本文選題：社區(qū)獲得性肺炎　切入點(diǎn)：蒿芩清膽湯　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討蒿芩清膽湯加味對(duì)社區(qū)獲得性肺炎(濕熱內(nèi)蘊(yùn)證)的臨床療效,通過(guò)對(duì)比蒿芩清膽湯加味聯(lián)合西醫(yī)治療與單純西藥常規(guī)治療在疾病總療效、中醫(yī)證候評(píng)分、住院天數(shù)及費(fèi)用、熱退時(shí)間及炎癥性指標(biāo)的差別,探討蒿芩清膽湯加味治療CAP的臨床價(jià)值。方法:通過(guò)選取符合中西醫(yī)診斷標(biāo)準(zhǔn)、病例納入標(biāo)準(zhǔn),不符合排除標(biāo)準(zhǔn)及剔除標(biāo)準(zhǔn)共52例病例,按隨機(jī)分組原則分為治療組和對(duì)照組各26例。對(duì)照組予以西醫(yī)常規(guī)抗感染、止咳化痰及營(yíng)養(yǎng)支持治療;治療組在西藥治療的基礎(chǔ)上予以蒿芩清膽湯加味湯劑治療,總療程為5天。通過(guò)對(duì)比兩組治療前、治療后第3天、治療后第5天的病情評(píng)分、中醫(yī)證候評(píng)分及相關(guān)炎癥指標(biāo)等,采用統(tǒng)計(jì)學(xué)軟件SPSS 20.0分析兩組相關(guān)數(shù)據(jù),科學(xué)評(píng)價(jià)蒿芩清膽湯加味在治療社區(qū)獲得性肺炎的臨床療效。結(jié)果:1.治療組的疾病總療效優(yōu)于對(duì)照組(P0.01);2.治療組平均住院天數(shù)5.88±0.95天,對(duì)照組平均住院天數(shù)7.27±2.44天,差異有統(tǒng)計(jì)學(xué)意義(P0.05);3.治療組平均住院費(fèi)用6802.3±1953.6元,對(duì)照組平均住院費(fèi)用為9326.8±6033.2元,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4.治療組平均熱退時(shí)間33.0±17.1h,對(duì)照組平均熱退時(shí)間63.2±64.9h,差異有統(tǒng)計(jì)學(xué)意義(P0.05);5.治療前兩組CPIS評(píng)分無(wú)明顯差別;治療后兩組CPIS評(píng)分均較前下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);治療組治療前后CPIS評(píng)分差值下降幅度大于對(duì)照組,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01);治療后治療組CPIS評(píng)分低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);6.治療前兩組CURB-65評(píng)分無(wú)明顯差別;治療后兩組CUBR-65評(píng)分均較前下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);治療組治療前后CURB-65評(píng)分差值下降幅度與對(duì)照組無(wú)明顯差別,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05);治療后治療組CURB-65評(píng)分低于對(duì)照組,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05);7.治療前兩組中醫(yī)證候評(píng)分無(wú)明顯差別;治療后兩組中醫(yī)證候評(píng)分均較前下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)于治療第3天的評(píng)分,治療組的下降幅度大于對(duì)照組,差異有顯著的統(tǒng)計(jì)學(xué)意義(P0.01);治療第3天至第5天,兩組證候評(píng)分的降低幅度差別無(wú)統(tǒng)計(jì)學(xué)意義(JP0.05);治療后治療組中醫(yī)證候評(píng)分低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);8.治療第3天兩組白細(xì)胞總數(shù)均較前下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);治療組第3天、第5天白細(xì)胞總數(shù)均低于對(duì)照組,但差異不具有統(tǒng)計(jì)學(xué)意義(P0.05);9.治療第3天、第5天兩組PCT均較前下降,但差異均不具有統(tǒng)計(jì)學(xué)意義(P0.05);治療組第3天、第5天PCT均低于對(duì)照組,但差異不具有統(tǒng)計(jì)學(xué)意義(P0.05);10.治療第3天、第5天兩組CRP均較前下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);治療組第3天、第5天CRP均低于對(duì)照組,差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01);11.治療后第3天、第5天兩組D-二聚體均較前下降,差異均具有顯著統(tǒng)計(jì)學(xué)意義(P0.01);治療組第3天、第5天D-二聚體均低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);12.CRP與D-二聚體存在線(xiàn)性相關(guān),相關(guān)系數(shù)為0.620,P0.01。結(jié)論:蒿芩清膽湯加味聯(lián)合西藥治療在疾病總療效、中醫(yī)證候改善、病情嚴(yán)重程度的改善方面均優(yōu)于單純西藥組;中西醫(yī)結(jié)合治療CAP可減少住院天數(shù)、降低住院費(fèi)用、縮短退熱時(shí)間;兩組治療對(duì)中醫(yī)證候改善程度的差異可能主要體現(xiàn)在治療前3天;治療后兩組降鈣素原均較前明顯下降,但兩組組內(nèi)、組間比較差別均無(wú)統(tǒng)計(jì)學(xué)意義,可能提示降鈣素原在評(píng)估非重癥CAP療效上價(jià)值有限;治療后兩組白細(xì)胞總數(shù)、C-反應(yīng)蛋白、D-二聚體均較前明顯下降,差異有統(tǒng)計(jì)學(xué)意義,且治療組上述數(shù)值低于對(duì)照組,提示中西結(jié)合治療對(duì)于降低炎癥指標(biāo)及改善凝血指標(biāo)方面優(yōu)于單純西藥組;C-反應(yīng)蛋白與D-二聚體在數(shù)值上存在線(xiàn)性相關(guān),提示CAP發(fā)生、發(fā)展的過(guò)程中炎癥因子與凝血功能存在相互的作用,其作用機(jī)理有待進(jìn)一步探討。
[Abstract]:Objective: To investigate the haoqinqingdan Decoction of community-acquired pneumonia (damp heat syndrome) clinical efficacy of Qingdan decoction combined with western medicine and simple western medicine therapy in the treatment of disease by comparing the total effect of Haoqin, TCM syndrome score, hospitalization days and expenses, the duration of fever and inflammatory index difference. Study on the clinical value of haoqinqingdan Decoction for the treatment of CAP. Methods: the selected traditional Chinese medicine and Western medicine diagnostic criteria, inclusion criteria, does not meet the criteria of a total of 52 cases and exclusion criteria excluded cases, were randomly divided into treatment group and control group with 26 cases in each group. The control group was given routine anti infection, cough and phlegm and nutritional support therapy; treatment group on the basis of Western medicine treatment to Hao Qin Qing Dan Tang Decoction, the total course of treatment for 5 days. By comparing the two groups before treatment, third days after treatment, treatment after fifth days of illness score, TCM Syndrome The score and the related inflammatory indicators, using statistical software SPSS 20 analysis of two groups of related data, evaluation of Haoqin Qing Dan Tang clinical science community acquired pneumonia in the treatment of the disease. Results: the total effect is better than the 1. treatment group, control group (P0.01); 2. in the treatment group the average hospitalization was 5.88 + 0.95 days, control the average length of stay was 7.27 + 2.44 days, the difference was statistically significant (P0.05); 3. in the treatment