芩夷复方治疗支气管哮喘急性发作期疗效观察

发布时间：2018-11-20 07:00

【摘要】：目的：论文系统地探讨了支气管哮喘的发病机制,回顾了中西医结合防治支气管哮喘的理论,认为支气管哮喘发病的中医重要环节为“伏痰”。芩夷复方是南京中医药大学刘隆棣教授治疗支气管哮喘的临床经验总结,按照祛风涤痰,降气平喘的机理组方,既往多项实验研究证实芩夷复方能抑制哮喘豚鼠的气道炎症反应,本研究拟通过临床研究进一步探讨其作用机理,并观察其与西药联合应用于临床,相对于单独用西药来说在缩短疗程、提高疗效方面的优势。方法：临床收集65例患者,临床分期为轻、中度支气管哮喘,中医分型为风痰证者,随机分为观察组(芩夷复方联合基础治疗(布地奈德福莫特罗粉吸入剂(规格：160ug/4.5ug/60吸),1吸bid。对于轻中度患者均如此,如哮喘不得缓解,可加吸,最多加至6吸/天；病情平稳后可减量,最少减至1吸／天；如病情加重,可静脉注射茶碱类或抗生素))33例和对照组(单用基础治疗)32例。通过对比观察组与对照组患者在治疗前后的相关临床及实验室指征(如血嗜酸粒细胞计数(Eos)、呼出气一氧化氮(FeNO)、肺功能(FEV1、FEV1/FVC)、中医症候、哮喘控制测试表评分(ACT)等),评估两种用药方案的临床效果。结果：(1)观察组总体有效率90%,对照组总体有效率80%,.但两组差异不大(P0.05)；(2)就中医症状与体征而言,观察组的咳嗽症状比对照组缓解明显(P0.05)；此外,两组其他中医症候均有缓解,但差异不大(P)0.05)；(3)喘息、哮呜音、气短、咳嗽、咯痰的改善时间而言,观察组明显短于对照组(P0.05);(4)就Eos、FEV1、FEV1/FVC、FeNO而言,两组治疗后均较治疗前好转,且观察组较对照组有显著差异(P0.05)；(4)就ACT评分而言,两组治疗后均较治疗前好转,且观察组与对照组之间有统计学差异(P＜0.05)。 (5)治疗前后两组评估的血常规、尿常规、肝肾功能、心电图均未见明显异常,无副作用产生。结论： (1)联合使用芩夷复方与基础治疗较单纯应用基础治疗更能减轻轻中度哮喘患者的咳嗽症状,且在症状(喘息、哮鸣音、气短、咳嗽、咯痰)的改善时间上明显少于单用基础治疗。(2)在Eos、FeNO、肺功能、ACT评分的改善上,观察组均优于对照组,芩夷复方配合基础治疗在哮喘的控制上优于对照组。(3)两组均未见不良反应发生,临床可推荐应用芩夷复方。
[Abstract]:Objective: this paper systematically discussed the pathogenesis of bronchial asthma, reviewed the theory of integrated traditional Chinese and western medicine to prevent and treat bronchial asthma, and considered that the important part of TCM in the pathogenesis of bronchial asthma was phlegm. Qinyi compound is Professor Liu Longdi's clinical experience in treating bronchial asthma at Nanjing University of traditional Chinese Medicine. The prescription is based on the mechanism of dispelling wind and purging phlegm and reducing qi and relieving asthma. Several previous experimental studies have confirmed that Qinyi compound can inhibit airway inflammation in asthmatic guinea pigs. This study intends to further explore its mechanism through clinical study and observe its combined use with western medicine in clinical practice. Compared with western medicine alone, it can shorten the course of treatment and improve the curative effect. Methods: 65 patients with mild and moderate bronchial asthma were collected. Randomly divided into observation group (Qinyi compound combined with basic treatment (budesonide formoterol powder inhaler (specification: 160ug/4.5ug/60 inhalation), 1 inhaled bid.) For mild to moderate patients, if asthma is not alleviated, can be added to the maximum of 6 per day, after the disease can be reduced to at least 1 inhalation / day; 33 cases were treated by intravenous injection of theophylline or antibiotics) and 32 cases in the control group (treated by basic therapy alone). The clinical and laboratory indications (such as blood eosinophils count, (Eos), exhalation, nitric oxide (FeNO), lung function (FEV1,FEV1/FVC), TCM symptoms) were compared between the observation group and the control group before and after treatment. To evaluate the clinical effects of the two drug regimens, the asthma control test scale score (ACT) et al.). Results: (1) the total effective rate was 90 in the observation group and 80 in the control group. But there was no significant difference between the two groups (P0.05); (2). In terms of TCM symptoms and signs, the cough symptoms in the observation group were significantly alleviated than those in the control group (P0.05). In addition, other TCM symptoms in the two groups were relieved, but the difference was not significant (P) 0. 05). (3) the improvement time of wheezing, shortness of breath, cough and sputum in the observation group was significantly shorter than that in the control group (P0.05); (4) as far as Eos,FEV1,FEV1/FVC,FeNO was concerned, the two groups were better after treatment than before, and there was significant difference between the observation group and the control group (P0.05). (4) as far as ACT score was concerned, both groups were better than those before treatment, and there was significant difference between the observation group and the control group (P < 0. 05). (5) the blood routine, urine routine, liver and kidney function, electrocardiogram of the two groups before and after treatment were not abnormal, and no side effects were found. Conclusion: (1) combined use of Qinyi compound and basic treatment can relieve cough symptoms of mild and moderate asthma patients more than simple basic treatment, and the symptoms (wheezing, shortness of breath, cough) in patients with mild and moderate asthma. (2) in the improvement of Eos,FeNO, pulmonary function and ACT score, the observation group was better than the control group. Qinyi compound combined with basic treatment was superior to the control group in the control of asthma. (3) there was no adverse reaction in both groups.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.12

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