加味人参胡桃汤联合西医常规治疗慢性阻塞性肺疾病急性加重期气虚血瘀痰阻证临床观察

Clinical observation of modified Renshen Hutao Decoction combined with Western medicine on acute exacerbation of chronic obstructive pulmonary disease with qi deficiency and blood stasis of phlegm obstruction syndrome

目的观察加味人参胡桃汤联合西医常规治疗慢性阻塞性肺疾病急性加重期(AECOPD)气虚血瘀痰阻证的临床疗效及对肺功能、血气指标、炎症因子和免疫球蛋白的影响。方法将110例AECOPD气虚血瘀痰阻证患者按照随机数字表法分为2组,对照组55例予西医常规治疗,治疗组55例在对照组治疗基础上应用加味人参胡桃汤。2组均连续治疗2周。比较2组疗效;比较2组治疗前后主要中医证候评分变化;比较2组治疗前后肺功能指标用力肺活量(FVC)、第1s用力呼气容积(FEV_(1))、FEV_(1)/FVC变化;比较2组治疗前后血气指标动脉血氧分压[p(O_(2))]、二氧化碳分压[p(CO_(2))]、动脉血氧饱和度(SaO_(2))变化;比较2组治疗前后血清白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)及免疫球蛋白G(IgG)、IgA、IgM水平变化。结果治疗组总有效率94.55%(52/55),对照组总有效率81.82%(45/55),治疗组疗效优于对照组(P<0.05)。2组治疗后咳嗽、咯痰色白或清稀、胸部憋闷、唇甲发绀、喘促气短评分及总评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后FVC、FEV_(1)、FEV_(1)/FVC均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。2组治疗后p(O_(2))、SaO_(2)均较本组治疗前升高(P<0.05),p(CO_(2))较本组治疗前降低(P<0.05),且治疗组治疗后p(O_(2))、SaO_(2)均高于对照组(P<0.05),p(CO_(2))低于对照组(P<0.05)。2组治疗后血清IL-8、TNF-α水平均较本组治疗前降低(P<0.05),且治疗组治疗后血清IL-8、TNF-α水平均低于对照组(P<0.05)。2组治疗后血清IgG、IgA、IgM水平均较本组治疗前升高(P<0.05),且血清IgG、IgA、IgM水平均高于对照组(P<0.05)。结论加味人参胡桃汤联合西医常规治疗AECOPD气虚血瘀痰阻证,有利于控制病情,有效抑制炎症因子,提高免疫力,改善肺功能及血气指标,安全可靠。

Objective To observe the clinical effect of modified Renshen Hutao Decoction combined with Western medicine on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with qi deficiency and blood stasis of phlegm obstruction syndrome.Methods A total of 110 patients with AECOPD(qi deficiency and blood stasis of phlegm obstruction syndrome)were randomly divided into the treatment group and the control group,50 cases in each,the treatment group was treated with modified Renshen Hutao Decoction in addition to conventional Western medicine.Both groups were treated for 2 consecutive weeks to assess clinical effects of the two groups.The key observition was traditional Chinese medicine(TCM)syndrome score,forced vital capacity(FVC),forced expiratory volume in 1 second(FEV_(1)),FEV_(1)/FVC,blood gas indicators including arterial partial pressure of oxygen[p(O_(2))],arterial partial pressure of carbon dioxide[p(CO_(2))]and arterial blood oxygen saturation(SaO_(2));serum interleukin 8(IL-8),tumor necrosis factorα(TNF-α),immunoglobulin G(IgG),IgA,and IgM levels.Results The overall effective rate in the treatment group was significantly higher than that in the control group(94.55%[52/55]vs 81.82%[45/55],[P<0.05],respectively).After treatment,scores of TCM syndromes(cough,expectoration,chest tightness,cyanosis,shortness of breath)in both groups were decreased(P<0.05),which in the treatment group were more prevalent(P<0.05);FVC,FEV_(1),FEV_(1)/FVC in the two groups were all increased compared with those before treatment(P<0.05),and the increase in the treatment group was more obvious(P<0.05);p(O_(2)) and SaO_(2) in both groups were higher(P<0.05),and p(CO_(2)) was lower(P<0.05);p(O_(2)),SaO_(2) in the treatment group were higher than the control group(P<0.05),and p(CO_(2)) was lower than the control group(P<0.05);the levels of serum IL-8 and TNF-αin groups were lower(P<0.05),the treatment group was more common(P<0.05),while the levels of serum IgG,IgA and IgM were higher(P<0.05),which was higher in the treatment group than in the control group(P<0.05).Conclusion For patients with AECOPD(qi deficiency and blood stasis of phlegm obstruction syndrome),modified Renshen Hutao Decoction combined with Western medicine is more conducive to control the disease by effectively inhibiting inflammatory factors,improving immunity,lung function and blood gas indexes,with safe and reliable.