消风止咳汤治疗风邪恋肺型感染后咳嗽临床观察

发布时间：2019-05-14 04:16

【摘要】：目的：通过对现代医学中感染后咳嗽(post-infectious cough PIC)的发病机理、临床特点.中西医目前治疗等方面的理论研究,运用肖波教授临床经验方“消风止咳汤”对辩证为风邪恋肺型感染后咳嗽进行治疗和观察其治疗效果,验证中医药在治疗感染后咳嗽方面有着较明显的优势,可以为众多感染后咳嗽患者带来更为廉便的治疗方案。方法：通过收录80例符合纳入标准且不符合排除标准的感染后咳嗽患者(失访病例除外),所有患者均为在2014年3月至2015年10月期间至广州中医药大学附属湛江市第二中医院接受门诊或住院治疗。把入组且符合纳入标准的80例患者按照随机数字表法随机分成研究组和对照组两组,其中研究组为40人,对照组为40人。两组患者较在性别、年龄、咳嗽症状积分、咳嗽严重程度视觉评分及中医症状积分等方面在治疗前经统计学比较,P0.05,无统计学差异,可以进行疗效差异性研究。研究组给予口服(广东一方制药生产)颗粒型中药,中药处方为肖波教授经验基本处方(消风止咳汤),根据临床实际辩证可进行适当的加减,于药杯中先加150-200ml开水,然后加入中药配方颗粒,搅拌至溶解充分后适温口服。用量：1服/次,2次/日,于早餐及晚餐30分钟后服用。对照组给予指南推荐西医常规用药治疗,给予富马酸酮替芬1粒(1.38mg)一日2次,右美沙芬15mg一日3次。两组治疗疗程均为10天,在治疗过程中4d,7d,10d及治疗结束1周,进行随访并记录相关观察指标。分别按照要求在相应时间点记录两组患者相对应治疗时间点的数据：咳嗽症状积分、咳嗽视觉评分、中医症状积分。每个患者在治疗开始前和治疗终结的1周后都进行安全性项目监测,以评估药物安全性。在治疗观察期间所有患者禁止使用除了试验药物之外的药物(外用或内服)。对所取得的临床资料数据运用SPSS18.0统计软件进行统计分析。数据以均数土标准差用(x±s)表示,计量资料用t检验,计数资料用X。检验,等级资料用秩和检验,重复测量设计采用方差分析,当P0.05时认为两组数据之间存在显著性差异,当P0.05时两组数据之间无显著性差异。结果：(1)临床结果分析显示运用肖波教授消“消风止咳汤”治疗的研究组中临床疗效、症状改善程度相对指南推荐的西药治疗对照组均有较明显优势,且不良反应少,无明显毒副作用。(2)临床研究结果显示,研究组治疗40例患者中治愈17例,在观察时间窗内治愈率为42.5%,总有效率为92.5%；而对照组同样治疗40例患者,其中治愈9例,在观察时间窗内治愈率为22.5%,总有效率为72.5%。经统计学分析两组在疗效方面比较存在显著性差异(P0.05)。经过治疗后两组患者在咳嗽症状积分、咳嗽视觉模拟评分、中医症状积分与治疗前比较都有积分有较明显下降,患者自觉症状改善,并且两组治疗后各种指标积分下降差值经过统计学比较存在显著性差异(P0.05)显示研究组比对照组效果更明显,且具有统计学意义。(3)经过不同治疗的患者在治疗后两组不良反应发生率分别为：研究组：7.5%,对照组27.5%。研究组中药在治疗过程中未发现肝肾功能损害及其他不良反应,而对照组有11位患者出现嗜睡,头晕、或胃肠道反应等不良反应,经停药后症状可消失。不良事件发生率两组比较研究组的不良反应率低于对照组,经X2检验有统计学意义。结论：肖波教授“消风止咳汤”在治疗感染后咳嗽(风邪恋肺型)临床试验中能取得较好的临床效果,并且安全有效,能有效地缓解患者临床症状,值得在临床中推广。
[Abstract]:Objective: To study the pathogenesis and clinical characteristics of post-infectious cough (PPIC) in modern medicine. The theoretical study on the current treatment of traditional Chinese and western medicine, using the "Xiaofeng Zhike Decoction" of Professor Xiao-bo's clinical experience, to treat and observe the treatment effect of the cough after the infection of the lung-type infection, and to verify the obvious advantages of the traditional Chinese medicine in the treatment of post-infection cough, Can provide a more effective treatment scheme for a plurality of patients with post-infection cough. Method:80 patients with post-infection cough (with the exception of lost-to-follow-up) included in the standard and not meeting the exclusion criteria were collected, and all the patients were admitted to the second middle-level hospital in Zhanjiang, Guangzhou, from March 2014 to October 2015 for outpatient or hospitalization. 80 patients enrolled and met the criteria were randomly divided into two groups in the study group and the control group according to the random digital table method. The study group was 40, and the control group was 40. There was no statistical difference between the two groups in the treatment of sex, age, cough symptom, the severity of cough, and the integral of the symptoms of TCM. The study group is given the granule type traditional Chinese medicine for oral administration (one of Guangdong's pharmaceutical production), and the prescription of the traditional Chinese medicine is the basic prescription of Professor Xiao Bo's experience (Xiaofeng Zhike Tang). According to the clinical practice, the appropriate addition and subtraction can be carried out, and 150-200 ml of boiled water is added in the medicine cup, and then the traditional Chinese medicine formula particles are added, Stirring until the solution is fully dissolved, and is suitable for oral administration. Dosage:1 service/ time,2 times/ day, and taken after 30 minutes of breakfast and dinner. The control group recommended that western medicine should be treated with