【摘要】 目的 探讨人参补肺汤合保元汤联合无创正压通气治疗慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Diseases, COPD)肺肾气阴两虚证的临床疗效。方法 选取2019年1月—2021年1月期间河南省周口市中医院收治的COPD患者100例，根据患者就诊顺序编号，采用随机数字表法将其分为对照组和观察组，每组各50例。对照组采用无创正压通气治疗，观察组在对照组基础上增加人参补肺汤合保元汤。治疗12周后，观察比较两组患者治疗后临床疗效，比较两组患者治疗前后中医证候积分、肺功能指标[呼气峰值流速(Peak Expiratory Flow, PEF)、第一秒用力呼气量(Forced Expiratory Volume in First Second, FEV1)、第一秒用力呼气量占用力肺活量比率(FEV1/FVC)]、慢性阻塞性肺疾病自我评估测试问卷(COPD Assessment Test, CAT)评分、改良版英国医学研究委员会呼吸问卷(Modified British Medical Research Council, mMRC)评分及无创正压通气时间，同时比较两组患者治疗前后血清基质金属蛋白酶-9(Matrix Metalloproteinase-9,MMP-9)、环氧化酶-2(Cycloxygenase-2,COX-2)及可溶性髓样细胞触发受体-1(Soluble Triggering Receptor Expresses on Myeloid Cells-1,sTREM-1)表达水平及不良反应发生情况。结果 治疗后观察组总有效率98.00%(49/50)优于对照组84.00%(42/50),差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均较治疗前降低，而肺功能指标PEF、FEV1/FVC及FEV1较治疗前升高，差异有统计学意义(P<0.05);且观察组中医证候积分低于对照组，肺功能指标高于对照组，差异有统计学意义(P<0.05)。治疗后两组患者CAT及mMRC评分均较治疗前降低，差异有统计学意义(P<0.05);且观察组CAT及mMRC评分均低于对照组，差异有统计学意义(P<0.05)。治疗后观察组机械通气时间(103.57±10.38)h低于对照组机械通气时间(119.48±11.47)h,差异有统计学意义(P<0.05)。治疗后两组患者MMP-9、COX-2及sTREM-1水平较治疗前降低，差异有统计学意义(P<0.05);且观察组MMP-9、COX-2及sTREM-1水平均低于对照组，差异有统计学意义(P<0.05)。两组患者不良反应发生情况比较，差异无统计学意义(P>0.05)。结论 人参补肺汤合保元汤联合无创正压通气能提高COPD肺肾气阴两虚证患者的治疗效果，降低患者中医证候积分，改善肺功能，缩短患者机械通气时间，调节细胞因子水平，安全可靠。更多还原

【Abstract】 Objective To explore the clinical efficacy of Renshen Bufei Decoction and Baoyuan Decoction combined with noninvasive positive pressure ventilation on chronic obstructive pulmonary disease(COPD)with qi-yin deficiency in lung and kidney.Methods A total of 100 COPD patients who were treated in Zhoukou Hospital of Traditional Chinese Medicine from January 2019 to January 2021 were randomized into observation group(n=50)and control group(n=50).The control group was treated with noninvasive positive pressure ventilation, and the observation group was treated with Renshen Bufei Decoction, Baoyuan Decoction, and noninvasive positive pressure ventilation.After 12 weeks of treatment, the clinical effect in the two groups was compared.The traditional Chinese medicine(TCM)syndrome score, pulmonary function indexes[peak expiratory flow(PEF),forced expiratory volume in the first second(FEV1),FEV1/forced vital capacity(FVC)],COPD assessment test(CAT)score, and modified British Medical Research Council Respiratory questionnaire(mMRC)score before and after treatment, and noninvasive positive pressure ventilation time were compared between the two groups.In addition, the serum levels of matrix metalloproteinase-9(MMP-9),cyclooxygenase-2(COX-2),and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)were compared between the two groups before and after treatment and the occurrence of adverse reactions was also compared.Results After treatment, the total effective rate of the observation group(98.00%,49/50)was higher than that of the control group(84.00%,42/50)(P<0.05).After treatment, the TCM syndrome scores were lower and the levels of PEF,FEV1/FVC,and FEV1 were higher than those before treatment in the two groups(P<0.05).Moreover, the of TCM syndrome score in the observation group was lower than that in the control group, and the levels of pulmonary function indexes in the observation group were higher than those in the control group(P<0.05).After treatment, the scores of CAT and mMRC were lower than those before treatment in the two groups(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).The time of mechanical ventilation in the observation group[(103.57±10.38)h]was shorter than that in the control group[(119.48±11.47)h]after treatment(P<0.05).After treatment, the levels of MMP-9,sTREM-1,and COX-2 were lower than those before treatment in both groups(P<0.05)and lower in the observation group than in the control group.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Renshen Bufei Decoction and Baoyuan Decoction in combination with noninvasive positive pressure ventilation can improve the efficacy on COPD patients with qi-yin deficiency in lung and kidney, reduce the TCM syndrome score, improve pulmonary function, shorten the time of mechanical ventilation, and regulate the level of cytokines.The combination is safe and reliable.更多还原