益气活血祛痰方治疗支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证的研究

Efficacy of decoction for replenishing Qi,activating blood and dispelling phlegm on asthma with

目的评价益气活血祛痰方联合西医治疗慢性持续期支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者的临床疗效。方法选择2016年1月—2021年6月于泰州市第四人民医院就诊的80例慢性持续期支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者,根据随机数字表分成对照组及观察组各40例,对照组给予常规治疗及持续气道正压通气,观察组在对照组治疗基础上给予益气活血祛痰方水煎液口服,2组均持续干预3个月。观察2组患者治疗前后中医证候积分(包括气喘、咳嗽、咳痰、打鼾、憋醒、日间嗜睡、倦怠乏力)、哮喘控制测试问卷(ACT)评分、圣乔治呼吸问卷(SGRQ)评分、Epworth嗜睡量表(ESS)评分、匹兹堡睡眠指数(PSQI)评分、肺功能指标[呼气峰值流速(PEF)、第一秒用力呼气容积占预计值百分比(FEV_(1)%预计值)、第一秒用力呼气容积与用力肺活量比值(FEV_(1)/FVC)]、多导睡眠图参数[呼吸暂停低通气指数(AHI)、快速眼动睡眠期(REM)、氧减指数(ODI)、动脉血氧饱和度(SaO_(2))、最低SaO_(2)、觉醒指数]、炎症相关指标[血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)水平和呼出气一氧化氮(FeNO)水平]变化,统计2组总体治疗效果及不良反应发生情况。结果2组治疗后中医证候积分、SGRQ评分、ESS评分、PSQI评分、AHI、ODI、觉醒指数及血清CRP、IL-6、TNF-α、VEGF水平和FeNO水平均较治疗前明显降低(P均<0.05),且观察组上述各项指标均明显低于对照组(P均<0.05);2组治疗后ACT评分、PEF、FEV_(1)%预计值、FEV_(1)/FVC、REM、SaO_(2)、最低SaO_(2)均较治疗前明显升高(P均<0.05),且观察组上述各项指标均明显高于对照组(P均<0.05)。观察组治疗3个月后的总有效率明显高于对照组[92.5%(37/40)比82.5%(33/40),P<0.05],治疗期间不良反应发生率明显低于对照组[10.0%(4/40)比27.5%(11/40),P<0.05]。结论益气活血祛痰方联合西医治疗支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者的效果优于单纯西医治疗,在减轻患者临床症状,控制哮喘发作,改善肺功能和睡眠质量方面具有明显优势,其作用机制可能与抑制炎症反应相关。

Objective It is to evaluate the clinical efficacy of decoction for replenishing Qi,activating blood and dispelling phlegm combined with western medicine in the treatment of patients with chronic persistent bronchial asthma and obstructive sleep apnea hypoventilation syndrome(OSAHS)of syndrome of Qi deficiency and phlegm stasis.Methods Eighty patients with chronic persistent bronchial asthma and OSAHS of syndrome of Qi deficiency and phlegm stasis treated in Taizhou Fourth People’s Hospital from January 2016 to June 2021 were selected,and were divided into control group and observation group according to the random number table,with 40 cases in each group.The control group was given conventional treatment and continuous positive pressure ventilation,and the observation group was treated with decoction for replenishing Qi,activating blood and dispelling phlegm on the basis of treatment in the control group.Both groups were continuously treated for 3 months.The syndrome scores(including asthma,cough,sputum,snoring,wakefulness,daytime sleepiness,tiredness and fatigue),scores of Asthma Control Test(ACT),St.George’s Respiratory Questionnaire(SGRQ),Epworth Sleepiness Scale(ESS),Pittsburgh Sleepiness Quotient Index(PSQI),pulmonary function indexes[peak expiratory flow(PEF),FEV_(1)%,FEV_(1)/FVC],polysomnographic parameters[apnea hypopnea index(AHI),rapid eye movement(REM),oxygen desaturation index(ODI),SaO_(2),minimum SaO_(2),arousal index],inflammation-related indexes[serum levels of C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VEGF),and level of exhaled exhaled nitric oxide(FeNO)]of the patients before and after treatment were observed in the two groups,the overall efficacy and the occurrence of adverse reactions in the two groups were calculated.Results The syndrome scores,SGRQ scores,ESS scores,PSQI scores,AHI,ODI,arousal index and levels of CRP,IL-6,TNF-α,VEGF in serum and exhaled FeNO of the two groups were significantly lower after treatment than those before treatment(all P<0.05),and all the above indicators of the observation group were significantly lower than those of the control group(all P<0.05);the ACT scores,PEF,FEV_(1)%,FEV_(1)/FVC,REM,SaO_(2),and minimum SaO_(2)of the two groups were all significantly higher than those before treatment(all P<0.05),and all the above indicators of the observation group were significantly higher than those of the control group(all P<0.05).The total effective rate of the observation group after 3 months of treatment was significantly higher than that of the control group[92.5%(37/40)VS.82.5%(33/40),P<0.05],and the incidence rate of adverse reactions during the treatment period was significantly lower than that of the control group[10.0%(4/40)VS.27.5%(11/40),P<0.05].Conclusion Decoction for replenishing Qi,activating blood and dispelling phlegm combined with western medicine is more effective than western medicine alone in the treatment of bronchial asthma with obstructive sleep apnea hypoventilation syndrome patients with OSAHS of syndrome of Qi deficiency and phlegm stasis,and it has obvious advantages in alleviating clinical symptoms,controlling asthma attacks,improving lung function and sleep quality,and its mechanism of action may be related to the inhibition of inflammatory response.