围贴敷期内外同治法治疗肺脾气虚型慢性阻塞性肺疾病的临床观察

发布时间：2018-05-17 00:41

本文选题：慢性阻塞性肺疾病 + 肺脾气虚证　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:通过围贴敷期内外同治法验证伏九穴位贴敷结合内服膏方在治疗COPD稳定期肺脾气虚证的有效性,确定培土生金理论指导下的内外同治法在COPD防治中的地位和作用。资料与方法:根据纳排标准,对2014年11月-2015年5月曾在辽宁中医药大学附属第二医院肺病科门诊及病房住院治疗,中医诊断为肺胀病,肺脾气虚证的患者进行电话随访,对于目前处于稳定期肺脾气虚证的患者告知研究相关情况,告知愿意参加研究的患者于2015年一伏前十天至门诊就诊,对前来门诊就诊患者按照随机数字表法进行随机分组。共纳入104例,治疗组与对照组各52例。治疗组予沙美特罗替卡松粉吸入剂(商品名:舒利迭,葛兰素史克公司,50ug/500ug)每次1吸,每日2次,同时配合围贴敷期伏九穴位贴敷结合内服健脾益肺膏。对照组:沙美特罗替卡松粉吸入剂每次1吸,每日2次。疗程均为86天,随访6个月。分别比较两组治疗前后、治疗前与随访后及随访后治疗组与对照组在肺功能,临床症状评分,呼吸困难评分,CAT评分,急性加重次数等方面的差异。结果:1.临床症状积分、生活质量评分(CAT)、呼吸困难程度方面,治疗组与对照组治疗后较治疗前均有所好转(P0.05);三者治疗组随访后与治疗前均有明显好转(P0.01),对照组随访后与治疗前均无明显差异(P0.05);三者随访后治疗组均优于对照组(P0.05)。2.肺功能:治疗组随访后与治疗前比较,FEV1%明显升高(P0.01),FEV1/FVC无明显差异(P0.05),对照组FEV1%,FEV1/FVC随访后与治疗前无明显差异(P0.05);随访后两组比较FEV1%治疗组高于对照组(P0.01)。3.急性加重次数:治疗组随访后与治疗前加重次数明显减少(P0.01);对照组随访后与治疗前加重次数无明显变化(P0.05);随访后治疗组急性加重次数明显少于对照组(P0.01)。4.安全性方面:两组治疗前后血常规,肝功,肾功均未见明显异常(P0.05)。结论:围贴敷期伏九穴位贴敷结合内服健脾益肺膏联合常规西医治疗COPD稳定期肺脾气虚型患者可明显改善患者呼吸困难程度,缓解临床症状,减缓肺功能下降,降低急性加重次数,从而提高患者生活质量,并且具有很好的长期疗效,安全性较高,值得临床推广应用。
[Abstract]:Objective: to verify the effectiveness of Fujiu acupoint application combined with internal plaster ointment in the treatment of lung and spleen qi deficiency syndrome in the stable period of COPD, and to determine the position and role of the internal and external treatment under the guidance of the theory of native gold in the prevention and treatment of COPD. Materials and methods: from November 2014 to May 2015, patients who had been hospitalized in the Department of Pulmonary Diseases and the second affiliated Hospital of Liaoning University of traditional Chinese Medicine, diagnosed as lung distension and deficiency of lung and spleen qi, were followed up by telephone. For the patients with lung and spleen qi deficiency syndrome in stable period, the patients who are willing to take part in the study will go to the outpatient clinic ten days before one volt in 2015. The patients who come to the clinic will be randomly divided according to the method of random digital table. 104 cases were included, 52 cases in the treatment group and 52 cases in the control group. The treatment group was treated with salmeterolticasone powder inhalant (commercial name: Schuliday, GlaxoSmithKline 50ugr / 500ug), 2 times a day, at the same time, combined with Nine acupoints and Jianpi Yifei ointment. Control group: salmeterol ticasone powder inhalation 1 time, 2 times a day. The course of treatment was 86 days, followed up for 6 months. The difference of pulmonary function, clinical symptom score, cat score and acute exacerbation were compared between the two groups before and after treatment, before and after treatment and after follow-up. The result is 1: 1. Clinical symptom score, quality of life score, degree of dyspnea, The treatment group and control group were all improved after treatment than before treatment, the three treatment groups had obvious improvement after follow-up and before treatment, the control group had no significant difference after follow-up and before treatment, the treatment group was better than the control group after follow up and before treatment, the treatment group was better than the control group. Pulmonary function: compared with before treatment, FEV1% in treatment group was significantly higher than that before treatment. There was no significant difference in FEV1 / FVC between treatment group and control group (P 0.05), but there was no significant difference in FEV1 / FVC in control group (P 0.05), and FEV1% in treatment group was higher than that in control group (P0.01 路3) after follow up. The times of acute aggravation: the times of aggravation after follow-up and before treatment in the treatment group were significantly decreased, while in the control group there was no significant change in the times of exacerbation after follow-up and before treatment, and after follow-up, the times of acute aggravation in the treatment group was significantly less than that in the control group. Safety: blood routine, liver function and renal function were not significantly abnormal before and after treatment in both groups. Conclusion: the combination of Fujiu acupoint application and internal administration of Jianpi Yifei ointment combined with routine western medicine can obviously improve the degree of dyspnea, relieve clinical symptoms and slow down the decline of pulmonary function in patients with lung and spleen qi deficiency in COPD stable period. Reducing the times of acute exacerbation, thus improving the quality of life of patients, and has a good long-term efficacy, high safety, worthy of clinical application.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.1

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