温阳化痰汤对慢性阻塞性肺疾病急性加重合并肺源性心脏病（痰湿阳虚证）的临床研究

Clinical Study of Wenyang Huatan Decoction on AECOPD Combined with Pulmonary Heart Disease (Syndrome of Phlegm-dampness-yang Deficiency)

目的观察温阳化痰汤对慢性阻塞性肺疾病急性加重(AECOPD)合并肺源性心脏病(痰湿阳虚证)患者C反应蛋白(CRP)、D二聚体(D-Di)、B型脑利钠肽(BNP)、血气分析等指标及临床疗效的影响。方法 76例AECOPD合并肺源性心脏病(痰湿阳虚证)患者随机分为两组,对照组给予西医基础综合治疗,治疗组在对照组的基础上给予中药温阳化痰汤治疗,两组治疗直到"AECOPD危险窗"出现。比较两组的临床疗效,以及治疗前后CRP、D-Di、BNP、氧合指数、二氧化碳分压(PaCO2)、进入AECOPD危险窗天数以及临床症状、COPD评估测试(CAT)评分情况。结果治疗组显效率为78.94%,高于对照组的55.26%(P <0.05);治疗组进入AECO-PD危险窗时间较对照组短(P <0.05);治疗进入AECOPD危险窗后,治疗组的CRP、D-Di、NT-BNP较治疗前显著改善(P <0.05),与对照组治疗后相比,差异有统计学意义(P <0.05);治疗组治疗后咯痰气急积分以及CAT积分明显优于对照组(P <0.05),咯痰积分组间差异无统计学意义(P> 0.05)。结论温阳化痰汤对AECOPD合并肺源性心脏病(痰湿阳虚证)患者疗效明显,可以缩短急性期天数,改善患者的症状,提高氧合水平,降低BNP、CRP、D-Di等因子水平。

Objective:To observe the effect of Wenyang Huatan Decoction on CRP,D-Di,BNP and blood gas analysis in patients with AECOPD complicated with pulmonary heart disease(phlegm-dampness-yang deficiency syndrome). Methods:76 patients were randomly divided into 2 groups,38 cases in each. The control group was treated with basic comprehensive treatment of Western medicine,while the treatment group was treated with Wenyang Huatan Decoction on the basis of the control group. The two groups were treated until "AECOPD risk window" appeared. The clinical efficacy,CRP,D-Di,BNP,oxygenation index,PaCO2,days of entering AECOPD risk window,clinical symptoms and CT scores were compared between the two groups before and after treatment. Results:The marked efficiency of the treatment group was 78.94%,which was higher than that of the control group(55.26%)(P < 0.05). The time of entering AECOPD risk window in the treatment group was shorter than that in the control group(P < 0.05);after it,CRP,D-Di and NT-BNP in the treatment group were significantly improved compared with those before treatment(P < 0.05),and there was significant difference between groups(P < 0.05). After treatment,the scores of sputum expectoration and CAT in the treatment group were significantly better than those in the control group(P < 0.05). There was no significant difference in the scores of sputum expectoration between the two groups(P > 0.05). Conclusion:Wenyang Huatan Decoction has obvious curative effect on AECOPD patients with pulmonary heart disease(phlegm-dampness-yang deficiency syndrome). It can shorten the days of acute phase,improve the symptoms of patients,increase the level of oxygenation,and reduce the levels of BNP,CRP,D-Di and other factors.