汉防己甲素联合乙酰半胱氨酸泡腾片治疗矽肺的疗效观察

Curative effect observation on tetrandrine combined with acetylcysteine effervescent tablet in treatment of silicosis

目的观察汉防己甲素联合乙酰半胱氨酸泡腾片治疗矽肺的临床疗效。方法 2012年3月—2015年3月,选取在开滦职业病防治院接受住院的矽肺患者2 400例,随机分为观察组和对照组,每组1 200例。对照组给予消咳喘、盐酸氨溴索葡萄糖注射液进行常规消炎、止咳、平喘治疗;观察组在此基础上给予汉防己甲素联合乙酰半胱氨酸泡腾片进行治疗,其中汉防己甲素口服100 mg/次,2次/d,3个月为1疗程,服用2个疗程;乙酰半胱氨酸泡腾片口服600 mg/次,2次/d,12 d为1疗程,服用4个疗程。观察两组患者治疗前后的临床症状、肺通气功能、血清中超氧化歧化酶(SOD)、细胞免疫指标(CD4+、CD8+、CD4+/CD8+)、胸部X线片的变化以及不良反应情况。结果治疗后,观察组患者咳嗽、咳痰、胸闷等临床症状较治疗前明显改善,且优于对照组,差异均有统计学意义(P<0.05);观察组的用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气量占用力肺活量比值(FEV1/FVC)较治疗前明显改善,优于对照组,差异均有统计学意义(均P<0.05);观察组的SOD、细胞免疫指标较治疗前均明显改善,均优于对照组,差异均有统计学意义(P<0.05);观察组患者的胸部X线片明显优于对照组,差异有统计学意义(P<0.05);观察组患者的不良反应情况少,通过临床干预即可改善。结论汉防己甲素联合乙酰半胱氨酸泡腾片治疗矽肺能够有效改善患者的临床症状、肺通气功能、血气分析指标和细胞免疫能力,无明显不良反应,临床效果明显,值得临床推广使用。

[Objective] To observe the clinical effects of tetrandrine combined with acetylcysteine effervescent tablet in treatment of silicosis. [Methods]2400 patients with silicosis,who were treated in Kailuan Hospital of Occupational Disease Prevention and Treatment from March 2012 to March 2015,were randomly divided into the observation group and the control group,1200 cases in each group. The control group was given the conventional therapy of diminish inflammation anti inflammation,relieving cough and asthma with Xiaokechuan and ambroxol hydrochloride and glucose injection. On the basis of conventional therapy,the observation group was treated with tetrandrine combined with acetylcysteine effervescent tablet. The patients were given 100 mg tetrandrine and 600 mg acetylcysteine effervescent tablet orally,twice a day,and 3 months was 1 course for tetrandrine,taking2 courses,while 12 days was 1 course for acetylcysteine effervescent tablet,taking 4 courses. The clinical symptoms,pulmonary ventilation function,super oxide dismutase（SOD）in serum,cellular immune index（CD4＋,CD8＋,CD4＋/CD8＋）,chest X ray film changes and adverse reactions in two groups were observed before and after treatment. [Results]After treatment,the clinical symptoms of cough,sputum and chest tightness in the observation group improved significantly,while the improvement in the observation group was higher than that in the control group,and the differences were statistically significant（P〈0.05）. In the observation group,the forced vital capacity（FVC）,forced expiratory volume in 1 second（FEV1） and forced expiratory volume accounts for 1 second（FEV1/FVC）after treatment improved as compared with those before treatment,while the improvement in the observation group was higher than that in the control group,and the differences were statistically significant（P〈0.05）. The levels of SOD and cellular immune indexes in the observation group after treatment improved as compared with those before treatment,while the improvement in the observation group was higher than that in the control group,and the differences were statistically significant（P〈0.05）. The chest X-ray result in the observation group was better than that in the control group,and the difference was statistically significant（P〈0.05）. The patients in the observation group had less adverse reactions,which could be improved by clinical interventions. [Conclusion]Tetrandrine combined with acetylcysteine effervescent tablet can effectively improve the patient＇s clinical symptoms,pulmonary ventilation function,blood gas analysis index and cell immunity,without obvious adverse reactions,and the clinical effect is obvious,which is worthy of clinical popularization and application.