【作者】 陈灿；

【导师】 林琳；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 背景感染后咳嗽(post-infectious cough,PIC)是指各种病原体如细菌、病毒、支原体、衣原体等所致的呼吸道感染以后继发的咳嗽,感染得到控制后而咳嗽症状不缓解。西医认为,感染后咳嗽的发病机制目前尚不十分明确,治疗方面,现代医学尚缺乏治疗感染后咳嗽的有效药物,而中医治疗咳嗽有其独特的优势,历代医家治疗顽咳、久咳的临床经验积累,为现代中医辨证施治治疗感染后咳嗽提供借鉴。近年来国内也对感染后咳嗽的辨证施治进行了一些探索性研究,但现有研究缺乏充分调研的依据和系统论证的基础,特别是对感染后咳嗽的诊断和纳入标准不明确,科研设计存在不足,难以形成规范并推广应用。根据《咳嗽的诊断与治疗指南》,感染后咳嗽的诊断需进行肺功能及诱导痰细胞学等检查排除相关疾病,这对于医疗技术和资源均短缺的基层医院实行起来相当困难,因此有必要建立简、验、廉的诊断、治疗方法,以便在基层医院推广应用。目的对感染后咳嗽诊疗方案进行简化,形成《感染后咳嗽简易诊治手册》,培训基层医生使用,在基层医院进行临床研究,在应用过程中不断优化改善,最后形成适宜推广的感染后咳嗽基层诊疗方案。方法应用初步制订的《感染后咳嗽简易诊断手册》,在三个基层医院中纳入100例病例,使用课题协定药物进行为期10天的治疗,在应用过程中发现问题并修改诊断程序,最后通过分析病例资料,最终形成适宜推广的感染后咳嗽基层诊疗方案。结果100例纳入病例在进行为期10天的治疗后,治疗前后咳嗽症状评分用秩和检验,结果表明治疗前后咳嗽症状评分有明显差异,好转率64.21%,痊愈率16.84%,治疗总有效率(包括好转及痊愈)81.05%,平均缓解时间为5.36±2.019天。结论应用《感染后咳嗽简易诊治手册》,简化了基层医院对感染后咳嗽的诊断程序,降低了诊断成本,在此基础上辨证中医药治疗,收到良好的治疗效果。但手册仍有一定的不足之处,主要是由于结合基层医院的设备特点而精减的诊疗手段有可能导致因检查不足而造成误诊。更多还原

【Abstract】 BackgroundPost-Infectious Cough is cough caused by respiratory tract infection which is infected by a rariety of pathogns such as bacteria, viruses, mycoplasma, chlamydia, etc, cough is not relieved while the infection is cured. In the opinion of western medicine, the pathognesis of PIC is still not exactly clear at present. For treatment, there is no effective drug for PIC in western medicine. But TCM has its distinct advantage in the therapy of cough. In the treatment of stubborn cough, chronic cough, ancient physicians had plenty of clinical experience, which can be referenced for TCM syndrome differentiation treatment of PIC nowadays. In recent years, some exploratory researches about TCM syndrome differentiation treatment of PIC have been taken in China. But it is hard to make a standard and popularize the manual for the existing researches are lack of foundation about sufficient surrey research and systemic argument, especially for the unclear diagnosis and inclusion criteria for PIC and the defective research design. According to the "Guide for diagnosis and treatment of cough", it is hard to take it into practice in primary hospitals, because of the shortage of medical technology and resources, because for the diagnosis of PIC, the Pulmonary Function Testing(PFT) and induced sputum cytological examination are needed to be undertaken t indentify and exclude the similar diseases. So it is necessary to form a simple effective and cheap way for diagnosis and treatment, in order to popularize it in primary hospitals.ObjectivesSimplify the diagnosis and treatment plan of Post-Infectious Cough, form the "simple diagnosis and treatment manual for Post-Infectious Cough", improving the manual in practice, form a plan which is suitable to popularize in primary hospitals, in the end.MethodsApply the initial formation of the "simple diagnosis and treatment manual for Post-Infectious Cough" in three primary hospitals.enrool 100 patients, take the drugs of task for 10 days, discover its defects and modify the way of diagnosis in practice, and finally form a diagnosis and treatment plan of PIC which is suitable to popularize in primary hospital by analyzing the medical cases.ResultAfter 10 days’treatment for the 100 including patients, compare the scores of cough before and after the treatment by way of Rank Sum Test. The result are significantly different. The rate of improvement is 64.21%, the rate of cure is 16.84%, the rate of effective (including the improve and cure) is 81.05%. The average time of remission is 5.36±2.019 days.ConclusionApplication of "simple diagnosis and treatment Manual for Post-Infectious Cough", had simplify the procedure for diagnosis and treatment of Post-Infectious Cough in primary hospitals, reduce the cost of diagnosis. Syndrome differentiation treatment of TCM on this basis, have satisfactory clinical effictiveness. But the manual is not perfeet, it is mainly because we have to cut down the examinations of diagnosis for the insufficient equipment in primary hospitals, and it may lead to misdiagnosis for the lack of necessary examinations.更多还原