儿童反复呼吸道感染的两联序贯性外治方案随机对照试验

Randomized Controlled Trial of Two Sequential External Treatment Protocols for the Recurrent Respiratory Tract Infection in Children

目的观察外治疗法防治儿童反复呼吸道感染的临床疗效,为优选治疗方案提供依据。方法将96例儿童反复呼吸道感染病例随机分为伏九穴位敷贴组(分别于冬季三九、夏季三伏各选3周给予伏九穴位敷贴治疗)、四时辨体捏脊组(分别于立春、立夏、立秋、立冬连续10天给予四时辨体捏脊治疗)、伏九穴位敷贴合四时辨体捏脊组(上述两种方法联合治疗),每组32例。连续治疗2年,统计各组患儿病情、病程、病种级别分布情况,比较各组患儿治疗1年、2年的临床疗效、中医证候疗效。结果治疗过程中共脱落7例,最终纳入89例进行统计分析。治疗1年、2年,伏九穴位敷贴合四时辨体捏脊组患儿急性呼吸道感染病情、病种、病程级别分布与伏九穴位敷贴组及四时辨体捏脊组比较差异均有统计学意义(P<0.05)。治疗1年,伏九穴位敷贴组、四时辨体捏脊组、伏九穴位敷贴组合四时辨体捏脊组临床疗效总有效率分别为80.0%、75.0%、87.1%;治疗2年,各组均为100%。治疗1年,伏九穴位敷贴组、四时辨体捏脊组、伏九穴位敷贴合四时辨体捏脊组中医证候疗效"显效+痊愈"率分别为60.0%、71.5%、87.0%;治疗2年,各组分别为80.0%、75.0%、87.1%;治疗1年、2年总有效率各组均为100%。各组治疗2年疗效均优于本组治疗1年(P<0.05);治疗1年、2年组间临床疗效及中医证候疗效比较差异均有统计学意义(P<0.01),伏九穴位敷贴合四时辨体捏脊组均优于其他两组(P<0.05),伏九穴位敷贴组与四时辨体捏脊组比较差异无统计学意义(P>0.05)。结论与伏九穴位敷贴及四时辨体捏脊疗法单独使用比较,伏九穴位敷贴联合四时辨体捏脊疗法疗效更佳,两法联合序贯治疗可成为防治儿童反复呼吸道感染的优选外治方案。

Objective To observe the curative effects of external treatment in preventing and treating recurrent respiratory tract infections in children, and to provide the basis for optimizing the treatment protocols. Methods A total of 96 children with repeated respiratory infections were randomly divided into a dog-day and coldest day acupoint application group given acupoint application for 3 weeks each in the coldest and dog days for 3 weeks), a four-solar term group given the treatment of chiropractics in the beginning of spring, summner, autumn and winter for 10 consecutive days, and a acupoint application combined with chiropractics group given the combined treatment mentioned above, with 32 cases in each group. After 2 years of treatment, the patients′ condition, treatment course, and entity class of the patients in each group were counted, and the clinical efficacy and TCM syndrome efficacy of each group for 1 year and 2 years of treatment were compared. Results A total of 7 cases were lost during the treatment, and 89 cases were finally included for statistical analysis. After 1 year and 2 years of treatment, the distribution of acute respiratory infection condition, disease species and disease course in the group of acupoint application combined with chiropractics group was statistically significant compared with the group of dog-day and coldest day acupoint application group and four-solar term chiropractics group(P<0.05). After 1 year of treatment, the total effective rate of clinical efficacy was 80.0%, 75.0% and 87.1% respectively in the dog-day and coldest day acupoint application group, four-solar term chiropractics group and acupoint application group combined with chiropractics group. After 2 years of treatment, the effective rate of all groups were 100%. After 1 year of treatment, the rates of "obvious effective + recovery" of TCM syndrome were 60.0%, 71.5% and 87.0% respectively in dog-day and coldest day acupoint application group, four-solar term chiropractics group, and acupoint application combined with four-solar term chiropractics group, and after 2 years of treatment, those were 80.0%, 75.0% and 87.1% respective. The total effective rate of treatment for 1 year and 2 years was 100% in all groups. The efficacy of 2 years of treatment in all groups was superior to that for 1 year treatment(P<0.05). The difference in clinical efficacy and TCM syndrome efficacy between the groups of 1 and 2 years of treatment was statistically significant(P<0.01). The acupoint application combined with chiropractics group was superior to the other 2 groups(P<0.05). There was no statistically significant difference in the group of dog-day and coldest day acupoint application group and four-solar term chiropractics group(P>0.05). Conclusion Compared with the single use of dog-day and coldest day acupoint application and four-solar term chiropractics group, acupoint application combined with chiropractics group has better curative effects, and the 2 methods combination sequential therapy can become the optimal external treatment protocols for preventing and treating repeated respiratory tract infections in children.