本文選題：補中柴前連梅煎 + 穩(wěn)定期　； 參考：《中國中醫(yī)科學院》2016年博士論文

【摘要】：支氣管擴張是呼吸系統(tǒng)難治性疾病之一,繼發(fā)性支氣管擴張發(fā)病機制的關鍵環(huán)節(jié)為支氣管感染和支氣管阻塞,兩者相互影響,形成惡性循環(huán)。大部分中醫(yī)藥專家認為在穩(wěn)定期支氣管擴張的病因病機以風、痰、熱、毒、虛為主,虛主要以氣虛為主。穩(wěn)定期支氣管擴張患者長期小劑量口服大環(huán)內(nèi)脂類抗生素的研究引起大家關注,發(fā)現(xiàn)長期小劑量大環(huán)內(nèi)酯類抗生素維持性治療可顯著減少急性加重的發(fā)生次數(shù)。中醫(yī)藥治療在整體調(diào)節(jié)、改善機體狀況、提高免疫力等方面具有一定優(yōu)勢,但在減少穩(wěn)定期急性加重次數(shù)的研究相對較少,加強中醫(yī)藥治療穩(wěn)定期支氣管擴張的研究,減少穩(wěn)定期支氣管擴張患者急性加重次數(shù)是一項重要研究課題。臨床中發(fā)現(xiàn)柴前連梅煎治療咳嗽日久,咳吐青綠痰病證,效果非常好,而穩(wěn)定期支氣管擴張患者反復咳吐青綠痰與之咳嗽日久,咳吐青綠痰病證非常相似。基于“火與元氣不兩立,一勝則一負”理論,同時根據(jù)穩(wěn)定期支氣管擴張肺脾氣虛、痰熱蘊肺的基本病機,組建了補中柴前連梅煎,從補元氣,瀉陰火,祛痰熱方面治療穩(wěn)定期支氣管擴張以減少急性加重次數(shù)。因此,我們開展了補中柴前連梅煎對穩(wěn)定期支氣管擴張急性加重次數(shù)影響的初步研究,為中醫(yī)藥治療穩(wěn)定期支氣管擴張?zhí)峁┮罁?jù)。目的：初步探討補中柴前連梅煎對穩(wěn)定期支氣管擴張急性加重次數(shù)的影響,為中醫(yī)藥治療穩(wěn)定期支氣管擴張?zhí)峁┮罁?jù)。方法：采用隨機對照的臨床試驗設計,選擇70例穩(wěn)定期無咯血患者,隨機分為試驗組及對照組,分別給與補中柴前連梅煎及阿奇霉素片治療12周,隨訪12周。采用主要療效指標(急性加重次數(shù)、癥狀評分、肺功能)及次要療效指標(血清免疫球蛋白、L6, mMRC評分,FACED評分)進行評價分析。結果：1急性加重次數(shù)兩組患者在3周、6周、9周、12周及隨訪12周急性加重次數(shù)組間比較無統(tǒng)計學差異(P0.05)。在治療12周期間試驗組的急性加重次數(shù)為0.49次／人,對照組為0.50次／人；隨訪12周內(nèi)試驗組的急性加重次數(shù)為0.48次／人,對照組為0.53次／人。兩組在3周、6周、9周、12周及隨訪12周急性加重頻次組間比較無統(tǒng)計學差異(P0.05)。2癥狀評分試驗組總有效率為93.94%,對照組的總有效率為93.75%,兩組之間療效比較無統(tǒng)計學差異(P0.05),兩組在0周、3周、6周及9周癥狀評分實測值組間比較無統(tǒng)計學差異(P0.05),在12周試驗組癥狀評分明顯小于對照組(P0.05)。兩組癥狀評分組內(nèi)前后比較都有顯著差異(P0.01),兩組在咳嗽、咯痰、胸悶氣短、乏力、納呆、自汗、腹脹及面色黃癥狀改善上無統(tǒng)計學差異(P0.05)。3肺功能兩組治療后VC、FEV1百分比組間比較無統(tǒng)計學差異(P0.05), FEV1/FVC百分比組間比較有顯著統(tǒng)計學差異(P0.05),其中FEV1/FVC百分比試驗組為74.30±11.046,對照組為61.40±14.377。兩組患者肺功能組內(nèi)前后比較無顯著差異(P0.05)。4 FACED評分及mMRC評分治療后兩組患者FACED評分及mMRC評分組間比較無統(tǒng)計學差異(P0.05),兩組患者mMRC評分組內(nèi)前后比較有顯著統(tǒng)計學差異(P0.01),FACED評分無統(tǒng)計學差異(P0.05)。5免疫球蛋白及IL6兩組患者治療后免疫球蛋白及IL6單項指標組間比較無統(tǒng)計學差異(P0.05),兩組免疫球蛋白及IL6組內(nèi)前后比較無統(tǒng)計學差異(P0.05)。結論：1補中柴前連梅煎能明顯減少穩(wěn)定期支氣管擴張患者急性加重次數(shù)。2補中柴前連梅煎能減輕穩(wěn)定期支氣管擴張患者的呼吸困難嚴重程度,明顯改善穩(wěn)患者的臨床癥狀。
[Abstract]:Bronchiectasis is one of the refractory diseases of the respiratory system. The key link of the pathogenesis of secondary bronchiectasis is bronchial infection and bronchial obstruction. Both of them affect each other and form a vicious cycle. Most Chinese medicine experts believe that the etiology and pathogenesis of bronchiectasis in the stable period are wind, phlegm, heat, poison, deficiency mainly, and asthenia mainly with Qi deficiency. The study of long term small dose oral macrocyclic lipid antibiotics in patients with stable bronchiectasis has caused attention. It is found that long-term small dose of macrolide antibiotics maintenance therapy can significantly reduce the incidence of acute aggravation. Chinese medicine treatment in the overall regulation, improve the body condition, improve immunity and so on. However, the study of acute exacerbation times in the stable period is relatively few. It is an important research topic to strengthen the study of bronchiectasis in the stable period of Chinese medicine and reduce the acute aggravation times of bronchiectasis in the stable period. Patients with periodic bronchiectasis cough and vomit green and green phlegm repeatedly and cough day long, cough and vomit green phlegm syndrome very similar. Based on the theory of "fire and Qi not two upright, one victory one negative" theory, according to the basic pathogenesis of bronchiectasis and spleen qi deficiency of the bronchiectasis in the stable period, the basic pathogenesis of phlegm heat accumulation is established, from supplementing qi, reducing Qi and eliminating phlegm heat from the Tonifying Qi, yin and Yin fire. To treat stable bronchiectasis in order to reduce the number of acute