活血化痰法治疗AECOPD痰瘀互结证临床观察及其对血液流变学、D-二聚体的影响

发布时间：2018-06-27 14:14

本文选题：慢性阻塞性肺疾病急性加重期 + 活血化痰法　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：观察活血化痰法对慢性阻塞性肺疾病急性加重期证属痰瘀互结患者症状体征、肺功能、血液流变学及D-二聚体的影响,评价活血化痰法在治疗慢性阻塞性肺疾病急性加重期中的应用价值,为临床上应用活血化痰法的应用提供更多依据,并试图初步探索血液流变学与D-二聚体在慢阻肺急性加重期的应用价值。方法：从2014年06月至2015年10月在四川省中医院呼吸科住院的慢阻肺患者中筛选出符合入选标准的56例,随机将其分成实验组和对照组,实验组28例,对照组28例。实验组与对照组均采用西医常规治疗,实验组在对照组的治疗基础上加用葶苈大枣泻肺汤合桂枝茯苓丸为基础的中药汤剂,两组疗程均为14天,治疗结束后比较两组患者症状体征积分、肺功能、血液流变学及D-二聚体指标变化。结果：1.本研究实验组脱落3例,对照组脱落4例,其余49例均顺利完成研究。实验组和对照组治疗前在性别、年龄、病情程度、症状体征积分及血液流变学各项实验室指标差异无统计学意义(P0.05),具有可比性。2.两组疗效比较,实验组有效率92.0%,对照组有效率87.5%,两组间比较P0.05,具有显著差异性,实验组优于对照组。3.治疗前后组内比较,实验组和对照组症状体征积分均有显著差异性(P0.05),说明两组患者症状及体征均得到改善；治疗后实验组与对照组症状体征积分有显著差异性,实验组疗效优于对照组。4.两组患者治疗后较治疗前FEV1%, FEV1/FVC均有所改善,治疗后两组患者FEV1占预计值%、FEV1/FVC组间无显著差异性(P0.05),说明实验组和对照组的治疗均能改善患者肺功能,二者效果相似。5.治疗后两组患者全血粘度、血浆粘度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数TK及血浆纤维蛋白原较治疗前均具有差异性(P0.05),红细胞压积无差异性(P0.05),而实验组在改善全血粘度、血浆粘度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数TK及血浆纤维蛋白原上更明显(P0.05)。结论：活血化痰法对于慢阻肺急性加重期证属痰瘀互结证患者疗效确切,能改善患者症状体征,影响血液流变学及D-二聚体,但对肺功能改善不明显。
[Abstract]:Objective: to observe the effects of Huoxue Huatan method on symptoms and signs, pulmonary function, hemorheology and D-dimer in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). To evaluate the value of activating blood circulation and removing phlegm in the treatment of acute exacerbation of chronic obstructive pulmonary disease, and to provide more evidence for clinical application of activating blood circulation and removing phlegm. We also try to explore the application value of hemorheology and D-dimer in acute exacerbation of COPD. Methods: from June 2014 to October 2015, 56 patients with COPD were selected from respiratory department of Sichuan traditional Chinese Medicine Hospital. They were randomly divided into two groups: experimental group (n = 28) and control group (n = 28). Both the experimental group and the control group were treated with routine western medicine. The experimental group was treated with Tinglida Zaoxie Lung decoction and Guizhi Fuling Pill on the basis of the treatment in the control group. The course of treatment in both groups was 14 days. Symptoms and signs scores, pulmonary function, hemorheology and D-dimer were compared between the two groups after treatment. The result is 1: 1. In this study, 3 cases were lost in the experimental group, 4 cases in the control group and 49 cases in the control group. There was no significant difference between experimental group and control group in sex, age, degree of illness, symptom and sign score and hemorheology before treatment (P0.05). The effective rate of the experimental group was 92.0 and that of the control group was 87.5. There was significant difference between the two groups (P0.05), and the experimental group was superior to the control group. 3. Before and after treatment, the scores of symptoms and signs in the experimental group and the control group were significantly different (P0.05), indicating that the symptoms and signs of the two groups were improved; after treatment, there were significant differences in the scores of symptoms and signs between the experimental group and the control group. The effect of the experimental group was better than that of the control group. The FEV1 / FVC of FEV1 and FEV1 / FVC were improved after treatment. There was no significant difference in FEV1 / FEV1 / FVC between the two groups after treatment (P0.05), indicating that the treatment of the experimental group and the control group could improve the pulmonary function of the patients, and the effect was similar between the two groups. After treatment, the whole blood viscosity, plasma viscosity, erythrocyte aggregation index, erythrocyte rigidity index, The erythrocyte deformability index (TK) and plasma fibrinogen were different from those before treatment (P0.05), but the hematocrit had no difference (P0.05), while in the experimental group, the whole blood viscosity, plasma viscosity, erythrocyte aggregation index, erythrocyte rigidity index were improved. Erythrocyte deformability index TK and plasma fibrinogen were more obvious (P0.05). Conclusion: the method of activating blood circulation and removing phlegm can improve the symptoms and signs of chronic obstructive pulmonary disease, affect hemorheology and D-dimer, but has no obvious improvement on pulmonary function.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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