三阴固本方联合呼吸功能训练治疗慢性阻塞性肺疾病稳定期随机平行对照研究

Randomized Parallel Controlled Study of the Sanyin Guben Decoction(三阴固本方) combined with Respiratory Function Training in the Treatment of Chronic Obstructive Pulmonary Disease in Stable Phase

[目的]观察三阴固本方联合呼吸功能训练治疗慢性阻塞性肺疾病稳定期疗效。[方法]使用随机平行对照方法,将90例住院患者按就诊顺序号随机分三组。强力安喘通组(A)30例,强力安喘通,2粒/次,3次/d。三阴固本方+强力安喘通组(B):三阴固本方(蛤蚧1对[去眼珠],虫草花20g,紫石英、紫皮胡桃各30g,沉香、^(川)贝母各15g,五味子、山茱萸、枸杞子、白术、巴戟、熟地、甜杏仁、茯苓、白果仁^(炒)、半夏各25g,红参25g,黄芪炙、桑白皮、山药各50g,甘草20g。如畏寒肢冷,阳虚甚者,加肉桂20g,补骨脂25g,附片^(熟)15g)共研末,炼蜜为丸,3次/d,每次服含生药8~10g丸药1丸,强力安喘通胶囊治疗同对照组。三阴固本方+呼吸功能训练组(C):呼吸功能训练方法(缩唇呼吸+腹式呼吸+呼吸操练习)呼吸功能训练时间:每周一、周四上午由呼吸康复治疗师指导训练,其余时间自行训练;三阴固本方治疗同B组。连续治疗12周为1疗程。观测临床症状、6min步行试验(6MWT)、改良呼吸困难指数(m MRC)、体质量指数(BMI)、1秒用力呼气容积(FEV)_1)、用力肺活量(FVC)、日常生活活动能力评分(ADL)Barthel指数、不良反应。治疗1疗程(12周),判定疗效。[结果]改良呼吸困难指数(m MRC)、1秒用力呼气容积预计值(FEV_1pre)、日常生活活动能力评分(ADL)Barthel指数C组与A组差异显著(P<0.05),其他各项观察指标组间无显著差异(P>0.05)。1秒用力呼气容积(FEV_1)、FEV1%pre(预计值)、FEV_1/FVC(用力肺活量)C组均明显改善(P<0.05),其余两组无明显变化(P>0.05)。急性加重次数三阴固本方+呼吸功能训练组(C)明显少于强力安喘通组(A)(P<0.05),三阴固本方+强力安喘通组(B)与强力安喘通组(A)及三阴固本方+呼吸功能训练组(C)均无显著差异(P>0.05),[结论]三阴固本方联合呼吸功能训练治疗慢性阻塞性肺疾病稳定期,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the therapeutic effect of Sanyin Guben Decoction combined with respiratory function training on stable chronic obstructive pulmonary disease. [Methods] Using random parallel control method,90 hospitalized patients were randomly divided into three groups according to the order number. Group A compound methoxyphenamine capsules,2 grains/times,3 times/d. Group B Sanyin Guben decoction（1 pairs of gecko（remove the eye）,cordyceps flower 20 g,amethyst,purplish walnut each 30 g,agilawood,fritillaria sichuan each 15 g,schisandra,cornus officinalis,Chinese wolfberry,atractylodes,morinda officinalis,radix rehmanniae rehmanniae,sweet almond,poria cocos,gingko seed,pinellia ternate,each 25 g,red ginseng 25 g,radix astragali,mulberry bark,yam,each 50 g,licorice 20 g,if accompanied by aversion to cold and obvious Yang deficiency,add cinnamon 20 g,psoralen 25 g,cooked aconite 15 g）.The above drugs are grinded into powder,making pellets by mixing medical powder with honey,3 times/d,1 pills containing 8-10 g of Chinese medicine powder each time,and compound methoxyphenamine capsules in thetreatment of the same control group. C group training method of respiratory function（pursed lip breathing,abdominal breathing and breathing exercises）,training time of respiratory function： every monday and thursday morning,guided by respiratory rehabilitation therapist,self training for the rest of the time. The treatment of the Sanyin Guben decoction is the same as that of the B group. Observe clinical symptoms,exercise endurance,dyspnea severity,body mass index,airflow obstruction,ADL and adverse reactions. After 1 courses of treatment（12 weeks）,the curative effect was determined. [Results] The observation index and pulmonary function in the treatment group were better than those in the control group （P〈0.05）. [Conclusion] The Sanyin Guben decoction combined with respiratory function training is effective in the treatment of stable chronic obstructive pulmonary disease. There is no serious adverse reaction. It is worth promoting.