小柴胡汤合下气升血汤加减治疗慢性肺源性心脏病失代偿期合并肝淤血的临床研究

发布时间：2018-09-13 11:31

【摘要】：目的:通过小柴胡汤合下气升血汤加减治疗慢性肺源性心脏病失代偿期合并肝淤血临床疗效观察,探讨一个比较完善的中西医结合治疗慢性肺源性心脏病失代偿期合并肝淤血的治疗方案。方法:选择符合慢性肺源性心脏病失代偿期合并肝淤血且中医辨证为痰饮阻肺兼络气不和型的患者60例,按入院先后顺序,随机分为联合组和对照组,对照组27例,联合组33例患者,两组在观察过程中均无剔除及脱落。对照组行西医常规治疗(控制感染、祛痰、解除气道痉挛、纠正水电解质和酸碱失衡、短程使用糖皮质激素、营养支持治疗),联合组基础治疗与对照组一致,同时加服小柴胡汤合下气升血汤加减,一次100ml,一日三次,1日1剂。疗程7天。记录两组患者年龄、性别、病程、治疗前、后各时间段(1天、3天、7天)中医证候积分、肺功能、NT-proBNP、动脉血气、hs-CRP、LVEF、肝、肾功能检查等指标,使用统计软件SPSS 13.0分析所得数据。结果:两组治疗前基础情况无显著性差异。(1)联合组临床疗效(93.9%)优于对照组(74.1%)。(2)联合组中医证候积分改善程度(治疗前积分-治疗后积分)与对照组比较有差异(P0.05)。(3)通气指标比较:FEV1、FEV1/FVC%、FEV1占预计值%较治疗前均有所提高(P0.01),但联合组升高较对照组更明显(P0.05),在统计学上有差异。(4)血气分析比较:联合组、对照组治疗后PaCO_2、PaO_2与治疗前比较均有差异(P0.01),联合组治疗后Pa CO_2、PaO_2与对照组比较无差异(P0.05)。(5)两组治疗后NT-proBNP较治疗前下降(P0.01),联合组治疗后NT-proBNP下降较对照组明显(P0.05),在统计学上有差异。(6)两组治疗后hs-CRP评分较治疗前下降(P0.01),联合组治疗后hs-CRP评分下降较对照组明显(P0.05),在统计学上有差异。(7)联合组治疗后心脏彩超LVEF值较治疗前升高(P0.05),在统计学上有差异,对照组治疗后LVEF值升高较对照组不明显(P0.05),差异没有统计学意义。(8)安全性比较:两组治疗后AST、ALT、BUN、Cr与治疗前比较无差异(P0.5)。结论:小柴胡汤合下气升血汤加减治疗慢性肺源性心脏病失代偿期合并肝淤血患者:(1)提高患者临床疗效;(2)改善患者通气功能;(3)纠正心衰;(4)减轻炎症反应;(5)改善心脏射血功能;(6)对肝、肾功等安全性指标影响较小。
[Abstract]:Objective: to observe the clinical effect of Xiaochaihu decoction combined with Xiaqi Shengxue decoction on the decompensation of chronic pulmonary heart disease with liver congestion. To explore a more perfect treatment of chronic pulmonary heart disease combined with liver congestion combined with traditional Chinese and western medicine. Methods: sixty patients with chronic pulmonary heart disease combined with liver congestion and syndrome differentiation of phlegm, drink, obstruction of lung and collaterals and qi disharmony were selected. According to the order of admission, they were randomly divided into two groups: the combined group and the control group, 27 cases in the control group. In the combined group of 33 patients, there was no removal or abscission in the observation process in both groups. The control group was treated with routine western medicine (controlling infection, expelling phlegm, relieving airway spasm, correcting water, electrolyte and acid-base imbalance, using glucocorticoid and nutrition support for short course), and the basic treatment in the combined group was the same as that in the control group. At the same time take Xiaochaihu decoction combined with Qi Shengxue decoction, 100 ml once, three times a day, 1 dose per day. The course of treatment was 7 days. The patients' age, sex, course of disease, time before and after treatment (1 day, 3 days and 7 days) were recorded. The scores of TCM syndromes, pulmonary function and NT-proBNPs, arterial blood gas, hs-CRPN LVEF, liver and kidney function were recorded. The data were analyzed by SPSS 13.0. Results: there was no significant difference between the two groups before treatment. (1) the clinical efficacy of the combined group (93.9%) was better than that of the control group (74.1%). (2). The improvement degree of TCM syndromes in the combined group (before and after treatment) was significantly higher than that in the control group (P0.05). (3). The ratio of FEV1 / FEV1 There were significant differences in PaCO_2,PaO_2 between the control group and before treatment (P0.01), but there was no difference in Pa CO_2,PaO_2 between the combined group and the control group after treatment (P0.05). (5). After treatment, the NT-proBNP of the combined group was lower than that of the control group (P0.01). The decrease of NT-proBNP in the combined group was significantly lower than that in the control group (P0.05). (6) the hs-CRP score of the two groups decreased after treatment (P0.01), the hs-CRP score of the combined group was significantly lower than that of the control group (P0.05), and there was statistical difference. (7) the value of cardiac color Doppler LVEF in the combined group was higher than that before treatment (P0.05), and the difference was statistically significant. The value of LVEF in the control group after treatment was not significantly higher than that in the control group (P0.05), the difference was not statistically significant. (8) comparison of safety: there was no difference between the two groups after treatment and before treatment (P0.5). Conclusion: Xiaochaihu decoction combined with Xiaqi Shengxue decoction for chronic pulmonary heart disease with liver congestion: (1) improve the clinical efficacy; (2) improve the ventilation function of the patients; (3) correct heart failure; (4) alleviate inflammation; (5) improve the heart. Visceral ejection function; (6) liver; The influence of safety indexes such as renal function was small.
【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】：R259

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