conventional medicine, and the ketotifen fumarate 1 particle (1.38 mg) was given 2 times a day, and the dextromethorphan was 15 mg daily for 3 times. The treatment course of the two groups was 10 days, and the follow-up was carried out for 4 days,7 days,10 days and 1 week after the treatment, and the relevant observation indexes were recorded. The data of the corresponding treatment time points of the two groups were recorded at the corresponding time points according to the requirements: the symptoms of cough, the visual score of the cough, and the integral of the symptoms of the Chinese medicine. Safety project monitoring was performed for each patient after 1 week of treatment initiation and end of treatment to assess drug safety. All patients were prohibited from using a drug (external or oral) other than the investigational drug during the treatment observation. The statistical analysis of the obtained clinical data was carried out using the SPSS18.0 statistical software. The data is represented by the standard deviation of the mean soil standard deviation (x% s). The measurement data is used for t-test, and the count data is used for X-ray. The rank and the test of the grade data are used for the measurement data. The analysis of variance is used for the repeated measurement design. When the difference between the two groups of data is considered as the difference between the two groups of data at the time of P0.05, There was no significant difference between the two groups when P0.05. Results: (1) The clinical result analysis showed that the clinical curative effect and the improvement degree of the clinical effect and the degree of improvement of the symptom in the study group treated by Xiao Bo's anti-"Xiaofeng Zhike Decoction" therapy had obvious advantages, with few adverse reactions and no obvious toxic and side effects. (2) The results showed that in the study group,17 cases were cured in 40 patients, the cure rate was 42.5% in the observation time window, the total effective rate was 92.5%, and the control group treated 40 patients, among which 9 cases were cured, and the cure rate in the observation time window was 22.5%. The total effective rate was 72.5%. There was a significant difference in the efficacy of the two groups (P0.05). After the treatment, the symptoms of the cough, the visual analogue of the cough and the integral of the symptoms of the traditional Chinese medicine and the pre-treatment of the symptoms of the cough were significantly reduced, and the patient's self-conscious symptoms were improved. There was a significant difference in the difference between the two groups after the treatment (P0.05). (3) The incidence of adverse reactions in the two groups after treatment was as follows: study group: 7.5%, control group 27.5%. In the study group, the function of the liver and the kidney and other adverse reactions were not found in the course of the treatment, while 11 patients in the control group had the adverse reactions such as somnolence, dizziness, or gastrointestinal reaction, and the symptoms may disappear after the drug withdrawal. The incidence of adverse events in the two groups was lower than that of the control group. Conclusion: Professor Xiao-bo's "Xiaofeng Zhike Decoction" has a good clinical effect in the clinical trial of treating cough after infection, and is safe and effective, and can effectively relieve the clinical symptoms of the patient and is worthy of being popularized in the clinic.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.1

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