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1、提要目的:觀察清肺補(bǔ)腎法治療慢性阻塞性肺疾病急性加重期(痰熱腎虛證)的臨床療效并探討其作用機(jī)制。為中醫(yī)藥治療慢阻肺急性發(fā)作提供新的臨床依據(jù)。方法:將60例診斷為慢性阻塞性肺疾病急性加重期并辨證為痰熱腎虛證的患者隨機(jī)分為試驗(yàn)組和對(duì)照組。試驗(yàn)組給予清肺補(bǔ)腎方聯(lián)合西醫(yī)抗感染、化痰、解痙平喘等常規(guī)治療。對(duì)照組單純使用西醫(yī)抗感染、化痰、解痙平喘等對(duì)癥治療。療程均為2周,觀察兩組患者綜合療效、癥狀體征積分、血?dú)夥治鲋笜?biāo)、肺功能、實(shí)驗(yàn)室指標(biāo)、肺動(dòng)脈壓及不良反應(yīng)等。結(jié)果:癥狀體征總積分比較,兩組總積分較治療前均明顯下降,治療后總積分
2、比較試驗(yàn)組低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);綜合療效比較,試驗(yàn)組總有效率96.7%,對(duì)照組總有效率90.0%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);血?dú)夥治鲋笜?biāo)比較,治療后兩組PaO2均顯著升高,PaCO2均明顯下降,試驗(yàn)組PaO2、PaCO2改善較對(duì)照組明顯(P<0.05);超聲心動(dòng)圖測(cè)得肺動(dòng)脈壓的比較,治療后肺動(dòng)脈壓值均有所下降(P<0.05),治療后兩組肺動(dòng)脈壓水平無(wú)明顯差異(P>0.05);肺功能指標(biāo)的比較,治療后兩組FEV1/FVC、FEV1%預(yù)計(jì)值均有所升高,試驗(yàn)組FEV1/FVC、FEV1%預(yù)計(jì)
3、值改善較對(duì)照組明顯(P<0.05);實(shí)驗(yàn)室檢查方面,兩組血白細(xì)胞總數(shù)、中性粒細(xì)胞百分比及降鈣素原測(cè)定值治療后均明顯降低,治療后測(cè)定值試驗(yàn)組略低于對(duì)照組(P<0.05)。結(jié)論:清肺補(bǔ)腎法聯(lián)合西醫(yī)常規(guī)治療對(duì)慢性阻塞性肺疾病急性加重期(痰熱腎虛證)具有良好的臨床療效,其綜合療效優(yōu)于西醫(yī)常規(guī)治療,能顯著改善患者的臨床癥狀和體征,糾正缺氧和二氧化碳潴留,降低肺動(dòng)脈壓,減輕炎癥反應(yīng),改善肺功能,有利于癥狀的早期緩解和病情的盡快控制。關(guān)鍵詞慢性阻塞性肺疾病急性加重期;清肺補(bǔ)腎法;痰熱腎虛證;臨床研究ClinicalObservat
4、ionofQingfeiBushenMethodonTreatingChronicObstructivePulmonaryDiseaseinAcuteExacerbationSpeciality:ChineseMedicineClinicalRespiratoryMedicineProfessionalAuthor:ZhengHaiTutor:ProfessorZhangWeiluAbstractObjective:ToobservetheclinicalefficacyofQingfeiBushenmethodin
5、treatingchronicobstructivepulmonarydiseaseinacuteexacerbationoftenreshenxusyndromeandexploreitsmechanism.ProvidenewclinicalbasisforChinesemedicinemethodofAECOPD.Methods:Accordingtorandomized,controlledprinciple,60patientsweredividedintoexperimentalgroupof30andc
6、ontrolgroupof30.TheexperimentalgroupwasgivenQingfeiBushenprescriptioncombinedwithconventionalwesterntreatment.Controlgroupweretreatedusingconventionalwesterntreatment.Thetreatmentlastedtwoweeks,patientswereobservedefficacy,symptomsandsigns,arterialbloodgasanaly
7、sis,pulmonaryfunction,laboratorytests,pulmonaryarterypressureandadversereactions.Results:Comparisonofthetotalscoreofsymptomsandsigns:thetwogroupstotalscoredecreasedsignificantlyaftertreatment,thetotalscoreoftheexperimentalgrouplowerthanthecontrolgroup,thediffer
8、encewasstatisticallysignificant(P<0.05);Integratedeffectofthetwogroupswerecompared,theexperimentalgroupwasefficiencyof96.7%,controlgroupwas90.0%,thedifferencewasstatisticall