清肺活血化痰方治疗痰瘀互结型慢性阻塞性肺疾病急性加重期临床观察

Clinical observation on Qingfei Huoxue Huatan recipe in the treatment of acute exacerbation of chronic obstructive pulmonary disease with phlegm and blood stasis syndrome

目的观察清肺活血化痰方治疗痰瘀互结型慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法将60例痰瘀互结型AECOPD患者按照随机数字表法分为2组。对照组30例予西医常规治疗;治疗组30例在对照组治疗基础上加用清肺活血化痰方。2组疗程均为14 d。比较2组治疗前后临床症状、体征积分变化;观察2组治疗前后肺功能指标第1 s用力呼气容积占预计值百分比(FEV1%)、用力肺活量(FVC)、FEV1/FVC变化;观察2组治疗前后动脉血气指标氧分压[p(O2)]、二氧化碳分压[p(CO2)]及白细胞介素17(IL-17)、D-二聚体(D-D)变化;比较2组疗效。结果 2组治疗后咳嗽、咯痰、喘息、肺部啰音积分均较本组治疗前降低(P<0.05),且治疗组治疗后咳嗽、喘息积分均低于对照组(P<0.05)。2组治疗后FEV1%、FVC、FEV1/FVC均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。2组治疗后p(O2)较本组治疗前升高(P<0.05),p(CO2)较本组治疗前降低(P<0.05),且治疗组治疗后p(O2)高于对照组(P<0.05),p(CO2)低于对照组(P<0.05)。治疗组治疗后IL-17、D-D均较本组治疗前降低,对照组治疗后D-D较治疗前降低(P<0.05),IL-17则无明显变化(P>0.05),但治疗后IL-17、D-D均低于对照组治疗后(P<0.05)。治疗组总有效率86.67%,对照组总有效率73.33%,治疗组疗效优于对照组(P<0.05)。结论清肺活血化痰方能提高痰瘀互结型AECOPD患者的临床疗效,改善肺功能,降低IL-17及D-D水平,促进炎症吸收。

Objective To observe the effect of Qingfei Huoxue Huatan decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with phlegm and blood stasis syndrome. Methods 60 patients with AECOPD were divided into two groups according to the random number table methos. 30 cases in control group were treated by conventional western medicine. 30 cases in treatment group were treated by Qingfei Huoxue Huatan recipe on the basis of the control group. Both groups were treated for 14 days. The clinical symptoms and signs of the two groups were compared before and after treatment. The changes of the first second forced expiratory volume as a percentage of the predicted value(FEV1%),forced vital capacity(FVC) and FEV1/FVC were observed before and after treatment between the two groups. The changes of oxygen partial pressure [p(O2)], carbon dioxide partial pressure [p(CO2)], interleukin-17(IL-17) and D-Dimer(D-D) of arterial blood gas were observed before and after treatment between the two groups, and the therapeutic effects of the two groups were compared. Results The scores of cough, expectoration, wheeze and lung rale in the two groups were lower than those in the group before treatment(P<0.05). The scores of cough and wheeze in the treatment group were lower than those in the control group(P<0.05). The FEV1 and FEV1/FVC in the two groups were higher than those in the group before treatment(P<0.05), and the increase in the treatment group was more obvious(P<0.05). After treatment, p(O2) in the treatment group was higher than that before treatment(P<0.05), p(CO2), IL-17 and D-D were lower than that before treatment(P<0.05). After treatment, p(O2) in the control group was higher than that before treatment(P<0.05), p(CO2) and D-D were lower than that before treatment(P<0.05). After treatment, p(O2) in the treatment group was higher than that in the control group(P<0.05). After treatment, p(CO2), IL-17 and D-D in the treatment group were lower than those in the control group(P<0.05). The total effective rate was 86.67% in treatment group and 73.33% in control group. The clinical curative effect of the treatment group was better than that of the control group(P<0.05). Conclusion Qingfei Huoxue Huatan decoction can improve the clinical effect of AECOPD with phlegm and blood stasis syndrome, and can improve lung function, reduce IL-17 and D-D levels, and promote the absorption of inflammation.