【摘要】：目的 本文從中西醫(yī)角度,分別論述小兒反復(fù)呼吸道感染的研究進(jìn)展。對(duì)反復(fù)呼吸道感染患兒進(jìn)行深入探討,針對(duì)臨床反復(fù)呼吸道感染常見滯熱型體質(zhì)患兒,運(yùn)用“清消防感顆�！狈剿幉⑴浜巷嬍持笇�(dǎo),觀察其臨床療效,并通過對(duì)復(fù)感兒血清TNF-α影響的研究,初步探討作用機(jī)制,為滯熱型體質(zhì)復(fù)感兒尋求一種安全、有效的藥物。 方法 臨床觀察病例來源于北京中醫(yī)藥大學(xué)東方醫(yī)院兒科及首都醫(yī)科大學(xué)附屬復(fù)興醫(yī)院,為2010年1月-2011年9月門診3-14歲滯熱型體質(zhì)反復(fù)呼吸道感染患兒。納入70例,剔除2例,脫落8例,最后60例,采用單純隨機(jī)、陽性藥平行對(duì)照的方法,分為治療組32例和對(duì)照組28例。中藥治療組給予口服清消防感顆粒并配合飲食指導(dǎo),西藥對(duì)照組給予口服核酪口服液,療程均為8周,分別于治療前,治療后2周、4周、8周、24周記錄滯熱型體質(zhì)癥狀改善情況、再感染次數(shù)及癥狀表現(xiàn)；并觀察清消防感顆粒對(duì)復(fù)感兒血清TNF-α水平的影響。 結(jié)果 (1)兩組患兒疾病總療效：顯效率治療組為62.5%,對(duì)照組為35.71%,治療組與對(duì)照組相比差異具有統(tǒng)計(jì)學(xué)意義(P0.01),認(rèn)為治療組顯效率高于對(duì)照組。兩種治療方法均能很好地減少呼吸道感染次數(shù)(P0.01),兩組在減少反復(fù)呼吸道感染次數(shù)上無明顯差異(P0.05),但兩種治法在改善患兒病種、病程情況方面有顯著差異(P0.05)。 (3)兩組患兒中醫(yī)證候總療效：總有效率治療組93.75%,對(duì)照組為71.42%；愈顯率治療組62.5%,對(duì)照組28.57%,治療組與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.01),認(rèn)為治療組改善滯熱型體質(zhì)中醫(yī)證候總有效率及愈顯率均高于對(duì)照組,認(rèn)為治療組在改善滯熱型體質(zhì)癥狀方面有明顯優(yōu)勢(shì)。 (4)清消防感顆粒改善滯熱型體質(zhì)單個(gè)癥狀方面：治療組和對(duì)照組均能明顯改善滯熱型體質(zhì)癥狀,尤其治療組在治療咽紅、口臭、大便干燥、手足心熱癥狀時(shí),癥狀的改善明顯優(yōu)于對(duì)照組(P0.01)；在改善口渴癥狀方面,治療組亦優(yōu)于對(duì)照組(P0.05)；在改善煩急癥狀方面,治療組較對(duì)照組無明顯差異(P0.05)。 (5)清消防感顆粒改善再次呼吸道感染癥狀：在服藥2周、4周、8周、24周后對(duì)照組再感染患兒例數(shù)均多于治療組；在服藥4周、8周、24周后,治療組和對(duì)照組再感染時(shí)癥狀積分均有明顯差異(P0.05),提示治療組在減輕再感染癥狀方面優(yōu)于對(duì)照組。 (6)兩種藥物均能明顯減少TNF-α的表達(dá)(P0.05),治療后兩組間TNF-α比較無明顯差異(P0.05)。 結(jié)論：本研究對(duì)清消防感顆粒的療效分別從臨床方面及對(duì)腫瘤壞死因子-α的影響兩方面進(jìn)行了驗(yàn)證。結(jié)果表明：清消防感顆粒對(duì)滯熱型體質(zhì)反復(fù)呼吸道感染患兒確有較好療效,能有效地減少呼吸道感染次數(shù),改善滯熱型體質(zhì)臨床癥狀,降低復(fù)感兒血清TNF-α水平,抑制氣道炎癥反應(yīng),使機(jī)體免疫達(dá)到平衡,療效可靠,值得臨床應(yīng)用。
[Abstract]:Objective to discuss the research progress of recurrent respiratory tract infection in children from the perspective of traditional Chinese and western medicine. In this paper, the children with recurrent respiratory tract infection (RRTI) were studied, and the clinical curative effect was observed by using the prescription of "Qingfanggan granule" and dietary guidance for the children with common heat-stagnation type of recurrent respiratory tract infection (RRTI). The effect of TNF- 偽 on serum TNF- 偽 was studied in order to find a safe and effective drug. Methods Clinical observation cases were collected from Pediatrics Department of Oriental Hospital of Beijing University of traditional Chinese Medicine and Fuxing Hospital affiliated to Capital Medical University. They were children with recurrent respiratory tract infection aged 3-14 years old from January 2010 to September 2011. 70 cases were included, 2 cases were excluded, 8 cases were removed, and 60 cases were left off. The patients were divided into treatment group (n = 32) and control group (n = 28). The traditional Chinese medicine treatment group was given oral Qingfanggan granule and diet guidance, while the western medicine control group was given the oral hedonia oral liquid for 8 weeks. The improvement of the physical symptoms of heat stagnation type was recorded before and after 2 weeks and 2 weeks and 8 weeks and 24 weeks after treatment, respectively. The effect of Qingfanggan granule on serum TNF- 偽 level in children with reinfection was observed. Results (1) the total curative effect of the two groups: the effective rate was 62.5 in the