良事件。统计方法：观察结束后,统一采用SPSS19.0统计软件包客观地进行各项数据的处理和分析。两观察组的计量资料采用配对设计资料的t检验以及独立样本的t检验进行分析比较。两观察组的计数资料采用2×2表资料的卡方检验进行分析比较。采用秩和检验比较等级资料。结果：1.基线资料经统计学检验,两组受试人员在民族分布、性别分布、年龄构成、病程分布上均无显著性差异(P值分别为0.086、0.248、0.103、0.064)；治疗前,两组患者的中医证候总评分、喘息性支气管炎生存质量量表总评分组间比较具有同质性(P值分别为0.838、0.052)。可见,两组治疗前各项资料的差异比较的P0.05,提示无统计学意义,如此,证明两组之间的基线资料是具有可比性的。2.中医证候总评分(1)组内比较对治疗组受试人员在治疗前、第9次治疗后、疗程结束时进行中医证候总评分,其均值分别为9.04±1.43、4.68±1.42、1.84±2.15,各时点分别与治疗前进行比较,P值均小于0.05,故可知该差异具有统计学意义。对对照组受试人员在治疗前、第9次治疗后、疗程结束时进行中医证候总评分,其均值分别为8.98±1.49、5.94±1.54、3.72±2.22,各时点分别与治疗前进行比较,P值均小于0.05,故可知该差异具有统计学意义。(2)组间比较对治疗组与对照组受试人员的中医证候总评分进行独立样本t检验,统计结果提示治疗组与对照组在第9次治疗后、治疗结束时的症候评分组间比较所得P值均小于0.05,具有统计学意义。3.喘息性支气管炎生存质量量表评分(1)组内比较对治疗组受试人员在治疗前、疗程结束时进行生存质量量表评分,其均值分别为105.04±22.76、204.82±20.03,治疗前与治疗结束时进行比较,P值小于0.05,故可知差异具有统计学意义。对对照组受试人员在治疗前、疗程结束时进行生存质量量表评分,其均值分别为113.70±21.26、158.26±21.21,治疗前与治疗结束时进行比较,P值小于0.05,故可知该差异具有统计学意义。(2)组间比较对治疗组与对照组受试人员的生存质量量表评分进行独立样本t检验,统计结果提示治疗组与对照组在治疗结束时的症候评分组间比较所得P值小于0.05,故可知该差异具有统计学意义。4.有效率经统计检验,完成疗程的合格受试者治疗组与对照组均为50例,治疗组的总有效率较高,为92%,而对照组的总有效率为74%。两组疗效的比较属于2个独立样本的等级资料比较,应用秩和检验检测得出P=0.0000.05,故可知治疗组与对照组的疗效比较有显著性差异。结论：综上所述,天灸疗法对于改善慢性喘息性支气管炎急性发作期的临床症状有较好的疗效,同时能够显著提高患者的生存质量,值得临床推广。
[Abstract]:Objective: in this paper, the patients who were diagnosed as acute attack of chronic asthmatic bronchitis (asthma: wind cold and lung type) were selected as the subjects of the acute attack of chronic asthmatic bronchitis in the hospital of the people's Hospital of Xinjiang. In recent years, the prevalence rate of chronic asthmatic bronchitis in China is increasing, which may be due to the accelerated aging of the population and the increase of air pollution, which seriously affects people's daily work and life quality. Xiao Haizi reclamation area is one of the three reclamation areas of the three division of the southern Xinjiang corps, which belongs to the arid desert climate, the temperature difference between day and night is large and the sandstorm is frequent. The chronic asthmatic bronchitis has become one of the common diseases because of the perennial wind sand and cold air. Therefore, a more effective method is used to treat this disease, thus improving the disease. The curative effect is of great significance, and the day moxibustion therapy is simple and easy to treat. There is no obvious toxic and side effects. Methods: 100 cases of observation cases collected in this clinical study were all derived from the outpatient in the medical department of the people's Hospital of Xinjiang. 100 cases of chronic asthmatic bronchitis were randomly assigned to the treatment group (day moxibustion group) and the control group (placebo group). The two groups of basic treatments were the same as Theophylline Sustained Release Capsules (xechuan Ding), each time 0.1g, morning and evening. Take 1 times and take 5 weeks without interruption. The treatment group: use the day moxibustion therapy on basic treatment. Drug composition: the day moxibustion ointment contains drugs such as yercaso, white mustard, asarum, and cabbage; the preparation method is provided by the pharmacy department of tuxunk City People's hospital. 80 mesh size sifting powder and evenly mixed into the powder for use; acupoint composition: (1) bilateral lung Yu, Wei Yu, Zhi room, Shan Zhong; (2) bilateral wind gate, spleen Yu, pogastric Yu, Tian Tun; (3) bilateral asthma, Shenshu, Xinshu and Zhong Wan. Alternate selection of three groups of acupoints. The medicinal powder is evenly blended into the ointment (the weight ratio of the powder and ginger juice is set to 3:4), and the ointment is cut into every 1cm x 1cm x 1cm size drug block, then the patient is taken to take the seat, and the drug block is placed in the center of the air permeable rubber cloth of about 5cm * 5cm with tweezers, and the rubber cloth is accurately attached to the acupoint, and the subjects can be tearing themselves after 2 hours' sticker enough. In the control group, a placebo patch was added to the basic treatment. Drug composition: a placebo (mainly composed of day moxibustion powder, red yeast red pigment powder, chestnut shell brown powder, buckwheat powder, 1:1:3:6) preparation methods: the general market buckwheat powder bought from the general market, chestnut shell brown powder, red yeast red pigment powder and day moxibustion powder powder, four A mixture of powder and powder is used to make a bulk agent. Acupoint composition: the same as the treatment group. Operation method: diluted a small amount of ginger juice with water (the proportion of ginger juice and water at 1:10), and evenly blend the placebo powder into the appearance of the day moxibustion ointment, the texture more similar to the ointment, and cut into each 1cm x 1cm x 1cm size drug block, followed by The patient took the seat, placed the drug block in the center of the air permeable rubber cloth of about 5cm x 5cm with tweezers, and put the rubber cloth to the acupoint accurately. The subjects