發(fā)布時間：2018-05-20 00:46

  本文選題：慢性阻塞性肺疾病 + 痰熱瘀肺證��； 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：慢性阻塞性肺疾病(COPD)在我國的發(fā)病人數(shù)眾多。不完全可逆的氣流受限是其主要特征。臨床多呈反復發(fā)作,并逐漸加重�；颊唛L期反復住院,多接受西藥抗生素和糖皮質(zhì)激素的治療,日久容易出現(xiàn)細菌耐藥和激素依賴等不良反應,同時伴有患者生活質(zhì)量的下降和沉重的經(jīng)濟負擔,對社會醫(yī)療資源也造成極大的浪費。導師申春悌教授臨床工作40余年,多采用中西醫(yī)結(jié)合的方法辨治COPD,取得較好的治療效果。導師發(fā)現(xiàn),在COPD急性加重期(AECOPD)D組患者中,痰熱瘀肺證是最常見的證型,并對該證型采用龍丹理肺湯加減進行治療,取得了較好的療效。為了進一步證實該方的臨床療效,本研究在西醫(yī)常規(guī)治療的基礎(chǔ)上加用龍丹理肺湯,進行了簡單隨機和對照的臨床研究。目的:觀察龍丹理肺湯對治療AECOPD(D組)痰熱瘀肺證的臨床療效,并進一步明確其是否具有改善中醫(yī)癥狀、肺功能、血粘度及協(xié)同抗感染的作用。方法:本研究采用加載性臨床試驗的方法。選取AECOPD(D組)痰熱瘀肺證的患者作為研究對象。共選取南京中醫(yī)藥大學附屬武進中醫(yī)醫(yī)院肺病科住院患者42例,根據(jù)入院日期的奇偶數(shù)進行簡單隨機,其中對照組21例,治療組21例。對照組采用常規(guī)西醫(yī)治療:抗感染(哌拉西林他唑巴坦鈉靜滴)、化痰(鹽酸氨溴索靜推)、解痙平喘(多索茶堿靜滴、布地奈德和硫酸特布他林霧化吸入),病情較重時予口服強的松3-5天抗炎平喘,同時予氧療,維持水、電解質(zhì)平衡等輔助治療。治療組在對照組常規(guī)治療的基礎(chǔ)上加用龍丹理肺湯中藥免煎顆粒劑,每日1劑,分兩次服。7天為1療程,共觀察14天。記錄治療初期和1周后兩組患者的臨床療效、血常規(guī)、血粘度、肺功能、血氣分析等相關(guān)指標。整理數(shù)據(jù),采用SPSS19.0對數(shù)據(jù)進行分析。結(jié)果:1.治療后兩組療效比較有差異。治療組:顯效率(57.14%),有效率(38.10%);對照組:顯效率(19.05%),有效率(76.19%)。經(jīng)χ 2檢驗兩組總的有效率存在統(tǒng)計學差異,治療組的臨床療效更優(yōu)于對照組(P0.05)。2.兩組治療后臨床主癥的比較有差異。經(jīng)過一周治療后,兩組臨床主癥均較同組治療前有明顯好轉(zhuǎn)(P0.01),但是組間比較無統(tǒng)計學差異。隨訪至第二周,進行組間比較,治療組咳痰和喘息好轉(zhuǎn)的情況優(yōu)于對照組(P0.05)。3.兩組治療前后感染性指標的比較有差異。兩組治療前后白細胞數(shù)、中性粒細胞數(shù)和hCRP的變化均具有統(tǒng)計學差異(P0.05)。組間比較,治療組hCRP下降得更明顯(P0.05)。4.兩組治療前后血氣指標的比較有差異。兩組治療前后PaO2和SaO2的變化均具有統(tǒng)計學差異(P0.05)。組間比較,治療組PaO2的升高更明顯(P0.05)。5.兩組治療前后肺功能指標的比較有差異。兩組治療前后FVC和FEV1的變化均具有統(tǒng)計學意義(P0.05)。組間比較,治療組FVC和FEV1均升高得更明顯(P0.05)。6.兩組治療前后血液流變學指標的比較無差異。兩組治療后全血粘度(低切、中切、高切)、血漿粘度和血沉均較治療前無明顯變化(P0.05)。結(jié)論:在常規(guī)AECOPD(D組)痰熱瘀肺證的治療過程中聯(lián)合使用龍丹理肺湯可以協(xié)助抗感染、改善缺氧和二氧化碳潴留,從而能提高臨床的治療效果。長期使用該方藥,還可以減輕患者的呼吸道癥狀。
[Abstract]:Chronic obstructive pulmonary disease (COPD) has a large number of patients in China. Incomplete and reversible airflow limitation is its main feature. The clinical symptoms are repeated episodes and gradually aggravated. Patients who have been hospitalized for a long time, receive more western medicine antibiotics and glucocorticoid treatment, and are likely to have adverse reactions such as bacterial resistance and hormone dependence, and are accompanied by a long time. The decline in the quality of life and the heavy economic burden of the patients have also caused great waste to the social medical resources. Professor Shen Chun FTI has been working for more than 40 years, using the method of combining traditional Chinese and Western medicine to distinguish COPD, and obtain better therapeutic effect. The teacher found that in the patients with acute exacerbation of COPD (AECOPD), the syndrome of phlegm and blood stasis is the most common. In order to further confirm the clinical curative effect of this prescription, in order to further confirm the clinical curative effect of this prescription, we added the long Danli lung soup on the basis of conventional treatment of Western medicine, and carried out a simple randomized and controlled clinical study. The clinical effect of the syndrome of stasis of lung and whether it has the effect of improving the symptoms of traditional Chinese medicine, lung function, blood viscosity and synergistic anti infection. Methods: This study adopts the method of loading clinical test. Select the patients of AECOPD (group D) phlegm and blood stasis lung syndrome as the research object. The lung disease of Wujin Affiliated Hospital of Nanjing University of Chinese Medicine is selected. 