中西医结合治疗肺栓塞16例的疗效评价

Therapeutic Evaluation of Traditional Chinese Medicine Combined with Western Medicine for Pulmonary Embolism:An Observation of 16 Cases

【目的】探讨中西医结合治疗肺栓塞的临床疗效。【方法】回顾性总结我院1999年6月至2005年6月6年间的全部肺栓塞患者16例,采用中西医结合治疗后的疗效情况,并与文献报道的采用纯西医治疗的6组145例肺栓塞患者进行荟萃分析比较。西医治疗措施主要有:应用尿激酶或重组纤溶酶原(rt-PA)溶栓治疗,低分子肝素和华法令抗凝治疗。中医治疗措施有:川芎嗪静脉滴注和中医辨证治疗(大致分3型:血瘀胸腑型用血府逐瘀汤加减,阳气暴脱兼血瘀型用参附汤治疗,痰瘀互结型用千金苇茎汤合桃红四物汤加减),总疗程为1个月。【结果】16例患者中治愈8例,好转5例,无效(自动转院)1例,死亡2例,病死率为12.5%。与采用纯西医治疗的6组145例文献报道的总病死率(28.28%)比较,差异无统计学意义(P>0.05),但文献报道的6组中有5组的病死率绝对值高于本组,其中与陈丽娟组(病死率为57.14%)比较,差异具有统计学意义(P<0.05)。【结论】采用以西医溶栓、抗凝和中医活血化瘀为主的中西医结合治疗肺栓塞病死率较低,但确切的结论有待进一步的大样本临床研究证实。

[ Objective] To observe the therapeutic effect of traditional Chinese medicine combined with western medicine （TCM-WM） for pulmonary embolism （PE）. [Methods] A retrospective study was carried out in 16 PE patients admitted in the First Affiliated Hospital of Guangzhou University of TCM from June, 1999 to June, 2005. The therapeutic effect of TCM-WM for PE was observed and compared with that of only western medicine （WM） for 6 groups of 145 patients with PE, which was reported in the published articles. WM regimen included embolysis treatment with urokinase and recombinant human tissue-type plasminogen activator （rt-PA）, and anticoagulant treatment with lowmolecular-weight heparin and warfarin. TCM regimen involved intravenous drip of ligustrazine and syndromedifferentiation treanlent （Modified Xuefu Zhuyu Decoction for blood-stasis stagnating chest, Shenfu Decoction for sudden loss of yang qi complicated with blood-stasis, Modified Qianjin Weijing Decoction and Taohong Siwu Decoction for phlegm blended with blood stasis）. The treatment course lasted for one month. [Results] Of 16 patients, 8 were cured, 5 effective, 1 ineffective （transferred to another hospital on a voluntary basis） and 2 dead, and the fatality rate was 12.5%, which did not differ from the total fatality rate （28.28%） in the reported 145 patients treated with only WM （ P 〉 0.05）. But in the reported 6 groups patients, the fatality rate in 5 groups was higher that in the 16 patients, and the difference （P 〈0.05） was significant between the 16 patients and the patients reported by Chen Lijuan （the fatality rate being 57.14%）. [Conclusion] The observation indicates that TCM-WM for PE is effective with lower fatality rate, less side effects. However, this conclusion should be further confirmed by a large sample-size study.