treatment group and 35.71 in the control group. The difference between the treatment group and the control group was statistically significant (P0.01). It was considered that the effective rate of the treatment group was higher than that of the control group. The two treatment methods can reduce the number of respiratory tract infections (P0.01), there is no significant difference in reducing the number of recurrent respiratory infections between the two groups (P0.05), but the two treatment methods can improve the disease types of children. There was significant difference in course of disease (P0.05). (3). The total effective rate of TCM syndromes was 93.75 in the treatment group and 71.42 in the control group. There was significant difference between the treatment group and the control group (P0.01). It was considered that the total effective rate and the more obvious rate of improving the TCM syndrome of the heat stagnation type in the treatment group were higher than those in the control group. It is believed that the treatment group has obvious advantages in improving the physical symptoms of the heat stagnation type. (4) Qingfanggan granule can improve the single symptom of the heat stagnation type constitution: both the treatment group and the control group can obviously improve the physical symptoms of the heat stagnation type. Especially in the treatment of red pharynx, bad breath, dry stool, hot hands and feet, the improvement of symptoms in the treatment group was significantly better than that in the control group (P0.01); in improving the symptoms of thirst, the treatment group was also better than the control group (P0.05); in improving the symptoms of irritation, the treatment group was also superior to the control group (P0.05). There was no significant difference between the treatment group and the control group (P0.05). (5). Qingfanggan granule improved the symptoms of re-respiratory tract infection: after 2 weeks, 4 weeks, 8 weeks and 24 weeks, the number of children in the control group was more than that in the treatment group, and after 4 weeks, 8 weeks and 24 weeks, the number of children in the control group was higher than that in the treatment group. There were significant differences in symptom scores between the treatment group and the control group (P0.05), which suggested that the treatment group was superior to the control group in alleviating the symptoms of reinfection. (6) both drugs could significantly reduce the expression of TNF- 偽 (P0.05), and after treatment, the TNF- 偽 expression was significantly reduced between the two groups. There was no significant difference (P0.05). Conclusion: the effect of Qingfanggan granule on tumor necrosis factor-偽 (TNF-偽) was verified in clinical and clinical aspects. The results showed that QFGG had a good effect on children with recurrent respiratory tract infection, which could effectively reduce the number of respiratory tract infections, improve the clinical symptoms of heat-stagnation constitution, and lower the level of TNF- 偽 in serum. Inhibition of airway inflammation, so that the body immune balance, the efficacy is reliable, worthy of clinical application.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R272

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