针灸、中药联合康复治疗尘肺病的临床随机对照研究

Clinical Randomized Controlled Study on Acupuncture, Herbs and Rehabilitation Treatment for Pneumoconiosis

目的:观察针灸、中药、康复等综合措施治疗尘肺病的临床疗效。方法:将150例尘肺病患者随机分为针刺组、中药组、康复组、综合组及对照组,每组30例。针刺组:取肺俞、膈俞、心俞、中府,加辨证取穴,肺燥津亏加太溪、太渊;痰浊壅肺加天突、膻中、尺泽;痰热郁肺加丰隆、合谷、列缺;肺肾气虚加肾俞、膏肓。中药组:1期尘肺用四君子汤,2期用四君子汤加二陈汤,3期在2期的基础上加水蛭、丹参等活血化瘀药物。康复组:以呼吸功能训炼和有氧训练为主。综合组:在针灸治疗的同时,配合中药和康复治疗。对照组:不做任何治疗。以上治疗除中药组每日2次,每次服用250 mL外,其他各组每日治疗1次,10次1个疗程,疗程间休息3天,治疗6个疗程后观察疗效。对各组患者治疗后的肺功能、临床症状、血氧饱和度、6分钟步行测试及血清铜蓝蛋白相对含量进行统计学分析。结果:肺功能,综合组用力肺活量(FVC)、第1秒时间肺活量(FEV1.0)、1秒率(FEV1/FVC)显著高于对照组(P<0.05),针刺组、中药组、康复组变化不大(P>0.05)。总有效率针刺组、中药组、综合组高于康复组(P<0.05)。血氧饱和度、6分钟步行距离、血清铜蓝蛋白相对含量等指标综合组、针刺组、中药组均优于较对照组(P<0.05),康复组变化不大(P>0.05)。结论:针刺、中药对尘肺病疗效肯定,但综合治疗疗效优于任何单纯治疗者。

Objective：To observe curative effects of acupuncture, herbs and rehabilitation therapy in treating pneumoconiosis. Methods： All 150 patients were randomized into acupuncture group, herb group, rehabilitation group, comprehensive group and the control group, 30 cases each group. The acupuncture group： FeiShu （BL13）, GeShu （BL17）, XinShu （BL15） and ZhongFu （LU1） were selected, other points were chosen according to syndrome differentiation, added TaiXi （KI3） and TaiYuan （LU9） when the patients were of pulmonary dryness and fluid defi-ciency pattern;added TianTu （RN22）, TanZhong （RN17） and ChiZe （LU5） when the patients were of lung accumu-lating phlegm turbidity pattern;FengLong （ST40）, HeGu （LI4） and LieQue （LU7） were supplemented when they were of phlegm heat stagnating in the lung pattern;ShenShu （BL23） and GaoHuang （BL43） were added when they were of Qi deficiency of lung and kidney pattern. Herb group：the patients suffering from pneumoconiosis at stage one took SiJunZi Tang, the patients with pneumoconiosis at stage two were administered with SiJunZi Tang and ErChen Tang, the patients with pneumoconiosis at stage three were given with the drugs of activating blood and e-liminating stagnation such as ShuiZhi （Leech）, DanShen （salvia miltiorrhiza Bunge） and others. Rehabilitation group：mainly training of respiratory function and aerobic training. Comprehensive group：acupuncture, herbs and rehabili-tation treatment. The control group：unhandled. Except herb group twice per day, 250mL each time, other groups once per day, ten times were one course of the treatment, the interval was three days, the data was counted after treating six courses of the treatment. Pulmonary function, clinical symptom, blood oxygen saturation degree, walking test in six minutes and relative contents of ceruloplasmin were statistically analyzed. Results：Pulmonary function, forced vital capacity （FVC） of comprehensive group, forced expiratory volume in the first second （FEV1.0） and one second rate （FEV1/FVC） were obviously higher than these of the control group （P〈0.05）, these parameters of acupuncture group, herb group and rehabilitation group were changed slightly （P〉0.05）. Total effective rates of acupuncture group, herb group and comprehensive group were higher than that of the rehabilitation group （P〈0.05）. Comprehensive group, acupuncture group and herb group were superior to the control group in blood oxygen satura-tion degree, walking test in six minutes and relative contents of ceruloplasmin （P〈0.05）, the changes of the rehabili-tation group were subtle （P〉0.05）. Conclusion：Acupuncture and herbs are definite in treating pneumoconiosis, but clinical effects of comprehensive treatment are superior to these of any of single therapy.