42 hospitalized patients were randomly selected according to the odd even number of admission dates, including 21 cases in the control group and 21 in the treatment group. The control group was treated with conventional western medicine: anti infection (piperacillin tazobactam sodium), phlegm (ambroxol hydrochloro), antispasmodic antiasthmatic (droxyophylline intravenous drip, budesonide and terbutaline sulfate inhalation). The treatment group was given 3-5 days of antiasthmatic antiasthmatic prednisone, oxygen therapy, maintenance of water and electrolyte balance. The treatment group was treated with long Daniel lung decoction free Decoction on the basis of conventional treatment in the control group, 1 doses per day, two times of.7 days as 1 courses, and a total of 14 days. The clinical records of two groups of patients in the early and 1 weeks after treatment were recorded. Effect, blood routine, blood viscosity, lung function, blood gas analysis and other related indexes. The data were collected and analyzed by SPSS19.0. Results: after 1. treatment, the two groups had different curative effects. The treatment group was effective (57.14%) and effective (38.10%); the control group was effective (19.05%) and effective (76.19%). The total effective rate of two groups was counted by chi chi 2 test. The clinical curative effect of the treatment group was better than that of the control group (P0.05).2. two groups. After one week treatment, the two groups of clinical main symptoms were significantly better than the same group (P0.01), but there was no statistical difference between the groups. The follow-up to second weeks was compared with the treatment group, the expectoration and wheezing improved in the treatment group. Compared with the control group (P0.05).3. two groups, there were differences in the infection index before and after treatment. The changes in the number of leucocytes, neutrophils and hCRP before and after treatment in the two groups were statistically different (P0.05). The comparison between the groups, the hCRP of the treatment group decreased more obviously (P0.05) the comparison of blood gas indexes before and after treatment in the two groups of.4. two groups. The two groups were treated. The changes of PaO2 and SaO2 were statistically different (P0.05). The increase of PaO2 in the treatment group was more obvious (P0.05) and the comparison of lung function indexes before and after treatment in group.5. two was significant. The changes of FVC and FEV1 before and after treatment in the two groups were statistically significant (P0.05). The FVC and FEV1 were increased more obviously in the treatment group (P0.05) two. There was no difference in hemorheological indexes before and after treatment. The whole blood viscosity (low cut, middle cut, high cutting), plasma viscosity and ESR in the two groups had no significant changes (P0.05). Conclusion: in the treatment of conventional AECOPD (group D) phlegm heat and blood stasis syndrome, the combination of dragon Danli lung soup can help anti infection, improve hypoxia and two oxidation. Carbon retention can improve the clinical therapeutic effect. Long term use of this drug can also relieve the respiratory symptoms of patients.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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