加味麻辛附子汤对慢阻肺急性加重期（肺肾阳虚型）患者SAA、hsCRP及PCT干预的临床观察

发布时间：2018-07-10 18:37

  本文选题：加味麻辛附子汤 + 慢性阻塞性肺疾病急性加重期　； 参考：《云南中医学院》2017年硕士论文

【摘要】：目的:通过对具有温肾补肺、化痰止咳平喘之功的加味麻辛附子汤配合西药治疗慢阻肺急性加重期(肺肾阳虚型)患者的炎性指标干预性临床观察,进一步验证加味麻辛附子汤治疗慢阻肺急性加重期的有效性,从而彰显中医药在急性病治疗方面的优势。方法:本课题在云南省中医医院肺病科住院部按预期纳入标准选择病例72例作为选受试对象,告知其本次试验性质及目的,并得到受试者本人及家属的同意,承诺按试验的方法规律服药,直到试验结束,纳入观察的患者采用随机分组法,随机分为治疗组36例和对照组36例。对照组在基础治疗上给予西药治疗;治疗组与对照组采用相同西医常规治疗,在此基础上加用加味麻辛附子汤治疗组疗程15天,15天后观察两组患者在治疗前和治疗后的综合临床疗效,并对两组患者治疗前后各项指标进行比较,参照《中药新药临床研究原则》相关为主要依据做出评分标准。结果:计划观察72例,实际观察72例,治疗组36例,对照组36例。治疗前两组患者性别、年龄无显著差异,具有可比性。经统计计算治疗组总有效率为88.8%,与对照组77.8%比较,其差异显著,具有统计学意义。综合两组患者治疗前后的中医证候积分、疗效性指标、安全性指标进行比较,可以得出:(1)两组治疗前中医症状积分、动脉血气分析、炎性指标、血常规、肺功能、住院时间、安全性指标等无明显差异,无统计学意义,具有可比性;(2)治疗后两组安全性指标吸、心率、血压、肝功(AST、ALT)、肾功(Cr、UREA)比较无明显差异,无统计学意义,说明本次研究观察安全可靠;(3)治疗后两组中医主要症状(咳嗽、咳痰、喘息、气短)及次要症状(畏寒、唇甲青紫、腰膝酸冷)积分比较均有显著差异,具有统计学意义;(4)治疗后两组炎性指标SAA、hs CRP治疗组改善优于对照组,差异显著,具有统计学意义;PCT治疗前后无明显变化,无显著差异,无统计学意义,说明本次选择观察的慢阻肺急性加重患者PCT无明显变化;(5)治疗后两组血常规比较,治疗组WBC(109/L)、NEUT(%)降低明显优于对照组,差异明显,具有统计学意义;(6)治疗后两组动脉血气比较,有显著差异,具有统计学意义;(7)治疗后两组住院时间比较,治疗组住院时间少于对照组,具有明显差异,具有统计学意义。结论:通过本课题的研究,运用中西医结合的方法比单纯西药更能有效的控制慢阻肺急性发作,综合两组患者治疗前后的中医证候积分、疗效性指标、安全性指标进行比较分析得出:(1)对患者呼吸、心率、血压、肝功、肾功能等安全性指标无明显影响,说明本次观察安全;(2)在改善患者临床症状、炎性指标、血常规、动脉血气、肺功能等方面治疗组优于对照组;(3)在缩短应用抗菌素和住院时间上治疗组明显优于对照组;(4)证实了说明中医中药在治疗急性病方面的有效性。
[Abstract]:Objective: to observe the inflammatory indexes of the patients with chronic obstructive pulmonary disease (COPD) in acute exacerbation (deficiency of lung and kidney yang) treated by modified Maxinfuzi decoction and western medicine, which has the function of warming the kidney and tonifying the lung, eliminating phlegm and relieving cough and relieving asthma. To further verify the effectiveness of modified Maxinfuzi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease, thus highlighting the advantages of traditional Chinese medicine in the treatment of acute diseases. Methods: according to the expected inclusion criteria, 72 cases were selected from the Department of Lung Disease of Yunnan traditional Chinese Medicine Hospital as subjects, and the nature and purpose of the trial were informed, and the consent of the subjects and their families was obtained. The patients were randomly divided into treatment group (n = 36) and control group (n = 36). The control group was treated with western medicine on the basis of basic treatment, while the treatment group and the control group were treated with the same routine western medicine. On this basis, the comprehensive clinical efficacy of the two groups before and after treatment was observed after 15 days and 15 days of treatment, and the indexes before and after treatment were compared between the two groups. According to the principles of Clinical Research of New Chinese Medicine, the main basis of scoring criteria was made. Results: 72 cases were planned, 72 cases were observed, 36 cases in treatment group and 36 cases in control group. There was no significant difference in sex and age between the two groups before treatment. The total effective rate of the treatment group was 88.8%, which was significantly higher than that of the control group (77.8%). By comparing the TCM syndromes, curative indexes and safety indexes before and after treatment, we can draw the following conclusions: (1) before and after treatment, the TCM symptom score, arterial blood gas analysis, inflammatory index, blood routine examination, lung function, hospitalization time, There was no significant difference in safety indexes between the two groups. (2) there was no significant difference between the two groups in terms of inhaling, heart rate, blood pressure, liver function (alt), renal function (Crus UREA), and there was no significant difference between the two groups. The results showed that this study was safe and reliable. (3) there were significant differences in scores of main symptoms (cough, expectoration, wheezing, shortness of breath) and secondary symptoms (chills, bluish lips, cold waist and knee acid) between the two groups after treatment. (4) after treatment, the inflammatory index SAAHs CRP in the two groups was improved better than that in the control group, the difference was significant, and there was no significant change, no significant difference and no statistical significance before and after treatment with PCT. The results showed that PCT had no significant change in patients with acute exacerbation of chronic obstructive pulmonary disease. (5) after treatment, the WBC (109 / L) net (%) in the treatment group was significantly lower than that in the control group, and the difference was significant. (6) the arterial blood gas of the two groups after treatment was significantly lower than that of the control group. There are significant differences, with statistical significance; (7) after the treatment of the two groups of hospitalization time comparison, the treatment group is less than the control group, there is a significant difference, with statistical significance. Conclusion: through the research of this subject, the method of combination of traditional Chinese and western medicine is more effective than western medicine in controlling acute attack of chronic obstructive pulmonary disease (COPD), and synthesizing TCM syndromes integral and curative effect index of two groups before and after treatment. The safety indexes were compared and analyzed: (1) there was no significant effect on the safety indexes such as respiration, heart rate, blood pressure, liver function and renal function, which indicated that this observation was safe; (2) it was improving the clinical symptoms, inflammatory indexes, blood routine examination, arterial blood gas, etc. The treatment group was superior to the control group in terms of lung function; (3) the treatment group was superior to the control group in shortening the use of antibiotics and hospital stay; (4) proved the effectiveness of TCM in the treatment of acute diseases.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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