清热化痰法对慢性阻塞性肺疾病急性加重期痰热证的基础与临床研究

【作者】 陈良；

【导师】 王琦；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2014， 硕士

【摘要】 慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease, COPD,简称慢阻肺)是呼吸系统常见病、难治病,以慢性进行性发展为显著特点,该病通常呈反复加重趋势,严重影响患者生存质量,同时增加患者家庭医疗经济负担。西医常规治疗普遍存在症状改善不够理想与迅速、住院时间长、住院周期短、住院费用高等问题；中医药在治疗呼吸系统疾病取得较好临床效果,且有低毒副作用、花费低、取药方便等优势,从而备受关注。[目的]探讨清热化痰中药在慢阻肺急性加重期痰热证的临床疗效。[方法]纳入患者为北京中医药大学附属东方医院(三级甲等)呼吸热病科2013年9月至2014年1月住院病例,共53例,分为对照组和治疗组,对照组采用西医常规治疗,治疗组在西医常规治疗基础上加清热化痰类中药口服治疗,观察患者住院第1天、第3天、第5天、第7天的症状评分,比较两组治疗前后积分及总住院天数,探讨清热化痰中药临床疗效。[结果]收集有效病例50份,其中对照组15份,治疗组35份,COPD Ⅰ、Ⅱ、 Ⅲ、Ⅳ分级分别为0、14、34、1例。1、主症：两组患者咳嗽、咳痰、喘憋治疗后均较有明显改善,且在治疗第5天后两组有差异(P<0.05)。2、次症：发热、心烦、口渴喜饮、舌质舌苔、小便黄赤、大便干结治疗后均有不同程度改善,治疗组症状积分较对照组改善较快,但两组除大便干结症状积分有差异外,其他无统计差异(P>0.05)。3、住院天数：对照组平均住院天数为15.33±2.47天,治疗组为10.20±1.84天,两组有明显统计差异(P<0.01)；两组性别、COPD分级无明显统计差异(P>0.05)。4、相关性：①年龄与COPD分级、住院天数、咳嗽、喘憋、舌质舌苔、大便干结呈正相关(P>0.05),与咳痰、发热、心烦、口渴喜饮呈负相关；②性别与喘憋、口渴喜饮、小便黄赤、住院天数呈正相关(P>0.05),与发热呈负相关。③COPD分级与喘憋程度、发热、口渴喜饮、舌质舌苔呈正相关(P>0.05)。④住院天数与年龄、性别、发热情况呈正相关(P>0.05),与心烦、口渴喜饮、舌质舌苔、小便黄赤、大便干结呈负相关。[结论]1、清热化痰中药能改善AECOPD患者呼吸道临床症状,如咳嗽、咯痰、喘憋,在住院治疗第5天后临床疗效较明显。2、清热化痰中药能缩短AECOPD患者住院时间。3、AECOPD患者住院时间、COPD分级及咳嗽、咳痰、喘憋与年龄呈正相关。更多还原

【Abstract】 Chronic Obstructive Pulmonary Disease (COPD) is one of diseases that difficult to treat and its character is chronic and processing, all of this makes patients’symptom serious time after time while takes a amount of money to treat it. The treatment of modern medicine now exists some problems like the symptoms and days in-patients last long, fee for service takes lot, and other all. Now many people pay attention to Chinese herbs because of its low side effect、lower fees、convenient to get and good effect on respiration disease.[Objective] To evaluate the curative effect of Chinese herbals formula with the function of clearing heat and resolving heat on AECOPD, and then give a guide to clinical work.[Methods] All53cases from the Department of Respiratory Medicine inpatients of Dongfang Hospital which is the second affiliated hospital of Beijing University, of Chinese Medicine during09/2013to01/2014, were divided into two groups, the control group and treatment group. The control group was given a therapy of modern medicine while the treatment was given the Chinese herbal compound orally at the same time. Observe the symptoms of the patients at the1st、3nd、5th、7th day, mark it with a sheet and account the days in hospital. Compare two groups scores and estimate the function of herbs.[Results] The available50cases are consisted of15in control group and35in the treatment group. The numbers of cases with COPD grader from I to IV were0、14、34、1.1、 Ma in Symptoms:the symptoms of two groups including cough、 expectoration and phlegm quantity、wheeze can be improved, the treatment group shows the significance after5th day in-patient (P<0.05).2、Secondary Symptoms:Fever、Agitation、Thirsty、Tongue fur、Yellow urine. Dry stools of patients from two groups also get improved while the treatment improves faster, the data shows no significance in two groups but the symptom of dry stools.3、Days in-patient:The average days in-patient were15.33±2.47in the control group while10.20±1.84in the treatment group. It shows a markedly significance in the two groups (P<0.01).4, Correlation:①The age was positively correlated with COPD grader、days in-patient. cough、wheeze、tongue fur and dry stools (P>0.05) while negatively correlated with expectoration and phlegm quantity、fever、agitation and thirsty.②Gender was positively correlated with wheeze、thirsty、yellow urine and days in-Patient while negatively correlated with fever.③COPD grade has a positive relation with wheeze、fever、thirsty、 and tongue fur (P>0.05).④Days in-Patient has a positive relation with age、 gender and fever while a negative relation with agitation、tongue fur、yellow urine and dry stools.[Conclusion]1、Formula with clearing heat and resolving heat can less clinical symptoms like cough、expectoration and phlegm quantity and wheeze especially in the5th、7thday.2、Formula with clearing heat and resolving heat can shorten the days in-patient on the patients with AECOPD.3、Days in-patient、COPD gender、cough、expectoration and phlegm quantity and wheeze have a positive relation with age in the patients with AECOPD.更多还原