大黄麻黄方对COPD缓解期患者肺功能及血压节律的影响

Effects of Chinese rhubarb and ephedra prescription on pulmonary function and blood pressure rhythmin patients with chronic obstructive pulmonary disease in remission stage

目的 探讨大黄麻黄方对慢性阻塞性肺疾病（COPD）缓解期患者肺功能及血压节律的影响.方法 选择2014年3月至2016年12月哈励逊国际和平医院收治的COPD缓解期患者152例,按随机数字表法分为西医对照组72例和大黄麻黄组80例.西医对照组给予常规治疗,大黄麻黄组在西医常规治疗基础上加用大黄麻黄方（大黄6 g、麻黄5 g、仙鹤草15 g、甘草15 g）,水煎服,每日2次口服,疗程为3个月.于治疗前和治疗1、2、3个月后检测两组患者的血气分析指标、肺功能、6 min步行距离（6MWD）,并观察两组改良医学研究委员会（mMRC）呼吸困难问卷评分、动态血压水平的变化及临床疗效.结果 与治疗前比较,两组治疗后血气指标动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）和肺功能指标1秒用力呼气容积（FEV1）占预计值的百分比（FEV1%）、FEV1与用力肺活量的比值（FEV1/FVC）以及6MWD均持续升高,动脉血二氧化碳分压（PaCO2）和mMRC评分均持续降低,西医对照组治疗2个月时与治疗前比较出现统计学差异,大黄麻黄组治疗1个月时就出现统计学差异.治疗3个月后,大黄麻黄组PaO2、SaO2、FEV1%、FEV1/FVC、6MWD明显高于西医对照组〔PaO2（1 mmHg=0.133 kPa）：95.42±14.88比88.28±13.38,SaO2：0.97±0.02比0.96±0.02, FEV1%：77.35±11.57比72.63±10.66,FEV1/FVC（%）：71.01±9.47比69.28±10.04,6MWD（m）：318.0±40.1比306.6±35.7〕,PaCO2、mMRC明显低于西医对照组〔PaCO2（mmHg）：40.35±7.58比43.57±7.85,mMRC评分（分）：1.09±0.65比1.23±0.69〕,两组各指标比较差异均有统计学意义（均P〈0.05）.治疗3个月后,西医对照组血压异常节律型患者降为44.4%（32/72）,大黄麻黄组降为32.5%（26/72）,大黄麻黄组治疗后降幅大于西医对照组,但两组比较差异无统计学意义（P〉0.05）.大黄麻黄组出现血压晨峰值的患者比例明显低于西医对照组〔23.8%（19/80）比73.6%（53/72）,P〈0.05〕,大黄麻黄组总有效率明显高于西医对照组〔92.5%（74/80）比73.6%（53/72）,P〈0.05〕.结论 大黄麻黄方对COPD缓解期患者血气分析、肺功能和血压节律有明显的改善作用,且疗效显著.

Objective To investigate the effect of Chinese rhubarb and ephedra prescription on the pulmonary function and blood pressure rhythm in patients with chronic obstructive pulmonary disease （COPD） in remission stage. Methods One hundred and fifty-two patients with COPD were admitted to Harrison International Peace Hospital from March 2014 to December 2016, and they were divided into a western medicine control group （72 cases） and a rhubarb and ephedra prescription group （80 cases） by random number table method, the conventional therapy was given to both groups, and in the rhubarb and ephedra group, additionally Chinese rhubarb and ephedra prescription （rhubarb 6 g, ephedra 5 g, agrimony 15 g, licorice 15 g） was applied, one dose orally taken daily, once 1/2 dose, 2 times a day, the therapeutic course being 3 months. The blood gas analysis, pulmonary function, 6-minute walking distance （6MWD） were detected, and modify medical research committee （mMRC） questionnaire for dyspnea score, the change of ambulatory blood pressure level monitoring and clinical effect were observed before and after treatment for 1, 2, 3 months. Results Compared with those before treatment, the blood gas indexes, the arterial partial pressure of oxygen （PaO2）, arterial blood oxygen saturation （SaO2）, and pulmonary function indexes, the percentage of one second forced expiratory volume （FEV1） in predictive value （FEV1%）, the ratio of FEV1/forced vital capacity （FEV1/FVC） and 6MWD levels in both groups were continuously increased after treatment, while the arterial partial pressure of carbon dioxide （PaCO2） and mMRC score were persistently decreased after treatment in the two groups. After treatment for 2 months, compared with before treatment, the statistical differences appeared in the western medicine control group, while in the rhubarb and ephedra group, the statistical differences turned up after 1 month of treatment. After 3 months of treatment,the PaO2, SaO2, FEV1%, FEV1/FVC and 6MWD in the rhubarb and ephedra group were significantly higher than those in the western medicine control group [PaO2（mmHg, 1 mmHg = 0.133 kPa）： 95.42±14.88 vs. 88.28±13.38, SaO2：0.97±0.02 vs. 0.96±0.02, FEV1%： 77.35±11.57 vs. 72.63±10.66, FEV1/FVC （%）： 71.01±9.47 vs. 69.28±10.04, 6MWD （m）： 318.0±40.1 vs. 306.6±35.7], PaCO2and mMRC were obviously lower in the rhubarb and ephedra group than those in the western medicine control group [PaCO2（mmHg）： 40.35±7.58 vs. 43.57±7.85, mMRC score： 1.09±0.65 vs. 1.23±0.69], the differences of the two groups were statistically significant （all P 〈 0.05）. After 3 months of treatment, in the western medicine control group, the percentage of patients with abnormal blood pressure rhythm was reduced to 44.4% （32/72）, while in the rhubarb and ephedra group, was decreased to 32.5% （26/72）, and the decrease amplitude of the rhubarb and ephedra group was greater than that of the western medicine control group （P 〉 0.05）. The ratio of blood pressure morning peak in the rhubarb and ephedra group was significantly lower than that in the western medicine control group [23.8% （19/80） vs. 31.9% （23/72）, P 〈 0.05], and the total effective rate in rhubarb and ephedra group was significantly higher than that in the western medicine control group [92.5% （74/80） vs. 73.6% （53/72）, P 〈 0.05]. Conclusion Chinese rhubarb and ephedra prescription can improve indexes of blood gas analysis, pulmonary function and blood pressure rhythm in COPD patients in remission phase, and its clinical efficacy is significant.