【摘要】：目的探討桂枝加黃芪湯合蒼耳子散加減內(nèi)服和熏鼻治療慢性鼻炎(肺脾氣虛、邪滯鼻竅證)近期對鼻塞、鼻阻力的改善作用,以及遠期對復(fù)發(fā)的影響。方法共入選178例患者,除去脫落共完成167例,隨機分為觀察組83例和對照組84例。對照組,鼻三針辨證取穴,6次為1個療程,共8個療程,每個療程間隔1d。觀察組,采用桂枝加黃芪湯合蒼耳子散加減內(nèi)服和熏鼻,兩組均連續(xù)觀察8周。主要療效指標(biāo)包括主觀鼻塞程度[采用視覺模擬評分(VAS評分)]和鼻氣道阻力。次要療效指標(biāo)包括鼻塞,頭痛、頭暈,嗅覺減退,鼻涕和鼻黏膜情況評分等中醫(yī)證候評分;進行鼻腔纖毛輸送功能(MTR)檢測和記錄24周內(nèi)患者復(fù)發(fā)頻率;并進行安全性評價。結(jié)果觀察組臨床療效總有效率為95.18%,高于對照組的84.52%(χ2=5.185,P=0.022 8);經(jīng)重復(fù)測量的方差分析,對照組和觀察組在治療后鼻塞程度VAS評分均呈下降趨勢(P0.05);經(jīng)配對t檢驗,觀察組在治療第21、28、35、42、49、56天鼻塞程度VAS評分均低于對照組(P0.01);經(jīng)重復(fù)測量的方差分析,對照組和觀察組在治療4、8周后鼻阻力檢測均顯著下降(P0.05),經(jīng)配對t檢驗,觀察組在治療4、8周后鼻阻力均低于對照組(P0.01);在治療后24周(隨訪期)兩組鼻阻力均較治療結(jié)束時升高,但觀察組鼻阻力仍然低于對照組(P0.01);治療后觀察組鼻塞,頭痛、頭暈,嗅覺減退,鼻涕和鼻黏膜情況評分均低于對照組(P0.01);治療后觀察組MTR快于對照組(P0.05);在24周的隨訪期內(nèi),觀察組復(fù)發(fā)率為85.54%,對照組為90.05%,組間比較差異無統(tǒng)計學(xué)意義(χ2=3.303,P=0.069 1),但觀察組平均復(fù)發(fā)次數(shù)低于對照組(P0.01)。結(jié)論桂枝加黃芪湯合蒼耳子散加減內(nèi)服和熏鼻治療慢性鼻炎肺脾氣虛、邪滯鼻竅型患者近期能改善患者主觀鼻塞癥狀,降低患者鼻阻力,降低中醫(yī)證候評分,促進MTR;遠期能維持患者鼻阻力處于低水平,并能減少復(fù)發(fā)次數(shù),臨床療效顯著且安全。
[Abstract]:Objective to investigate the short-term improvement of nasal obstruction and nasal resistance in the treatment of chronic rhinitis (deficiency of lung and spleen qi, stagnation of nose orifices) by oral administration of Guizhi plus Huangqi decoction combined with Cangerzi Powder and fumigation of nose, and the long-term influence on recurrence. Methods 178 patients were enrolled and 167 cases were completed. They were randomly divided into the observation group (83 cases) and the control group (84 cases). In the control group, there were 8 courses of treatment, 6 times as a course of treatment, and the interval of each course was 1 day. In the observation group, Guizhi and Huangqi decoction combined with Cangerzi Powder were used for 8 weeks. The main outcome measures included subjective nasal congestion [visual analogue score (VAS)] and nasal airway resistance. The secondary curative effects included nasal congestion headache dizziness olfactory loss nasal mucous membrane score and nasal mucosal condition score. The nasal cilium transport function (MTR) was used to detect and record the recurrence rate of patients within 24 weeks and the safety evaluation was carried out. Results the total effective rate of the observation group was 95.18%, which was higher than that of the control group (84.52%) (蠂 2 = 5.185%, P < 0.022 8). After repeated measurement, the VAS scores of nasal congestion in the control group and the observation group showed a downward trend (P0.05), and the VAS score of the observation group was lower than that of the control group on day 21, 2835, 42, 4956 days after treatment (P0.01). After repeated measurement of ANOVA, the nasal resistance in the control group and the observation group decreased significantly after 48 weeks of treatment (P0.05), and the nasal resistance in the observation group was lower than that in the control group after 48 weeks of treatment (P0.01). The nasal resistance in the observation group was still lower than that in the control group 24 weeks after treatment (P0.01), but the nasal resistance in the observation group was still lower than that in the control group (P0.01). After treatment, the scores of nasal congestion, headache, dizziness, decreased olfaction, nasal snot and nasal mucosa in the observation group were lower than those in the control group (P0.01), MTR in the observation group was faster than that in the control group after treatment (P0.05). During the follow up period of 24 weeks, the recurrence rate of the observation group was 85.54 and that of the control group was 90.05. There was no significant difference between the two groups (蠂 2, 3.303, P < 0.069 1), but the average number of recurrence in the observation group was lower than that in the control group (P0.01). Conclusion Guizhi and Huangqi decoction combined with Cangerzi Powder can improve the subjective nasal congestion symptoms, reduce the nasal resistance, reduce the score of TCM syndromes and promote MTR; in the treatment of chronic rhinitis with deficiency of lung and spleen qi and stagnation of nose resuscitation. In the long term, it can maintain low nasal resistance and reduce the number of recurrence. The clinical efficacy is significant and safe.
【作者單位】： 河南省許昌市中心醫(yī)院中醫(yī)康復(fù)科;
【分類號】：R276.1

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