慢性阻塞性肺疾病急性加重期中西医结合治疗的临床研究

Clinical Research on Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease(COPD)with Integration of Traditional Chinese Medicine and Western Medicine

目的观察慢性阻塞性肺疾病急性加重的发病特点及中西医结合治疗对疾病恢复的影响。方法采用前瞻性、随机、对照、单盲的研究方法。所有的患者纳入后均进行肺功能的评估和症状评估,作为基线资料。急性发作后对照组给予常规西医治疗,试验组在此基础上给予中医辩证治疗,观察肺功能指标及症状恢复情况。结果98例患者共发作268次,每名患者每年急性加重发作的的中位数为2.2(1.3,3.5)。急性加重发作前即有症状的变化,呼吸困难占72.0%,痰量增加占41.4%,脓痰占28.0%,感冒占33.2%,喘息加重占30.1%例,咳嗽加重占23.9%例,CAT评分从基线增加3(2,4)。PEFR恢复时间8(1,14)天,FEV1恢复时间8(2,14)天,FVC恢复时间8(3,15)天,症状恢复时间为7(4,14)天。试验组在4周、12周时恢复比例高于对照组。多因素分析结果显示中药治疗、激素应用、喘息加重是恢复时间缩短的因素,而呼吸困难、感冒是使恢复时间延长的因素。结论慢性阻塞性肺疾病急性加重前期多有症状变化。中药治疗和激素的应用可缩短恢复时间;发作时喘息症状加重也是恢复快的预测因素,而呼吸困难加重延长患者的恢复;感冒诱发的急性加重恢复缓慢。

Objective:To observe the characteristics of acute exacerbation of chronic obstructive pulmonary disease(COPD)and the effect of integrated traditional Chinese and Western Medicine on disease recovery.Method:A prospective,randomized,controlled,and single blind study was conducted.All the patients were included in the assessment of lung function and the assessment of the symptoms as baseline data.After acute attack,the control group was given routine western medicine treatment,and the experimental group was given dialectical treatment of traditional Chinese medicine on,pulmonary function index and symptom recovery were observed.Results:A total of 98 patients had 268 episodes.The median of acute exacerbations per patient was 2.2(1.3,3.5)each year.There were changes in symptoms before acute exacerbation.dyspnea 72%,phlegm increased 41.4%,sputum accounted for 28%,colds accounted for 33.2%,wheezing aggravated 30.1%cases,cough aggravated 23.9%cases,CAT score increased 3(2,4)from baseline.The recovery rate of the experimental group at 4W and 12W was higher than that of the control group.The results of multifactor analysis showed that the treatment of Chinese medicine,the application of hormone and the aggravation of wheezing were the factors that shortened the recovery time,while the respiratory difficulty and the cold were the factors that made the recovery time prolonged.Conclusion:Chronic obstructive pulmonary disease has symptoms changes before acute exacerbation.The treatment of Chinese medicine and the application of hormone can shorten the time of recovery;the aggravation of the symptoms of wheezing during the attack is also the predictor of the rapid recovery,while the dyspnea is aggravated and the recovery of the patients is prolonged;the acute aggravation of the cold induced recovery is slow.