exacerbations. Therefore, we have carried out a preliminary study on the effect of the decoction of Chinese medicine of Bu Zhong Chai on the acute exacerbation of bronchiectasis in the stable period, to provide a basis for the treatment of bronchiectasis in stable period of Chinese medicine. The effect of acute aggravation times was provided for the treatment of bronchiectasis in stable period of Chinese medicine. Methods: 70 cases of stable and non hemoptysis were randomly divided into experimental group and control group by randomized controlled clinical trial design. The patients were randomly assigned to the test group and the control group for 12 weeks, respectively, and followed up for 12 weeks. The standard (acute aggravation, symptom score, lung function) and secondary curative effect index (serum immunoglobulin, L6, mMRC score, FACED score) were evaluated. Results there was no statistical difference between the two groups of 1 acute aggravation groups at 3 weeks, 6 weeks, 9 weeks, 12 weeks, and 12 weeks (P0.05). In the treatment group, the experimental group was treated for the period of 12 weeks. The times of acute aggravation were 0.49 times per person and 0.50 times in the control group; the acute aggravation times of the test group were 0.48 times in the 12 week follow-up group and 0.53 times in the control group. The two groups were in 3 weeks, 6 weeks, 9 weeks, 12 weeks and 12 weeks of follow-up (P0.05), the total effective rate of the.2 symptom score group was 93.94%, and the total effective rate was 93.94%. The total effective rate of the group was 93.75%. There was no statistical difference between the two groups (P0.05). There was no statistical difference between the two groups at 0 weeks, 3 weeks, 6 and 9 weeks (P0.05), and the symptom scores in the 12 week group were significantly smaller than those in the control group (P0.05). There were significant differences between the two groups before and after the symptom score group (P0.01), and two groups in the two groups. There was no statistical difference between coughing, phlegm, shortness of chest tightness, fatigue, fatigue, anathesis, self perspiration, abdominal distension and yellow symptoms (P0.05), there was no statistical difference between the two groups of.3 lung function after treatment (P0.05), and there was a significant statistical difference between the FEV1/FVC percentage groups (P0.05), and the percentage of FEV1/FVC percentage was 74.30 + 11.046 in the group of FEV1/FVC. In the control group, there was no significant difference in the pulmonary function group between the 61.40 + 14.377. two groups (P0.05), and there was no statistical difference between the FACED score and the mMRC score group in the two groups after the treatment of the mMRC score (P0.05). There was significant difference (P0.01) between the two groups before and after the mMRC score group (P0.01), and there was no statistical difference between the FACED scores (P0.01). P0.05) there was no statistical difference between.5 immunoglobulin and IL6 two groups after treatment (P0.05). There was no statistical difference between the two groups of immunoglobulin and IL6 group (P0.05). Conclusion: 1 Bu Zhong Chai Lian Mei decoction can significantly reduce the acute exacerbation times of stable bronchiectasis patients.2 complacation. Pre - Lian Mei decoction can relieve the severity of dyspnea in patients with bronchiectasis in stable stage, and improve the clinical symptoms of stable patients.

【學位授予單位】：中國中醫(yī)科學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R259

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