麻杏石甘汤+中医定向透药联合西药治疗小儿肺炎(风热犯肺)随机平行对照研究

Randomized Parallel Controlled Study of Maxing Shigan Decoction plus Chinese Medicine Directional Penetration combined with Western Medicine in the Treatment of infantile pneumonia(Fengre Fanfei)

[目的]观察麻杏石甘汤+中医定向透药联合西药治疗小儿肺炎(风热犯肺)疗效。[方法]使用随机平行对照方法,将80例住院患者病志号抽签随机分为两组。对照组40例利巴韦林10mg/kg·d-1,阿奇霉素10mg/kg·d-1+5%葡萄糖250mL,1次/d,静滴。治疗组40例麻杏石甘汤、中医定向透药。麻杏石甘汤(麻黄、甘草各6g,杏仁9g,生石膏18g),1剂/d,水煎200mL,2次/d,早晚温服,<3岁:每三天1剂,3~6岁:每两天1剂,>6岁:1剂/d,肺热重、壮热汗出增加生石膏剂量,加黄芪、桑白皮各6g;痰多气急加枇杷叶、紫菀、葶苈子各6g;无汗恶寒减少石膏剂量,加薄荷、紫苏叶、鲜芦根。中医定向透药选麻黄、杏仁、生石膏、川贝母、金银花等,研碎加蜂蜜、鲜姜汁调制成膏状,密封保存,取4g药膏敷于肺俞,并采用中医定向透药仪治疗,30min/次,2次/d;西药治疗同对照组。连续治疗10d为1疗程。观测临床表现、退热时间、咳嗽消失时间、啰音消失时间、中医证候积分、TNF-α、IL-6、RAGE、不良反应。治疗1疗程(10d),判定疗效。[结果]治疗组显效20例,有效18例,无效2例,总有效率95.00%;对照组显效13例,有效17例,无效10例,总有效率75.00%;治疗组疗效优于对照组(P<0.05)。退热时间、咳嗽消失时间、啰音消失时间治疗组优于对照组(P<0.01)。中医证候积分、TNF-α、IL-6、RAGE两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]麻杏石甘汤+中医定向透药联合西药治疗小儿肺炎(风热犯肺),疗效满意,无严重不良反应,值得推广。

[Objective] To observe the curative effect of Maxing Shigan decoction plus Chinese medicine directional penetration combined with western medicine on infantile pneumonia(Fengre Fanfei).[Method]80 inpatients were randomly divided into two groups by drawing lots on their disease signs. The control group consisted of 40 cases of ribavirin 10 mg/kg·d-1, azithromycin 10 mg/kg·d-1+5% glucose 250 mL, once a day, intravenous drip. The treatment group consisted of 40 cases of Maxing Shigan decoction and directional Chinese medicine penetration. Maxing shigan decoction(Mahuang,Gancao each 6 g, Xingren 9 g, Shengshigao18 g), 1 dose/day, water decoction 200 mL, twice a day, morning and evening warm clothes,<3 years old:every three days 1 dose, 3~6 years old: every two days 1 dose,>6 years old: 1 dose/day, lung heat, strong heat sweating, increase the dose of gypsum, add Huangqi, Sangbaipi each 6 g;excessive phlegm add Pipaye,Ziwan, Tinglizi each 6 g;aversion to cold reduceShigao, add Bohe, Zisuye, Xianlugen. Mahuang, Xingren,Shengshigao, Chuanbeimu, Jinyinhua and so on were selected for directional penetration of traditional Chinese medicine. They were crushed and mixed with honey and ginger juice to form a paste, sealed and preserved.4 g ointment was applied to the lungs and treated with directional penetration apparatus of traditional Chinese medicine for 30 minutes, twice a day. Western medicine was the same as the control group. Continuous treatment for 10 days is a course of treatment. Clinical manifestations, antipyretic time, cough disappearance time, rale disappearance time, TCM syndrome score, TNF-alpha, IL-6, RAGE and adverse reactions were observed. One course of treatment(10 days) was used to determine the curative effect.[Result] In the treatment group, 20 cases were markedly effective, 18 cases were effective, 2 cases were ineffective, and the total effective rate was 95.00%. In the control group, 13 cases were markedly effective, 17 cases were effective and 10 cases were ineffective, the total effective rate was 75.00%. The curative effect of the treatment group was better than that of the control group(P<0.05). The antipyretic time, cough disappearance time and rale disappearance time in the treatment group were better than those in the control group(P<0.01). TCM syndrome score, TNF-α, IL-6 and RAGE were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01).[Conclusion] Maxing Shigan decoction plus directional traditional Chinese medicine combined with western medicine in the treatment of pediatric pneumonia(Fengre Fanfei) has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.