【摘要】：目的:通過觀察補氣溫陽法聯(lián)合長效支氣管舒張劑對慢性阻塞性肺疾病穩(wěn)定期肺陽虛證患者的臨床療效,總結(jié)其對患者肺通氣功能、急性加重次數(shù)、生活質(zhì)量、呼吸困難癥狀、肺陽虛癥狀等方面的影響。初步探討補氣溫陽法在慢性阻塞性肺疾病穩(wěn)定期中的作用機制,為中西醫(yī)結(jié)合治療本病提供更多的臨床依據(jù)。方法:本研究采用回顧性分析的方法,篩選整理2014年9月至2015年9月,于湖北省中醫(yī)院肺病科治療的武漢市慢阻肺重癥患者數(shù)據(jù)庫資料。所有患者必須符合2013年慢性阻塞性肺疾病GOLD指南穩(wěn)定期診斷標(biāo)準(zhǔn)以及中醫(yī)“肺脹”肺陽虛證標(biāo)準(zhǔn)。在符合納入標(biāo)準(zhǔn)和除外排除標(biāo)準(zhǔn)條件下,篩選出使用長效支氣管舒張劑(英國葛蘭素史克生產(chǎn)的沙美特羅氟替卡松粉吸入劑50ug/250ug和正大天晴藥業(yè)生產(chǎn)的噻托溴銨粉霧劑18ug聯(lián)用)治療12周的30例患者設(shè)為對照組。在同期患者中篩選使用長效支氣管舒張劑治療12周(同對照組),同時使用補氣溫陽辨證方12周的30例患者設(shè)為觀察組。提取60例患者的基本信息,分析兩組患者治療前后隨訪錄入的病程、病情嚴(yán)重程度、肺功能、生活質(zhì)量評分、呼吸困難程度、肺陽虛癥狀等評估量表數(shù)據(jù)(慢阻肺數(shù)據(jù)庫隨訪周期為12周),并記錄治療后1年內(nèi)的急性加重次數(shù)。本文數(shù)據(jù)運用統(tǒng)計學(xué)軟件SPSS17.0進行分析。結(jié)果:1.肺功能評價:治療前后比較,兩組患者FEV1%預(yù)計值以及FEV1/FVC均提高,且觀察組治療前后差異有顯著統(tǒng)計學(xué)意義(P0.01);治療結(jié)束后,觀察組FEV1%預(yù)計值及FEV1/FVC較對照組均有明顯提高,差異有統(tǒng)計學(xué)意義(P0.05)。治療結(jié)束后,兩組患者肺功能穩(wěn)定的人數(shù)比較,觀察組明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。2.急性加重次數(shù):治療后觀察組患者急性加重次數(shù)較對照組明顯減少,差異存在統(tǒng)計學(xué)意義(P0.05)。3.肺陽虛癥狀評分:治療結(jié)束后,兩組患者肺陽虛癥狀評分均低于治療前,觀察組治療前后評分差異存在顯著統(tǒng)計學(xué)意義(P0.01),對照組治療后較治療前有改善,但差異無統(tǒng)計學(xué)意義;治療結(jié)束后兩組組間比較,觀察組肺陽虛癥狀評分明顯低于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。4.呼吸困難癥狀嚴(yán)重程度的改善:治療結(jié)束后,兩組患者mMRC分級比較,差異具有統(tǒng)計學(xué)意義(P0.05);治療前后觀察組在mMRC分級的分布差異存在統(tǒng)計學(xué)意義(P0.05);治療前后對照組在mMRC分級的分布無顯著差異;5.生活質(zhì)量的改善:治療結(jié)束后,兩組患者的CAT評分與治療前相比較均有降低(P0.05);治療結(jié)束后,觀察組CAT評分明顯低于對照組,有顯著性差異(P0.01)。結(jié)論:補氣溫陽辨證方聯(lián)合長效支氣管舒張劑治療COPD穩(wěn)定期肺陽虛證患者,對患者肺功能有明顯改善作用,能減少急性加重的次數(shù),可延長穩(wěn)定期持續(xù)的時間,使患者呼吸困難的癥狀得以緩解,提升了患者的生存質(zhì)量,還能緩解患者肺陽虛癥狀。中西醫(yī)結(jié)合治療較單純西醫(yī)治療有明顯優(yōu)勢,對不同體質(zhì)特征的患者辨證用藥,提高治療效果,提升患者生活品質(zhì)。
[Abstract]:Objective: To observe the effect of combined long-acting bronchodilator and long-acting bronchodilator on the patients with chronic obstructive pulmonary disease with chronic obstructive pulmonary disease, and to sum up its effects on the function of lung ventilation, the number of acute exacerbations, the quality of life, the symptoms of dyspnea, and the symptoms of lung-yang deficiency. To explore the mechanism of warming yang in the stabilization of chronic obstructive pulmonary disease, it can provide more clinical evidence for the treatment of this disease with the combination of traditional Chinese and western medicine. Methods: A retrospective analysis was used to screen the data of the patients with chronic obstructive pulmonary disease in Wuhan, from September 2014 to September 2015. All patients must meet the criteria for the stabilization of the period of stable period of the GOLDs in the chronic obstructive pulmonary disease in 2013, as well as the traditional Chinese medicine "swelling of the lung" lung-yang deficiency syndrome standard. in that condition that meet the inclusion criteria and the exclusion criteria, A control group was selected for 30 patients with 12 weeks of treatment with a long-acting bronchodilator (50 ug/250 ug of the Salmeterol fluticasone powder inhaler manufactured by GlaxoSmithKline and 18 ug of a bitutobromate powder, manufactured by Zhengda