發(fā)布時(shí)間：2018-04-12 19:19

  本文選題：小柴胡湯 + 上氣道咳嗽綜合征��； 參考：《西南醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:上氣道咳嗽綜合征(upper airway cough syndrome,UACS)是慢性咳嗽的常見(jiàn)病因。本研究通過(guò)《傷寒論》小柴胡湯加減結(jié)合常規(guī)西醫(yī)治療UACS的療效觀察,探討該中西醫(yī)結(jié)合治療方案的療效,為進(jìn)一步提高治療UACS臨床療效提供依據(jù)。方法:按照《咳嗽的診斷與治療指南》(2009版)[1]上氣道咳嗽綜合征的診斷標(biāo)準(zhǔn)及《中醫(yī)診斷與鑒別診斷學(xué)》確定邪客少陽(yáng)證患者實(shí)際有意義102例,治療組與對(duì)照組各51例完成研究。對(duì)照組西醫(yī)常規(guī)治療包括:依巴斯汀片10mg 1次/d,復(fù)方甘草口服溶液10 m L 3次/d;7天為1個(gè)療程,觀察1-2個(gè)療程。治療組經(jīng)中醫(yī)辨證為少陽(yáng)證,在上述西醫(yī)治療基礎(chǔ)上用小柴胡湯加減治療,基本藥物組成:柴胡12g,黃芩15g,黨參12g,半夏15g,甘草6g,杏仁15g,桔梗15g,前胡15 g,蜜麻黃5-8g,五味子6-10g。每天1劑,水煎3次,分三次服,7天為1個(gè)療程,觀察1-2個(gè)療程。分別觀察兩組患者治療前,治療后3天、7天、14天臨床療效,癥狀積分,療程結(jié)束后2周隨訪與療程結(jié)束時(shí)臨床情況對(duì)比,治療前、后的肝功能(AST、ALT),腎功能(BUN、Cr)情況,用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:⑴臨床療效:治療后第3天,治療組有效率72.5%%,對(duì)照組有效率58.8%%;治療后第7天,治療組有效率86.2%,對(duì)照組78.4%;治療后第14天,治療組有效率達(dá)到90.19%,對(duì)照組為82.3%;三個(gè)時(shí)間段兩組比較,經(jīng)卡方檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。⑵癥狀積分:治療前后兩組癥狀積分均值對(duì)比顯示,治療組(P0.01),差異明顯,有統(tǒng)計(jì)學(xué)意義;對(duì)照組(P0.05),差異有統(tǒng)計(jì)學(xué)意義,但不如治療組明顯。⑶療程結(jié)束后2周隨訪:治療組總有效率為92.1%,對(duì)照組總有效率80.3%,與療程結(jié)束時(shí)臨床情況比較,差異不大,P值0.05,沒(méi)有統(tǒng)計(jì)學(xué)意義。⑷兩組患者治療時(shí)間比較:治療組在治療后第3天即有顯著效果,愈顯率(痊愈率+顯效率)分別是治療組41.1%、對(duì)照組13.7%,兩組差距達(dá)到27.4%;治療后第7天,愈顯率分別是治療組72.5%、對(duì)照組47.0%,兩組差距達(dá)到25.5%;治療后第14天,愈顯率分別是治療組78.4%、對(duì)照組64.7%,愈顯率差值為13.7%;三個(gè)時(shí)間段愈顯率經(jīng)卡方檢驗(yàn),P值都0.01,但差距在依次遞減。說(shuō)明中西醫(yī)結(jié)合組療效不僅高于單純西藥治療,還可縮短病程時(shí)間。⑸治療前后肝、腎功能:經(jīng)t檢驗(yàn)及秩和檢驗(yàn)比較,結(jié)果提示差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:⑴對(duì)于上氣道綜合征,中醫(yī)辨證屬少陽(yáng)證患者,用小柴胡湯加減配合常規(guī)西醫(yī)治療臨床療效優(yōu)于西藥治療;⑵小柴胡湯加減配合常規(guī)西醫(yī)治療UACS,臨床癥狀改善優(yōu)于西藥治療;⑶小柴胡湯加減配合常規(guī)西醫(yī)治療UACS,治療時(shí)間縮短,療效穩(wěn)定。⑷該治療方案對(duì)肝功、腎功無(wú)影響,安全性好。
[Abstract]:Objective: upper airway cough syndrome is a common cause of chronic cough.In this study, the therapeutic effect of Xiaochaihu decoction combined with conventional western medicine on UACS was observed, and the curative effect of this scheme was discussed, which provided the basis for further improving the clinical efficacy of UACS.Methods: according to the diagnostic criteria of upper airway cough syndrome and the diagnosis and differential diagnosis of TCM, 102 patients with Shaoyang syndrome were confirmed according to the guidelines for the diagnosis and treatment of cough (2009 edition). The treatment group and control group (51 cases each) completed the study.The routine treatment of western medicine in the control group included: Ebastin tablet 10mg 1 / d, compound liquorice oral solution 10 mL / 3 / d for 7 days as a course of treatment, observe 1-2 courses of treatment.1 dose per day, 3 times of decoction, divided into 3 times for 7 days as a course of treatment, observe 1-2 courses of treatment.The clinical curative effect, symptom score, two weeks follow-up after treatment and the clinical situation at the end of the course of treatment were observed before and 3 days after treatment and 3 days after treatment. The liver function before and after treatment was compared with that at the end of the course of treatment. The liver function and renal function were compared before and after treatment.SPSS17.0 statistical software was used for statistical analysis.Results: on the third day after treatment, the effective rate of the treatment group was 72.5 and the effective rate of the control group was 58.8. On the 7th day after treatment, the effective rate of the treatment group was 86.2 and that of the control group was 78.4. on the 14th day after treatment, the effective rate of the treatment group was 86.2 and the control group was 78.4.The difference was statistically significant in the control group (P 0.05), but was not as good as that in the treatment group 2 weeks after the end of the course of treatment. The total effective rate in the treatment group was 92. 1%, and the total effective rate in the control group was 80. 3%, which was compared with the clinical situation at the end of the course of treatment.The difference was not significant (P = 0.05). There was no significant difference between the two groups in the treatment time: the treatment group had significant effect on the 3rd day after treatment.The effective rate of healing was 41.1 in the treatment group, 13.7in the control group, the difference between the two groups was 27.44.On the 7th day after treatment, the effective rate was 72.5 in the treatment group, and 47.0 in the control group, the difference between the two groups reached 25.5. on the 14th day after treatment,The effective rates were 78.4% in the treatment group and 64.7% in the control group, respectively, and the difference was 13.7.The significant recovery rates in the three periods were all 0.01 by chi-square test, but the difference was decreasing in turn.The results showed that the curative effect of TCM combined with western medicine was not only higher than that of western medicine alone, but also could shorten the course of disease before and after treatment. The function of liver and kidney: t test and rank sum test, the results showed that there was no significant difference between the two groups (P 0.05).Conclusion for the patients with upper airway syndrome, Xiao Chai Hu decoction combined with routine western medicine is superior to western medicine in treating the patients with Shaoyang syndrome according to syndrome differentiation of traditional Chinese medicine.2Xiaochaihu decoction combined with routine western medicine to treat UACS.The clinical symptom improvement was better than that of Xiaoxiaochaihu decoction combined with routine western medicine in UACS.The treatment time was shortened, and the curative effect was stable. 4. The treatment plan had no effect on liver function and renal function.Good safety.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R256.1

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