针刺联合中药治疗卒中相关性肺炎痰热壅肺证的疗效观察

Efficacy observation of acupuncture combined with Chinese herbal medicines on phlegm heat accumulating in the lung pattern of stroke-related pneumonia

目的 观察针刺联合截喘汤加减治疗卒中相关性肺炎(stroke-associated pneumonia, SAP)痰热壅肺证的临床疗效。方法 选取99例SAP痰热壅肺证患者,随机分为针刺组、中药组和联合组,每组33例。3组患者均给予内科常规基础治疗,针刺组予以针刺治疗,中药组予以截喘汤加减,联合组予以截喘汤加减联合针刺治疗。比较3组治疗前后中医证候积分、血炎性因子水平[白细胞计数(white blood cell, WBC)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)和白细胞介素-6(interleukin-6, IL-6)]及血清免疫球蛋白[免疫球蛋白A(immunoglobulin A, IgA)、免疫球蛋白G(immunoglobulin G, IgG)、免疫球蛋白M(immunoglobulin M,IgM)]水平变化,比较3组临床疗效和致病菌清除率。结果 联合组的愈显率为65.6%,高于中药组的43.8%和针刺组的18.8%,差异有统计学意义(P<0.05)。与治疗前比较,3组治疗后中医证候积分均下降(P<0.05),且联合组低于中药组和针刺组(P<0.05)。与治疗前比较,3组治疗后血WBC、血清TNF-α和IL-6水平均下降(P<0.05),血清IgA、IgG和IgM水平均上升(P<0.05),且联合组各项炎症指标和免疫球蛋白水平优于中药组和针刺组(P<0.05)。联合组致病菌清除率与中药组和针刺组比较,差异无统计学意义(P>0.05)。结论 在内科常规治疗基础上,针刺联合截喘汤加减治疗SAP痰热壅肺证,可显著控制肺部感染,增强机体免疫功能,降低炎性因子水平,临床疗效显著。

Objective To observe the clinical effect of acupuncture combined with Jiechuan decoction in the treatment of phlegm heat accumulating lung pattern of stroke-associated pneumonia(SAP).Method Ninety-nine patients with phlegm heat accumulating lung pattern of SAP were randomly divided into an acupuncture group,an herbal medicine group and a combination group,with 33 cases in each group.All patients in 3 groups were given routine internal basic treatment.The acupuncture group was given add-on acupuncture treatment.The herbal medicine group was given add-on Jiechuan decoction.The combination group was given add-on Jiechuan decoction and acupuncture treatment.The traditional Chinese medicine(TCM)symptom scores,blood inflammatory factor levels[white blood cell(WBC),tumor necrosis factor-a(TNF-a)and interleukin-6(IL-6)]and serum immunoglobulin[immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)]before and after treatment were compared among the three groups.The clinical efficacy and pathogenic bacteria clearance rate of the three groups were compared.Result The curative rate of the combination group was 65.6%,which was higher than that of the herbal medicine group(43.8%)and the acupuncture group(18.8%),the difference was statistically significant(P<0.05).Compared with the same group before treatment,the TCM syndrome scores of the 3 groups were decreased after treatment(P<0.05),and they were lower in the combination group than in the herbal medicine group and acupuncture group(P<0.05).Compared with the same group before treatment,the blood WBC,serum TNF-aand IL-6 levels of the 3 groups were decreased after treatment(P<0.05),and the level of serum IgA,IgG and IgM was increased after treatment(P<0.05).The inflammation indexes and immunoglobulin levels of the combination group were superior to those of the herbal medicine group and the acupuncture group(P<0.05).There was no significant difference in the pathogenic bacteria clearance rate among the combination group,the herbal medicine group and the acupuncture group(P>0.05).Conclusion Adding acupuncture and Jiechuan decoction to the routine internal medical treatment can significantly control lung infection,enhance immune function and reduce inflammatory factors with marked clinical efficacy.