were told that the subjects could tear themselves down after 2 hours of sticker. The two groups of subjects were treated 3 times a week for 5 weeks, that is, 15 times, each time was 2 hours, each time interval of treatment should be equal to 148 hours, each time interval of treatment interval of more than 148 hours, The treatment completed more than 12 times (including 12 times) as the completion of treatment. Before the treatment, after ninth treatment, the total score of TCM syndrome in two groups of patients and the integral changes of Asthmatic bronchitis quality of life questionnaire, AQLQ were evaluated at the end of the course of treatment, and two groups of clinical effects were evaluated at the end of the course of treatment. The calculation was efficient and recorded the adverse events of the study at any time. Statistical method: after the observation was finished, the data were processed and analyzed objectively by the SPSS19.0 statistical software package. The measurement data of the two observation group were compared with the t test of paired design data and the t test of the independent sample. Two observation. The count data of the group were compared with the chi square test of 2 * 2 table data. The rank sum test was used to compare the grade data. Results: the 1. baseline data were statistically tested. There were no significant differences between the two groups in ethnic distribution, sex distribution, age composition and course distribution (P value was 0.086,0.248,0.103,0.064); before treatment, The total score of TCM syndrome in the two groups and the total score of the quality of life scale of asthmatic bronchitis were homogeneity (P value was 0.838,0.052). It is clear that the difference of the data between the two groups before treatment is P0.05, suggesting that the baseline data between the two groups are comparable to the.2. syndrome. In the total score (1), the total score of TCM syndrome was compared to the treatment group before the treatment, and the average value of the TCM syndrome was 9.04 + 1.43,4.68 + 1.42,1.84 + 2.15 at the end of the course of treatment. The value of the total score was 9.04 + 1.42,1.84 + 2.15 respectively. The value of P was less than 0.05, so the difference was statistically significant. Before treatment, after ninth times of treatment, the total score of TCM syndromes was carried out at the end of the course of treatment, the mean value was 8.98 + 1.49,5.94 + 1.54,3.72 + 2.22 respectively, each time point was compared with that before treatment, and the value of P was less than 0.05. (2) the total score of TCM syndrome in the treatment group and the control group was compared. Independent sample t test, the results showed that the treatment group and the control group after ninth times of treatment, the symptom score between the end of the treatment group P values were less than 0.05, statistically significant.3. asthmatic bronchitis quality of life scale score (1) in the group compared to the treatment group before the treatment, the end of the course of survival at the end of the quality of life. The mean value of the scale was 105.04 + 22.76204.82 + 20.03 respectively. Compared with the end of treatment, the value of P was less than 0.05, so the difference was statistically significant. Before the treatment of the control group, the quality of life scale was scored at the end of the course of treatment, the average value was 113.70 + 21.26158.26 + 21.21, before and after treatment. At the end of the treatment, the P value was less than 0.05, so the difference was statistically significant. (2) the group was compared with the independent sample t test for the quality of life scale of the treatment group and the control group. The statistical results suggested that the value of P between the treatment group and the control group at the end of the treatment group was less than 0.05, so it was known that the difference between the treatment group and the control group was less than 0.05. The difference has statistical significance.4. effective rate through statistical test, complete course of qualified subjects in the treatment group and the control group are 50 cases, the total effective rate of the treatment group is higher, 92%, and the total effective rate of the control group is 74%. two group comparison of the 2 independent samples of the grade data comparison, using the rank sum test to get P=0.0000.05 Therefore, it can be seen that the curative effect of the treatment group and the control group has a significant difference. Conclusion: in summary, the day moxibustion therapy can improve the clinical symptoms of the acute attack of chronic asthmatic bronchitis, and can significantly improve the quality of life of the patients, and it is worthy of clinical promotion.

【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】：2016
【分类号】：R246.1

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