苏葶麻杏石甘汤联合常规疗法治疗痰热郁肺证慢性阻塞性肺疾病急性加重期临床研究
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Clinical Study on Suting Maxing Shigan Tang Combined with Routine Treatment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Phlegm- Heat Constraining Lung Syndrome
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    摘要:

    目的:观察苏葶麻杏石甘汤联合西药常规治疗痰热郁肺证慢性阻塞性肺疾病急性加重期(AECOPD) 的临床疗效。方法:将80 例痰热郁肺证AECOPD 患者按随机数表法分为试验组和对照组各40 例。试验组1 例未能坚持用药而脱落;对照组1 例因拒绝复查疗效指标而被剔除,共有78 例患者完成临床观察。2 组均采用西药常规治疗,试验组加用苏葶麻杏石甘汤治疗。治疗14 d 后,比较2 组患者临床疗效、中医证候积分、炎症指标[中性粒细胞与淋巴细胞比值(NLR)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)]、血凝指标[纤维蛋白原(Fib)、D-二聚体(D-D)]、肺功能[第1 秒用力呼气容积(FEV1)、FEV1/FVC、FEV1 占预计值百分比(FEV1%)]及血气分析指标[氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2)]水平。结果:试验组临床显控率为69.23%,对照组为28.21%,2 组比较,差异有统计学意义(P<0.05)。治疗前,2 组咳嗽、咯痰、气短、喘息、紫绀、啰音等中医证候评分及总分比较,差异均无统计学意义(P>0.05);治疗后,2 组上述各项证候评分及总分均较治疗前降低(P<0.05),且试验组各项评分均低于对照组(P<0.05)。治疗前,2 组NLR、hs-CRP、PCT 水平比较,差异均无统计学意义(P>0.05);治疗后,2 组NLR、hs-CRP、PCT 水平均较治疗前降低(P<0.05),且试验组NLR、hs-CRP、PCT 水平均低于对照组(P<0.05)。治疗前,2 组Fib、D-D 水平比较,差异均无统计学意义(P>0.05);治疗后,2 组Fib、D-D 水平均较治疗前降低(P<0.05),且试验组Fib、D-D 水平均低于对照组(P<0.05)。治疗前,2 组FEV1、FEV1/FVC、FEV1%比较,差异均无统计学意义(P>0.05);治疗后,2 组FEV1、FEV1/FVC、FEV1%均较治疗前升高(P<0.05),且试验组FEV1、FEV1/FVC、FEV1%均高于对照组(P<0.05)。治疗前,2 组PaO2、PaCO2、SaO2 水平比较,差异均无统计学意义(P>0.05)。治疗后,2 组PaO2、SaO2 水平均较治疗前升高(P<0.05),PaCO2 水平均较治疗前降低(P<0.05);且试验组PaO2、SaO2 水平均高于对照组(P<0.05),PaCO2 水平低于对照组(P<0.05)。治疗期间,2 组均无明显不良反应发生。结论:苏葶麻杏石甘汤联合西药常规治疗能提高痰热郁肺证AECOPD 患者的临床疗效,能有效控制炎症反应,改善肺功能及凝血功能,且安全性高。

    Abstract:

    Abstract:Objective:To observe the clinical effect of the therapy of Suting Maxing Shigan tang combined with routine western medicine on acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with phlegm- heat constraining the lung syndrome. Methods:A total of 80 AECOPD patients with phlegm-heat constraining the lung syndrome were divided into the experiment group and the control group according to the random number table method,with 40 cases in each group. One case in the experiment group failed to adhere to medication and dropout;one case in the control group was excluded because of the refusal to review the indexes of the curative effect, and a total of 78 patients completed the clinical observation. Both groups were treated with routine western medicine, and the experiment group was additionally treated with Suting Maxing Shigan tang. Fourteen days after treatment,the clinical effects,Chinese medicine syndrome scores and levels of inflammatory indexes[neutrophil- to- lymphocyte ratio(NLR), high- sensitivity C- reactive protein(hs- CRP) and procalcitonin(PCT)],coagulation indexes[fibrinogen(Fib) and D- dimer(D- D)],the lung function [forced expiratory volume in one second(FEV1),FEV1/FVC and FEV1 percentage in the predicted value(FEV1%)] and indexes of blood gas analysis [partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2) and oxygen saturation(SaO2)] were compared between the two groups. Results:The remarkably effective rate was 69.23% in the experiment group,and was 28.21% in the control group, the difference being significant(P<0.05). Before treatment, there was no significant difference being found in the comparison of Chinese medicine syndrome scores and total scores of cough, expectoration, shortness of breath, wheezing,cyanosis and rales between the two groups(P>0.05);after treatment,the scores and total scores of the above syndromes in the two groups were decreased when compared with those before treatment(P<0.05),and the scores in the experiment group were lower than those in the control group(P<0.05). Before treatment,there was no significant difference being found in the comparison of levels of NLR,hs-CRP and PCT between the two groups(P>0.05);after treatment,the above levels in the two groups were decreased when compared with those before treatment(P<0.05),and the above levels in the experiment group were lower than those in the control group(P<0.05). Before treatment, there was no significant difference being found in the comparison of levels of Fib and D-D between the two groups(P>0.05);after treatment,the above indexes in two groups were decreased when compared with those before treatment(P<0.05),and the above scores in the experiment group were lower than those in the control group(P<0.05). Before treatment, there was no significant difference being found in the comparison of FEV1,FEV1/FVC and FEV1% between the two groups(P>0.05);after treatment, the above indexes in the two groups were increased when compared with those before treatment(P<0.05),and the above indexes in the experiment group were higher than those in the control group(P<0.05). Before treatment, there was no significant difference being found in the comparison of levels of PaO2,PaCO2 and SaO2 between the two groups(P>0.05). After treatment,the levels of PaO2 and SaO2 in the two groups were increased when compared with those before treatment (P<0.05),and levels of PaCO2 were decreased(P<0.05);the levels of PaO2 and SaO2 in the experiment group were higher than those in the control group(P<0.05),and the level of PaCO2 was lower(P<0.05). During treatment,no obvious adverse reactions occurred in both groups. Conclusion: The therapy of Suting Maxing Shigan tang combined with routine western medicine for AECOPD with phlegm-heat constraining the lung syndrome can improve the clinical effect,effectively control the inflammatory responses,enhance the lung function,and reduce coagulation function with high safety.

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伍美琴,肖顺琼,王淑美,肖光志,曾朝芬.苏葶麻杏石甘汤联合常规疗法治疗痰热郁肺证慢性阻塞性肺疾病急性加重期临床研究[J].新中医,2022,54(10):105-109

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  • 在线发布日期: 2022-05-24
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