group the average hospitalization expenses of 6802.3 + 1953.6 yuan, the control group the average hospitalization expenses for 9326.8 + 6033.2 yuan, the difference was statistically significant (P0.05); 4. in the treatment group the average duration of fever was 33 + 17.1h, the control group the average duration of fever 63.2 + 64.9h, the difference was statistically significant (P0.05); 5. of the two groups before treatment CPIS score had no significant difference; the two groups after treatment CPIS score decreased than before, the differences were statistically significant (P0.05); the treatment group before and after treatment CPIS score decreased Larger than that of the control group, the difference was statistically significant (P0.01); the CPIS score of treatment group than the control group, the difference was statistically significant (P0.05); 6. of the two groups before treatment CURB-65 score had no significant difference; the two groups after treatment CUBR-65 score decreased than before, the differences were statistically significant (P0.05); the treatment group before and after the CURB-65 score decreased amplitude had no significant difference with the control group, the difference was not statistically significant (P0.05); the CURB-65 score of treatment group than the control group, the difference was not statistically significant (P0.05); 7. for two groups of TCM syndrome score had no significant difference before treatment; the two groups after treatment of TCM syndrome scores decreased, the differences were statistically significant (P0.05); for the third day treatment score, treatment group decreased than that of control group, the difference was statistically significant (P0.01); for third days to fifth days, two groups of syndrome score The reduction of the difference was not statistically significant (JP0.05); after treatment, TCM syndrome score lower than the control group, the difference was statistically significant (P0.05); 8. for third days, two groups of white blood cell counts were decreased, the differences were statistically significant (P0.05); the treatment group for third days, fifth days, the total number of white blood cells are compared with the control group, but the difference was not statistically significant (P0.05); 9. for third days, fifth days and two in group PCT decreased than before, but the difference was not statistically significant (P0.05); the treatment group for third days, Fifth days PCT were lower than the control group, but the difference was not statistically significant (P0.05); 10. for third days, fifth days and two in group CRP decreased than before, the differences were statistically significant (P0.05); the treatment group for third days, fifth days CRP were lower than the control group, the difference was statistically significant (P0.01); third days and 11. days after treatment, the fifth group two D- two dimer decreased than before, the difference all have significant The statistical significance (P0.01); the treatment group for third days, fifth days and two D- dimer were lower than the control group, the difference was statistically significant (P0.05); 12.CRP and D- dimer has two linear correlation, the correlation coefficient was 0.620, P0.01. conclusion: haoqinqingdan decoction combined with western medicine treatment of the disease in the total effect. Improve the TCM syndrome, severity were better than the pure western medicine group; CAP treatment can reduce the hospitalization time of Integrated Chinese and Western medicine, reduce hospitalization costs, shorten the cooling time; two groups of treatment of TCM syndrome improvement is mainly reflected in the 3 day before treatment, the difference in the degree of the two groups after treatment; procalcitonin were decreased significantly, but in the two groups, the differences between the two groups were not statistically significant, suggesting procalcitonin in evaluation of limited value non severe CAP effect; two groups of white blood cell counts after treatment, C- reactive protein, D- two dimers were decreased significantly, the difference There was statistical significance, and the numerical treatment group than the control group, suggesting that the combination of Chinese and Western treatment to reduce inflammation and improve blood coagulation index index is better than pure western medicine group; C- reactive protein and D- dimer has two in numerical linear correlation, suggesting that CAP has occurred, the interaction between inflammation and coagulation function in the process of development further, to explore its mechanism.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 于喜洪;;中醫(yī)治療社區(qū)獲得性肺炎61例臨床療效分析[J];中國(guó)醫(yī)藥指南;2016年32期