Tianqing Pharmaceutical Co., Ltd.). In the same period, the long-acting bronchodilator was used for 12 weeks (in the same control group). The basic information of 60 patients was extracted, and the course, severity of the disease, lung function, quality of life, the degree of dyspnea, and the symptoms of lung-yang deficiency were analyzed in the two groups. The follow-up period of the chronic obstructive pulmonary database was 12 weeks. The number of acute exacerbations within 1 year after treatment was recorded. The data of this paper is analyzed by using the statistical software SPSS17.0. Results:1. Pulmonary function evaluation: compared before and after treatment, the predicted value of FEV1% and FEV1/ FVC in both groups were increased, and the difference between the observation group and the before and after treatment was significant (P0.01); after the treatment, the predicted value of FEV1% and FEV1/ FVC in the observation group were significantly improved, and the difference was statistically significant (P0.05). After the treatment, the number of lung function in the two groups was stable, and the observation group was significantly higher than that in the control group (P <0.05). The number of acute exacerbations: the number of acute exacerbations in the treated group was significantly lower than that in the control group (P0.05). After the treatment, the scores of lung-yang-deficiency symptoms in the two groups were significantly lower than those before treatment (P 0.01), and the difference between the two groups was improved before and after the treatment, but the difference was not significant. After the treatment, the scores of lung-yang-deficiency symptoms in the group were significantly lower than that in the control group, and the difference was statistically significant (P0.05). The scores of mMRC in the two groups were statistically significant (P0.05). There was no significant difference in the distribution of mMRC in the control group before and after treatment (P0.05). 5. The improvement of the quality of life: after the treatment, the CAT score of the two groups was lower than that of the control group (P0.05); after the treatment, the CAT score of the observation group was significantly lower than that of the control group, and there was a significant difference (P0.01). Conclusion: The effect of the combined long-acting bronchodilator and long-acting bronchodilator on the lung function of the patients with COPD during the stabilization period can be improved, the number of acute exacerbations can be reduced, the duration of the stabilization period can be prolonged, and the symptoms of the patient's breathing difficulty can be relieved, The survival quality of the patient is improved, and the symptoms of lung-yang deficiency of the patient can be relieved. The combination of traditional Chinese and western medicine has a clear advantage over the treatment of pure western medicine, and the treatment effect is improved and the quality of life of the patient is improved.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.9

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