加味大承气汤改善慢性阻塞性肺疾病急性加重期肺热腑实证患者炎性反应的研究

Clinical Study of Dachengqi Decoction Improving AECOPD Inflammatory Response

目的:在观察通里攻下加味大承气汤对于慢性阻塞性肺疾病急性加重期肺热腑实证患者临床疗效及炎性指标影响的基础上,探讨其临床作用,为治疗提供实践依据。方法:60例慢性阻塞性肺疾病急性加重期肺热腑实证患者按随机表法分为治疗组(传统抗炎解痉平喘等治疗+加味大承气汤)和对照组(传统抗炎解痉平喘等治疗),分别于治疗前及治疗后第3,6,9天测定体温、白细胞计数、中性粒细胞百分比、CRP以及测定治疗前及治疗后第9天两组患者PCT值,并比较两组患者的主要症状、体征、临床疗效及两组患者抗生素使用天数。结果:(1)治疗组与对照组疗效比较:治疗组控显率为70.00%,总有效率为100%,对照组控显率为40%,总有效率为100%。两组间比较总有效率无显著性差异(P>0.05),说明治疗组与对照组的临床总疗效相当,但治疗组控显率明显高于对照组,且治疗组患者大便改善情况明显优于对照组。(2)治疗组与对照组炎症反应指标比较:在白细胞计数、中性粒细胞百分比、CRP及PCT等炎性指标方面及在体温下降方面,两组治疗后均比治疗前得到明显好转(P<0.05),且治疗组优于对照组(P<0.05)。(3)治疗组与对照组抗生素使用天数比较:治疗组抗生素使用天数明显低于对照组(P<0.05)。结论:中药加味大承气汤可以明显改善慢性阻塞性肺疾病急性加重期肺热腑实证患者的临床症状,减轻炎症反应,减少抗生素使用天数,对慢性阻塞性肺疾病急性加重期肺热腑实证的治疗具有积极的探索意义。

Objective ： On the basis of the observation on clinical effects of the method of purging to relax the bowels treating patients with AECOPD as well as the influence of indicators of inflammation, this study was designed to make a thorough inquiry into therapeutic action of Dachengqi treatment on AECOPD. Methods：60 inpatients who were diagnosed the accumulation of lung heat in accordance with the criterion of AECOPD syndrome were collected and divided into treating group（ traditional anti-inflam- matory, antispasmodic and anti-asthma ＋ Dachengqi Decoction） and contrast group （ traditional anti-inflammatory, antispasmodic and anti-asthma） at random. Before and after therapy, the indicators including body temperature, the number of leukocyte, the per- centage of neutrophils,C-reaction protein（CRP） ,procalcitonin（PCT） and the days of antibiotic use were observed. The course of the treatment was nine days. Results： （ 1 ） Comparison of effects between treating group and contrast group：21 cases in treating group improved markedly, accounting for 70%. The total effective rate was 100%. In contrast group, the total effective rate was 100%. There was no significant difference（P 〉 0.05 ） between treating group and contrast group in ratio of efficiency. But there was significant difference（P 〈0.05） between treating group and contrast group in ratio of the control and markedly efficiency. Compared with treating group and contrast group, the constipation was improved better. （2） Comparison of the changes of the number of leukocyte, CRP, PCT, the percentage of neutrophils, and the days of antibiotic use and body ttemperature between trea- ting group and contrast group before and after treatment ： Compared with six indicators in treating group before and after treatment, there was distinctive improvement（ P 〈 0.05 ）. The therapeutic group applying the therapy of Dachengqi decoction of the method of Purging to relax the bowels of TCM combined with basal treatment of modem-western medicine showed greater improvements and therapeutic effects than those of the contrast group. （3） Comparison of changes in the days of antibiotic use between treating group and contrast group ：The days of antibiotic use in treating group was significantly shorter than the control group＇ s. Conclusion：The therapeutic group applying the therapy of Dachengqi decoction of the method of purging to relax the bowels of TCM combined with basal treatment of modem-western medicine shows better improvements and therapeutic effects than those of the control group. The clinic symptom,sign,inflammatory response and the days of the use of antibiotics can be significantly improved with Dachengqi Decoction in patients with AECOPD. More and more it has been applied into clinical practice.