2 周勇;陳澤玲;王緗峗;;珠海市社區(qū)獲得性肺炎疾病負(fù)擔(dān)研究[J];深圳中西醫(yī)結(jié)合雜志;2016年20期

3 劉美蓉;陳哲;;尿抗原檢測(cè)肺炎鏈球菌對(duì)社區(qū)獲得性肺炎臨床價(jià)值研究[J];中國(guó)實(shí)用內(nèi)科雜志;2016年08期

4 翟惠芬;胡文娟;郭東星;王良玉;蔚然;徐波;辛德莉;;成人社區(qū)獲得性肺炎肺炎支原體感染率和耐藥率的調(diào)查[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2016年13期

5 王濤;;痰熱清聯(lián)合頭孢哌酮鈉舒巴坦鈉治療社區(qū)獲得性肺炎80例臨床研究[J];中國(guó)農(nóng)村衛(wèi)生;2016年08期

6 劉先文;;PCT、CRP、D-二聚體與重癥社區(qū)獲得性肺炎發(fā)展及預(yù)后的關(guān)系研究[J];臨床醫(yī)學(xué);2016年04期

7 周東花;秦英;張菊紅;;加味麻杏石甘湯治療痰熱壅肺型社區(qū)獲得性肺炎臨床觀(guān)察[J];河北中醫(yī);2016年02期

8 韓丹;鐘新生;;中性粒細(xì)胞/淋巴細(xì)胞計(jì)數(shù)比值在老年人肺部細(xì)菌感染診斷中的應(yīng)用價(jià)值[J];中國(guó)老年學(xué)雜志;2016年07期

9 陳暉;王丹;李亞明;張進(jìn)召;兀威;;血清前白蛋白動(dòng)態(tài)變化評(píng)估重癥社區(qū)獲得性肺炎預(yù)后的價(jià)值[J];臨床肺科雜志;2016年03期

10 蔣玲玉;秦志強(qiáng);高興華;陳顯源;羅英琳;蔣靖生;陸明智;龔繼榮;侯玉榮;黃立新;黃文;黃君杏;陳民生;何文真;朱江風(fēng);;廣西成人社區(qū)獲得性肺炎889例病原學(xué)多中心調(diào)查[J];中國(guó)臨床新醫(yī)學(xué);2016年02期

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