清热利湿活血解毒中药联合西药治疗腹型过敏性紫癜湿毒内蕴证75例临床观察

Clinical Observation on Decoction of Clearing Heat,Promoting Dieresis,Invigorating the Circulation of Blood and Removing Toxin Combined with Western Medicine in Treating 75 Patients with Abdominal Type Anaphylactoid Purpura with Syndrome of Damp Toxin Accu

目的 观察清热利湿活血解毒中药联合西药治疗腹型过敏性紫癜湿毒内蕴证的临床疗效。方法将111例腹型过敏性紫癜湿毒内蕴证患儿随机分为治疗组75例和对照组36例。对照组给予注射用甲泼尼龙琥珀酸钠2 mg/（kg·d）,每12 h静脉滴注1次,足量应用3~5天后,根据病情酌情减量;同时给予维生素C注射液,每日0.2 g,氨甲苯酸注射液,每日50 mg,均静脉滴注1次。治疗组在对照组的基础上给予口服清热利湿活血解毒中药汤剂,每日1剂。两组疗程均为2周。治疗前后对腹痛、便血、呕血、呕吐、纳呆、腹胀、皮肤紫癜、大便潜血及腹部B超进行评分,观察两组患儿腹痛消失时间,判定临床疗效。结果 治疗组临床疗效愈显率为85.4%,总有效率为96.0%;对照组分别为69.5%和94.5%,两组临床疗效比较差异有统计学意义（P〈0.05）,治疗组优于对照组。两组治疗后腹痛、纳呆、腹胀、皮肤紫癜、腹部B超评分及总积分均较本组治疗前降低（P〈0.05）,且治疗后治疗组腹痛、纳呆、腹部B超评分及总积分均低于对照组（P〈0.05）。两组患儿治疗后便血、呕血、呕吐症状均消失。治疗组腹痛消失时间早于对照组（P〈0.05）。结论 清热利湿活血解毒中药联合西药治疗腹型过敏性紫癜湿毒内蕴证临床疗效优于单纯西药治疗,可明显改善临床症状、体征,缩短腹痛消失时间。

Objective To observe therapeutic effects of decoction of clearing heat, promoting dieresis, invigorating the circulation of blood and removing toxin combined with western medicine on abdominal type anaphylactoid purpura with syndrome of damp toxin accumulating inside. Methods A total of 111 children with abdominal type anaphylactoid purpura of damp toxin accumulating syndrome were randomly divided into treatment group （75 cases） and control group （36 cases）. The control group was given intravenous drip with prednisolone sodium succinate, 2 rag/（ kg · d）, once every 12 h, and reduced the methylprednisolone according to state of illness after full dose for 3 5 days. At the same time the control group was given intravenous drip with vitamin C 0. 2 g and aminomethylbenzoic acid, 50 mg once a day. Additionally, the treatment group orally took decoction of clearing heat, promoting dieresis, invigorating the circulation of blood and removing toxin, 1 dose daily. Courses of treatment were 2 weeks, Before and after the treatment, respectively graded symptoms of abdominal pain, hemafecia, hematemesis, emesis, loss of appetite, abdominal distension, skin purpura and abdominal B ultrasonic and observed the time of abdominal pain disap- pearing in the two groups to evaluate clinical effects. Results In the treatment group, remarkably effective rate was 85.4% , total effective rate was 96.0%, while that was 69.5% and 94.5% respectively in the control group. The difference between both groups was statistically significant （P 〈 0. 05 ）. After treatment, scores of abdominal pain, loss of appetite, abdominal distension, skin purpura and abdominal B ultrasonic and aggregate score of both groups were lower than those before treatment （P 〈 0. 05 ）. After treatment, scores of abdominal pain, loss of appetite and abdominal B ultrasonic and aggregate score in the treatment group were lower than those in the control group （P 〈 0. 05 ）. After treatment, hemafecia, hematemesis, emesis disappeared in the two groups. In the treatment group, the time of abdominal pain disappearing was shorter than that in the control group （ P 〈 0. 05 ）. Conclusion The efficacy of clearing heat, promoting dieresis, invigorating the circulation of blood and removing toxin combined with western medicine for abdominal type anaphylactoid purpura with syndrome of damp toxin accumulating inside was superior to the treatment of only western medicine. It may obviously improve symptoms and signs and shorten the time of abdominal pain disappearing.