健脾益气中药干预肺结核细胞免疫失衡及护理干预的研究

Study of Jianpi Yiqi traditional Chinese medicine intervention on tuberculosis immune imbalance and nursing intervention

目的探讨健脾益气中药治疗老年肺结核患者细胞免疫功能的影响及护理干预效果。方法选择解放军第三。几医院2009年1月～2012年1月门诊及住院部收治的老年肺结核患者100例，随机分为两组，每组50例，对照组采用抗痨化疗方案基础上（2HREZ／4HR），实验组在基础化疗方案基础上加用益气健脾中药治疗，两组共治疗6个月，分别在治疗前后采空腹静脉血检测外周血中T淋巴细胞亚群CD3、CD4和CD8，以痰涂片法及治疗前后胸部X线改变考核疗效。结果两组患者治疗后4、6个月CD3＋细胞百分比与治疗前比较差异均有统计学意义（P〈0．05）；实验组治疗后6个月CD3＋细胞百分比为（70．89±5．68）％，与对照组[（67．88±8．52）％]比较差异有统计学意义（t=4．699，P〈0．05）；实验组患者治疗后4、6个月CD4＋细胞百分比[（37．56±6．42）％、（39．26±8．87）％]，与对照组[（35．56±7.46）％、（37．16±7．69）％]比较差异有统计学意义（t=2．957、3．016，均P〈0．05）；实验组治疗2、4、6个月后CD47CD8＋比值与治疗前比较，差异均有统计学意义（P〈0．05）；与对照组治疗2、4、6个月后的CD4＋／CD8’比值分别为（1．63±0．57）、（1．65±0．55）、（1．63t0．64），与对照组[（1．42±0．51）、（1．43±0．47）、（1．48±0．58）]比较差异有统计学意义（t=2．747、2．764、2．032，均P〈0．05）；实验组治疗与护理干预后再咳血、服药依从性及规律生活情况明显优于对照组，差异有统计学意义（P〈0．05）。结论益气健脾中药能显著提高肺结核患者细胞免疫水平；应用综合护理早期对肺结核患者实施干预能有效提高患者的治疗依从性，改善其认知及行为，提高患者的生存质量，值得临床推广使用。

Objective To investigate the influence of Jianpi Yiqi traditional Chinese medicine （TCM） treatment on cellular immune function of elderly tuberculosis patients and analyze the nursing intervention effect. Methods 100 cases of outpatient and inpatient elderly tuberculosis patients in the 309th Hopital of PLA from January 2009 to January 2012 were chosen, all patients were randomly divided into two groups, with 50 cases in each group, patients in the control group were treated with base anti-tuberculosis chemotherapy （2HREZ/4HR）, the experimental group was given Jianpi Yiqi TCM treatment on basis of control group, the two groups were all treated for six months, before and after treatment, the fasting venous blood was taken for detection of peripheral blood T lymphocytes subsets CD3, CD4 and CDS, sputum smear and chest X-ray were used to assess treatment efficacy. Results 4, 6 months after treatment, the percentage of CD3＋ cells of two groups were significantly different compared with that before treatment （P 〈 0.05）; 6 months after treatment, the percentage of CD3＋ cells between experimental group [（70.89±5.68）%] and control group [（67.88±8.52）%] was significantly different （t = 4.699, P 〈 0.05）; 4, 6 months after treatment, percentage of CD4＋ cell of experimental group [（37.56±6.42）%, （39.26±8.87）%] and control group [（35.56±7.46）%, （37.16±7.69）%] were significantly different （t = 2.957, 3.016, all P 〈 0.05）; 2, 4, 6 months after treatment, CD4＋/CD8＋ ratio of experimental group were （1.63±0.57）, （1.65±0.55）, （1.63±0.64）, these were significant different compared with that before treatment （P 〈 0.05）, and compared with control group [（1.42±0.51）, （1.43±0.47）, （1.48±0.58）], the differences were statistical- ly significant （t = 2.747, 2.764, 2.032, all P 〈 0.05）; after treatment and care intervention, the hemoptysis, medication compli- ance and life law of experimental group were significantly better than those of the control group, and the differences were sta- tistically significant （P 〈 0.05）. Conclusion Jianpi Yiqi TCM treatment can significantly improve the level of cellular immunity in patients with pulmonary tuberculosis; early integrated intervention can improve compliance, cognition and behavior, and also improve the patient＇s quality of life, it is worthy of promotion in clinic.