小五味子汤加减配合推拿手法治疗小儿慢性感染后咳嗽的临床观察

Clinical Efficacy of Modified Xiao Wuweizitang Combined with Massage Manipulation on Chronic Post-infection Cough

目的:观察小五味子汤加减配合推拿手法治疗小儿慢性感染后咳嗽(风邪伏肺证)的疗效及对患儿免疫功能和痰上清液炎症因子的影响。方法:将135例患儿采用随机按数字表法分为对照组和观察组。对照组59例采用苏黄止咳胶囊,3~6岁,1粒/次;6~12岁,2粒/次,3次/d;配合推拿手法治疗,1次/d。观察组63例,采用小五味子汤加减内服和推拿手法治疗。两组疗程均为连续治疗10 d。于治疗前和治疗后5,10 d进行咳嗽视觉模拟评分(VAS),咳嗽症状积分和风邪伏肺证评分;进行治疗前后莱塞斯特咳嗽问卷(LCQ)评分;检测治疗前后CD3^+,CD4^+,CD8^+水平,计算CD4^+/CD8^+;检测治疗前后痰上清白细胞介素-8(IL-8),IL-4,肿瘤坏死因子-α(TNF-α)和P物质(SP)和降钙素原基因相关肽(CGRP)水平。结果:观察组患儿在治疗后5 d和治疗后10 d咳嗽VAS评分、咳嗽症状积分和风邪伏肺证积分均低于对照组(P<0.01);观察组临床疗效优于对照组(χ^2=7.513,P<0.01);观察组咳嗽消失率57.81%,高于对照组的38.98%(χ^2=4.356,P<0.05);观察组平均咳嗽消失时间短于对照组(P<0.01);观察组LCQ问卷各维度和LCQ总分均高于对照组(P<0.01);观察组患儿痰上清液中TNF-α,IL-8,IL-4,CGRP和SP水平均低于对照组(P<0.01)。结论:小五味子汤加减联合推拿手法治疗小儿慢性感染后咳嗽,患儿可减轻咳嗽症状,缩短咳嗽病程,提高咳嗽消失率,提高患儿的生活质量,临床疗效显著,并能起到调节患儿免疫功能,减轻气道炎症反应和气道高反应、降低咳嗽反射敏感性的作用。

Objective: To observe the effect of modified Xiao Wuweizitang combined with massage manipulation on chronic post-infection cough(syndrome of wind-pathogenic pulmonary embedding),and immunity and inflammatory factors.Method: One hundred and thirty-five patients were randomly divided into control group and observation group by random number table.Patients(59 cases) in control group got Suhuang Zhike capsules,1 granule/time for 3 to 6-year-old children,2 granules/time,3 times/days for 6 to 12-year-old children,and massage manipulation,1 time/day.Patients(63 cases) in observation group got modified Xiao Wuweizitang combined with massage manipulation.A course of treatment was 10 days.Before treatment,and at the 5^th and 10^th day after treatment,visual analogue score of cough(VAS),cough symptom,syndrome of wind-pathogenic pulmonary embedding and leicester cough questionnaire(LCQ) were scored.And levels of CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,interleukin-8,IL-4,tumor necrosis factor-α(TNF-α),substance P(SP) and calcitonin gene related peptide(CGRP) were detected.Result: At the 5^th and 10^th day after treatment,scores of VAS,cough symptom and syndrome of wind-pathogenic pulmonary embedding in observation group were lower than those in control group(P<0.01),and the clinical efficacy was superior to that in control group(χ^2= 7.513,P<0.01).The disappearance rate of cough in observation group was 57.81%,which was higher than 38.98% in control group(χ^2= 4.356,P<0.05).And the average time of disappearance of cough was shorter than that in control group(P<0.01).Scores of LCQ questionnaire(physiology,psychology and society) and the total score were higher than those in control group(P<0.01),and levels of TNF-α,IL-8,IL-4,CGRP and SP were lower than those in control group(P<0.01).Conclusion: Modified Xiao Wuweizitang combined with massage manipulation can relieve cough symptom,shorten the cough course,increase rate of the disappearance of cough,improve the quality of life of children,regulate immune function of children,reduce airway inflammation,airway hyperresponsiveness and cough reflex sensitivity.