【摘要】：目的:1.探討清熱化痰法治療急性氣管-支氣管炎合并全身炎癥反應(yīng)綜合征患者(痰熱壅肺證)的臨床療效。2.通過Meta分析探究國內(nèi)外研究文獻關(guān)于痰熱清注射液治療全身炎癥反應(yīng)綜合征患者的臨床療效以及臨床安全性。方法:1.選取天津市南開醫(yī)院急診科和呼吸科2014年11月至2015年11月期間收治的急性氣管-支氣管炎合并SIRS患者(痰熱壅肺證)60例,隨機分為對照組、治療組各30例;上述患者均給予西醫(yī)常規(guī)治療以及抗SIRS治療,治療組患者再加用清熱化痰中成藥。對兩組患者的治療前后的中醫(yī)證候積分、體溫(T)、心率(HR)、呼吸頻率(RR)、白細胞計數(shù)(WBC)、前降鈣素原(PCT)、C-反應(yīng)蛋白(CRP)、活化部分凝血活酶時間(APTT)、血漿凝血酶時間(TT)、血漿凝血酶原時間(PT)的變化情況以及臨床療效,統(tǒng)計后進行對比分析;同時觀察兩組患者的并發(fā)癥及死亡情況。2.應(yīng)用計算機與手工檢索,查找國內(nèi)外的大型數(shù)據(jù)庫,包括中國知網(wǎng)(CNKI)、維普期刊資源整合服務(wù)平臺(VIP)、中國生物醫(yī)學文獻數(shù)據(jù)庫、萬方醫(yī)學網(wǎng)、Ovid/Pubmed以及Embase等,以“痰熱清注射液/Tanreqing injection”、“全身炎癥反應(yīng)綜合征/systemic inflammatory response syndrome/SIRS”、“Meta分析/Meta-analysis”、“臨床研究/clinical research”為檢索詞,從2000-1-1至2015-5-30公開發(fā)表的關(guān)于痰熱清注射液對SIRS患者療效的臨床隨機對照試驗(RCT),文獻語種為中文或英文,選用Jadad質(zhì)量評分標準對文獻實施質(zhì)量評估,并且應(yīng)用軟件Rv Man5.3對所有納入的研究文獻給予評估分析。結(jié)果:1.治療組患者治療前后的中醫(yī)證候積分、HR、T、WBC、CRP、PCT、APTT、PT的改善明顯優(yōu)于對照組,消化道出血的發(fā)生率、麻痹性腸梗阻的發(fā)生率較對照組更低,臨床總有效率明顯高于對照組;且上述比較差異均具有統(tǒng)計學意義(P0.05)。2.本次研究11篇文獻共811例SIRS患者最終納入,其中對照組患者396例,治療組患者415例。兩組患者均給予西醫(yī)常規(guī)抗SIRS治療,治療組患者在此基礎(chǔ)上加用痰熱清注射液。最終的Meta分析結(jié)果顯示:治療組患者的臨床總有效率明顯高于對照組,WBC水平、CRP水平、PCT水平、TNF-a水平、IL-6水平、T值較對照組下降更為明顯,且上述比較差異均具有統(tǒng)計學意義(P0.05);所有納入文獻中均未報告有不良反應(yīng)的發(fā)生。結(jié)論:1.清熱化痰法治療急性氣管-支氣管炎合并全身炎癥反應(yīng)綜合征患者的臨床療效明顯,不僅能夠降低患者的中醫(yī)證候積分、穩(wěn)定患者的生命體征、改善患者的炎癥反應(yīng)、血凝指標,提高臨床總有效率,尚能夠降低急性氣管-支氣管炎合并SIRS患者并發(fā)癥的發(fā)生率。2.Meta分析結(jié)果顯示:痰熱清注射液能夠減輕全身炎癥反應(yīng)綜合征患者體內(nèi)的炎癥反應(yīng),提高臨床總有效率,效果良好、可靠,并且無臨床不良反應(yīng)發(fā)生,安全性較高。3.痰熱清注射液是中成藥清熱化痰法的典型代表,能夠治療多種疾病伴隨的全身炎癥狀態(tài),方便快捷、安全有效。
[Abstract]:Purpose 1. To explore the clinical effect of clearing heat and removing phlegm in treating acute tracheobronchial bronchitis complicated with systemic inflammatory response syndrome (phlegm-heat obstruction of lung syndrome). To explore the clinical efficacy and safety of Tanreqing injection in treating patients with systemic inflammatory response syndrome by meta-analysis. Method 1: 1. From November 2014 to November 2015, 60 patients with acute trachea bronchitis complicated with Sirs (phlegm-heat obstructing lung syndrome) were randomly divided into control group (n = 30) and treatment group (n = 30). All the patients were treated with routine western medicine and anti-Sirs. The patients in the treatment group were treated with traditional Chinese medicine for clearing heat and resolving phlegm. The TCM syndromes integral before and after treatment for the two groups of patients, Changes of body temperature (T), heart rate (HR), respiratory rate (RR), leukocyte count (WBC), procalcitonin (PCT) C-reactive protein (CRP), activated partial thromboplastin time (APTT), plasma thrombin time (TT), plasma prothrombin time (PT) and clinical efficacy were observed. At the same time, the complications and death of the two groups were observed. Large databases at home and abroad were searched by computer and manual search, including CNKI, VIP, Chinese Biomedical Literature Database, Ovid / Pubmed and Embase, etc. "Tanreqing injection", "systemic inflammatory response syndrome / Sirs", "Meta-analysis / meta-analysis", "clinical study / clinical research" as the key words. A randomized controlled trial (RCT) on the efficacy of Tanreqing injection in patients with Sirs was published from January 1, 2000 to May 30, 2015.The literature was conducted in Chinese or English. Jadad quality scoring criteria were used to evaluate the quality of the literature. And the software Rv Man5.3 is applied to evaluate and analyze all the research literature involved. The result is 1: 1. The improvement of TCM syndrome score before and after treatment in the treatment group was significantly better than that in the control group. The incidence of gastrointestinal hemorrhage and the incidence of paralytic intestinal obstruction were lower and the total clinical effective rate was significantly higher than that in the control group. The differences were statistically significant (P0.05). A total of 811 Sirs patients were included in this study, including 396 patients in the control group and 415 patients in the treatment group. Both groups were treated with routine anti-Sirs therapy, and the patients in the treatment group were treated with Tanreqing injection. The results of Meta-analysis showed that the total effective rate of the patients in the treatment group was significantly higher than that in the control group. The levels of CRP and PCT, TNF-a and IL-6 levels were significantly lower in the treatment group than in the control group. The differences were statistically significant (P0.05), and no adverse reactions were reported in all the literatures. Conclusion 1. The treatment of acute tracheobronchial bronchitis with systemic inflammatory response syndrome by clearing heat and removing phlegm has obvious clinical effect. It can not only reduce the TCM syndromes of the patients, stabilize the vital signs of the patients, but also improve the inflammatory reaction of the patients. The results of Meta analysis showed that Tanreqing injection could reduce the inflammatory reaction in patients with systemic inflammatory response syndrome (Sirs), and could reduce the incidence of complications in patients with acute trachea bronchitis and Sirs. 2. The results of Meta analysis showed that Tanreqing injection could alleviate the inflammatory reaction in patients with systemic inflammatory response syndrome (Sirs). Improve the total clinical effective rate, good effect, reliable, and no clinical adverse reactions, the safety is high. 3. Tanreqing injection is a typical representative of traditional Chinese patent medicine to clear away heat and dissipate phlegm. It can treat systemic inflammation accompanied by many diseases, which is convenient, quick, safe and effective.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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