中医临床路径治疗急性上呼吸道感染628例临床观察

Clinical Observation of 628 Patients with Acute Upper Respiratory Infection Treated According to Chinese Medicine Clinical Pathway

目的观察中医临床路径治疗急性上呼吸道感染的临床疗效。方法按中医外感发热的辨证标准将该病分为风寒束表证、风热犯表证、暑湿袭表证、卫气同病证、热毒袭肺证5个证型,予中医临床路径协定方治疗,观察患者治疗4 h、24 h、72 h时发热、头痛、咽痛、全身酸痛、咳嗽改善情况。结果完成观察628例,其中风寒束表证102例、风热犯表证208例、卫气同病证217例、暑湿袭表证78例、热毒袭肺证23例。72 h痊愈485例,5例恶化转为肺炎。4 h、24 h、72 h退热有效率分别为46.66%、54.45%、93.47%。卫气同病证24 h退热有效率高于4 h(P<0.05),其他证型72 h退热有效率高于24 h(P<0.05)。卫气同病证4 h、24 h退热有效率优于风寒束表证、风热犯表证(P<0.01),前者24 h退热有效率亦高于暑湿袭表证(P<0.05)。4 h、24 h、72 h头痛、咽痛、全身酸痛治疗有效率分别为37.90%、66.08%、82.32%。风寒束表证、风热犯表证、暑湿袭表证及卫气同病证各症状24 h治疗有效率优于4 h(P<0.05),风寒束表证、风热犯表证、卫气同病证及热毒袭肺证各症状72 h治疗有效率优于24 h(P<0.05)。卫气同病证各症状4 h有效率44.24%高于风热犯表证33.65%(P<0.05)。4 h、24 h、72 h咳嗽治疗有效率分别为34.55%、59.71%、73.73%。风寒束表证、风热犯表证、暑湿袭表证及卫气同病证咳嗽24 h治疗有效率高于4 h(P<0.05)。风寒束表证、风热犯表证及卫气同病证咳嗽72 h治疗有效率高于24 h(P<0.05)。结论中医临床路径治疗急性上呼吸道感染疗效确切。

Objective To observe the clinical efficacy of the therapy according to Chinese medicine clinical pathway in the treatment of acute upper respiratory infection. Methods The syndromes of the disease were divided into syndrome of superficies tightened by wind-cold,syndrome of superficies attacked by wind-heat,syndrome of superficies attacked by summer-heat-dampness,syndrome of Weifen and Qifen,and syndrome of heat-toxicity blocking lung according to standards of syndrome differentiation of fever caused by exogenous pathogens. The patients were given prescriptions specified in the Chinese medicine clinical pathway. The improvements of fever,headache,sore throat,general sour pain and cough were observed at the 4 th hour,24 th hour and 72 nd hour of treatment. Results Six hundred and twenty-eight patients had finished the observation. There were 102 patients with syndrome of superficies tightened by wind-cold,208 patients with syndrome of superficies attacked by wind-heat,217 patients with syndrome of disease involving Weifen and Qifen,78 patients with syndrome of superficies attacked by summer-heatdampness,and 23 patients with syndrome of heat-toxicity blocking lung. There were 485 patients recovering in 72 hours and 5 patients deteriorating into pneumonia in 72 hours. The effective rates of antipyretic action were 46. 66%,54. 45% and 93. 47% in 4 hours,24 hours and 72 hours,respectively. The effective rate of antipyretic action in 24 hours in patients with syndrome of disease involving Weifen and Qifen was higher than that in 4 hours（ P 0. 05）.The effective rates of antipyretic action in 72 hours in patients with the other syndromes were higher than those in 24 hours（ P 0. 05）. The effective rates of antipyretic action in 4 hours and in 24 hours in patients with syndrome of disease involving Weifen and Qifen were higher than those in patients with syndrome of superficies tightened by windcold and patients with syndrome of superficies attacked by wind-heat（ P 0. 01）. The effective rate of antipyretic action in 24 hours in patients with syndrome of disease involving Weifen and Qifen was also higher than that in patients with syndrome of superficies attacked by summer-heat-dampness（ P 0. 05）. The effective rates of headache,sore throat and general sour pain at the 4 th hour,24 th hour and 72 nd hour of treatment were 37. 90%,66. 08% and82. 32%,respectively. The effective rates of all the above symptoms in patients with syndrome of superficies tightened by wind-cold,syndrome of superficies attacked by wind-heat,syndrome of superficies attacked by summer-heat-dampness and syndrome of disease involving Weifen and Qifen at the 24 th hour of treatment were higher than those at the4 th hour of treatment（ P 0. 05）. The effective rates of all the above symptoms in patients with syndrome of superficies tightened by wind-cold,syndrome of superficies attacked by wind-heat,syndrome of disease involving Weifen and Qifen and syndrome of heat-toxicity blocking lung at the 72 nd hour of treatment were higher than those at the 24 th hour of treatment（ P 0. 05）. The effective rate of all the above symptoms in patients with syndrome of disease involving Weifen and Qifen at the 4 th hour of treatment was 44. 24% and the rate in patients with syndrome of superficies attacked by wind-heat at the 4 th hour of treatment was 33. 65%. The rate in patients with syndrome of disease involving Weifen and Qifen at the 4 th hour of treatment was higher than that in patients with syndrome of superficies attacked by wind-heat（ P 0. 05）. The effective rates of cough at the 4 th hour,24 th hour and 72 nd hour of treatment were 34. 55%,59. 71% and 73. 73%,respectively. The effective rates of cough in patients with syndrome of superficies tightened by wind-cold,syndrome of superficies attacked by wind-heat,syndrome of superficies attacked by summer-heat-dampness and syndrome of disease involving Weifen and Qifen at the 24 th hour of treatment were higher than those at the 4 th hour of treatment（ P 0. 05）. The effective rates of cough in patients with syndrome of superficies tightened by wind-cold,syndrome of superficies attacked by wind-heat and syndrome of disease involving Weifen and Qifen at the 72 nd hour of treatment were higher than those at the 24 th hour of treatment（ P 0. 05）. Conclusion Therapy based on Chinese medicine clinical pathway seems to have definite curative effect in the treatment of acute upper respiratory infection.