中医辨证论治疗法对支气管哮喘住院患者应用价值的探讨

发布时间：2019-01-22 09:51

【摘要】：研究背景:支气管哮喘[1]是由多种细胞包括气道的炎性细胞(如肥大细胞、嗜酸性粒细胞、T淋巴细胞、中性粒细胞)和结构细胞(如气道上皮细胞、平滑肌细胞等)以及细胞组分参与的气道慢性炎症性疾病。慢性炎症导致气道高反应性,通常表现为可逆性的气流受限,并引起反复发作性的喘息、气急、胸闷或咳嗽等症状,常在夜间和清晨发作、加剧,多数患者可自行缓解或经治疗缓解[2]。患者哮喘急性发作时其工作、学习和生活会受到严重困扰,病情重的患者需要住院治疗,因而给社会和家庭带来一定的经济和生活负担,目前己成为一个不可忽视的公共卫生问题[3]。中医药在治疗哮喘方面疗效确凿,不但可缓解哮喘急性发作时的症状,而且可通过补虚扶正达到控制复发的效果。因而对于哮喘急性发作住院的患者,配合中医治疗疗效确凿,但该法是否能够缩短患者住院时间,加快撤减激素、减少激素的用量等缺乏系统评价。因此,对住院哮喘患者运用中医辨证论治疗法的应用价值进行研究具有重要的现实意义。研究目的:通过观察分析哮喘患者住院期间支气管哮喘相关中西医治疗方案、住院时间、症状改善情况、撤减激素等,探讨中医辨证论治疗法的优势和价值,为建立一个规范、有效的中医辨证论治疗法+西医基础治疗的中西医结合治疗方案提供实践依据。研究方法:选取支气管哮喘急性发作期的患者60例,分为两组,分别采用西医、中西医结合方法治疗。主要通过观察以下项目评价各组疗效:哮喘症状控制时间,住院时间;入院前、出院后4周哮喘控制测试评分(ACT评分);入院时、入院第7天(或出院时)、出院时临床症状体征积分;糖皮质激素使用量、撤减时间及总的使用时间等。通过统计学方法,比较西医治疗与中医辨证论治疗法+西医基础治疗两组患者治疗的情况。研究结果:两组患者在性别、年龄及病程上无明显差异。两组患者在哮喘症状控制时间、住院时间比较差异有统计学意义。两组患者在入院时症状体征积分及入院时ACT评分无明显差异。两组患者在入院第7天(或出院时)、出院时症状体征积分、出院后4周ACT评分比较差异有统计学意义。两组患者在糖皮质激素使用量、激素撤减时间比较差异有统计学意义。研究结论:中医辨证论治疗法结合西医治疗哮喘急性发作住院患者,相较单纯西医治疗,在改善患者症状,缩短住院时间,加快激素撤减、减少激素副作用等方面存在优势,中医辨证论治疗法在哮喘急性发作住院患者中的应用具有重要价值。
[Abstract]:Background: bronchial Asthma [1] is composed of a variety of cells including inflammatory cells (such as mast cells, eosinophils, T lymphocytes, neutrophils) and structural cells (such as airway epithelial cells). Smooth muscle cells, etc.) and cellular components are involved in chronic inflammatory diseases of the airway. Chronic inflammation leads to airway hyperresponsiveness, usually characterized by reversible airflow limitation and recurrent wheezing, shortness of breath, chest tightness or cough, often occurring at night and early in the morning. Most of the patients were able to relieve by themselves or after treatment [2]. During the acute attack of asthma, the work, study and life of the patients will be seriously disturbed. The seriously ill patients need to be hospitalized, thus bringing a certain amount of economic and living burden to the society and families. At present, it has become a public health problem which can not be ignored. Chinese medicine has definite curative effect in treating asthma. It can not only relieve the symptoms of acute attack of asthma, but also control the recurrence by reinforcing deficiency and strengthening the center. Therefore, for the inpatients with acute asthma attack, the curative effect of TCM treatment is definite, but whether this method can shorten the hospitalization time, speed up the withdrawal of hormone, reduce the amount of hormone and so on is lack of systematic evaluation. Therefore, it is of great practical significance to study the application value of TCM dialectical therapy in asthmatic patients. Objective: to explore the advantages and value of TCM syndrome differentiation therapy through observing and analyzing the treatment plan, duration of stay, symptom improvement, withdrawal of hormone and so on, in order to establish a standard for the treatment of bronchial asthma during hospitalization. Effective TCM syndrome differentiation therapy and western medicine basic treatment of integrated traditional Chinese and western medicine treatment program to provide practical basis. Methods: 60 patients with acute attack of bronchial asthma were divided into two groups. The efficacy of each group was evaluated by observing the following items: asthma symptom control time, hospitalization time, asthma control test score (ACT score) before admission and 4 weeks after discharge. On admission, on the 7th day of admission (or at discharge), the clinical symptoms and signs scores, glucocorticoid usage, withdrawal time and total use time were obtained. By means of statistics, the treatment of western medicine and traditional Chinese medicine syndrome differentiation therapy were compared between the two groups. Results: there was no significant difference in sex, age and course of disease between the two groups. There was a significant difference in symptom control time and hospitalization time between the two groups. There was no significant difference in symptom score and ACT score between the two groups. There were significant differences between the two groups on the 7th day of admission (or at discharge), the scores of symptoms and signs at discharge, and the ACT score at 4 weeks after discharge. There were significant differences in glucocorticoid use and withdrawal time between the two groups. Conclusion: there are advantages in improving symptoms, shortening hospitalization time, quickening hormone withdrawal, reducing hormone side effects and so on, compared with western medicine alone in treating inpatients with acute asthma attack by TCM treatment based on syndrome differentiation and western medicine. The application of TCM treatment based on syndrome differentiation in patients with acute asthma attack is of great value.
【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】：2017
【分类号】：R256.12

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