桂枝加黄芪汤合苍耳子散加减内服和熏鼻治疗慢性鼻炎的研究

发布时间：2019-01-02 07:13

【摘要】：目的探讨桂枝加黄芪汤合苍耳子散加减内服和熏鼻治疗慢性鼻炎(肺脾气虚、邪滞鼻窍证)近期对鼻塞、鼻阻力的改善作用,以及远期对复发的影响。方法共入选178例患者,除去脱落共完成167例,随机分为观察组83例和对照组84例。对照组,鼻三针辨证取穴,6次为1个疗程,共8个疗程,每个疗程间隔1d。观察组,采用桂枝加黄芪汤合苍耳子散加减内服和熏鼻,两组均连续观察8周。主要疗效指标包括主观鼻塞程度[采用视觉模拟评分(VAS评分)]和鼻气道阻力。次要疗效指标包括鼻塞,头痛、头晕,嗅觉减退,鼻涕和鼻黏膜情况评分等中医证候评分;进行鼻腔纤毛输送功能(MTR)检测和记录24周内患者复发频率;并进行安全性评价。结果观察组临床疗效总有效率为95.18%,高于对照组的84.52%(χ2=5.185,P=0.022 8);经重复测量的方差分析,对照组和观察组在治疗后鼻塞程度VAS评分均呈下降趋势(P0.05);经配对t检验,观察组在治疗第21、28、35、42、49、56天鼻塞程度VAS评分均低于对照组(P0.01);经重复测量的方差分析,对照组和观察组在治疗4、8周后鼻阻力检测均显著下降(P0.05),经配对t检验,观察组在治疗4、8周后鼻阻力均低于对照组(P0.01);在治疗后24周(随访期)两组鼻阻力均较治疗结束时升高,但观察组鼻阻力仍然低于对照组(P0.01);治疗后观察组鼻塞,头痛、头晕,嗅觉减退,鼻涕和鼻黏膜情况评分均低于对照组(P0.01);治疗后观察组MTR快于对照组(P0.05);在24周的随访期内,观察组复发率为85.54%,对照组为90.05%,组间比较差异无统计学意义(χ2=3.303,P=0.069 1),但观察组平均复发次数低于对照组(P0.01)。结论桂枝加黄芪汤合苍耳子散加减内服和熏鼻治疗慢性鼻炎肺脾气虚、邪滞鼻窍型患者近期能改善患者主观鼻塞症状,降低患者鼻阻力,降低中医证候评分,促进MTR;远期能维持患者鼻阻力处于低水平,并能减少复发次数,临床疗效显著且安全。
[Abstract]:Objective to investigate the short-term improvement of nasal obstruction and nasal resistance in the treatment of chronic rhinitis (deficiency of lung and spleen qi, stagnation of nose orifices) by oral administration of Guizhi plus Huangqi decoction combined with Cangerzi Powder and fumigation of nose, and the long-term influence on recurrence. Methods 178 patients were enrolled and 167 cases were completed. They were randomly divided into the observation group (83 cases) and the control group (84 cases). In the control group, there were 8 courses of treatment, 6 times as a course of treatment, and the interval of each course was 1 day. In the observation group, Guizhi and Huangqi decoction combined with Cangerzi Powder were used for 8 weeks. The main outcome measures included subjective nasal congestion [visual analogue score (VAS)] and nasal airway resistance. The secondary curative effects included nasal congestion headache dizziness olfactory loss nasal mucous membrane score and nasal mucosal condition score. The nasal cilium transport function (MTR) was used to detect and record the recurrence rate of patients within 24 weeks and the safety evaluation was carried out. Results the total effective rate of the observation group was 95.18%, which was higher than that of the control group (84.52%) (蠂 2 = 5.185%, P < 0.022 8). After repeated measurement, the VAS scores of nasal congestion in the control group and the observation group showed a downward trend (P0.05), and the VAS score of the observation group was lower than that of the control group on day 21, 2835, 42, 4956 days after treatment (P0.01). After repeated measurement of ANOVA, the nasal resistance in the control group and the observation group decreased significantly after 48 weeks of treatment (P0.05), and the nasal resistance in the observation group was lower than that in the control group after 48 weeks of treatment (P0.01). The nasal resistance in the observation group was still lower than that in the control group 24 weeks after treatment (P0.01), but the nasal resistance in the observation group was still lower than that in the control group (P0.01). After treatment, the scores of nasal congestion, headache, dizziness, decreased olfaction, nasal snot and nasal mucosa in the observation group were lower than those in the control group (P0.01), MTR in the observation group was faster than that in the control group after treatment (P0.05). During the follow up period of 24 weeks, the recurrence rate of the observation group was 85.54 and that of the control group was 90.05. There was no significant difference between the two groups (蠂 2, 3.303, P < 0.069 1), but the average number of recurrence in the observation group was lower than that in the control group (P0.01). Conclusion Guizhi and Huangqi decoction combined with Cangerzi Powder can improve the subjective nasal congestion symptoms, reduce the nasal resistance, reduce the score of TCM syndromes and promote MTR; in the treatment of chronic rhinitis with deficiency of lung and spleen qi and stagnation of nose resuscitation. In the long term, it can maintain low nasal resistance and reduce the number of recurrence. The clinical efficacy is significant and safe.
【作者单位】：河南省许昌市中心医院中医康复科;
【分类号】：R276.1

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