穴位贴敷治疗慢性阻塞性肺疾病(痰浊壅肺型)的优化研究

Optimization Research on Applying Acupoint Application in the Treatment of COPD Due to Retention of Phlegmdampness in Lungs

目的:探讨穴位贴敷治疗慢性阻塞性肺疾病(痰浊壅肺型)患者的最佳穴位组合及药物配伍。方法:将94例痰浊壅肺型COPD患者随机分成A组24例(化痰药+化痰穴组)、B组24例(化痰药+常规穴组)、C组23例(常规药+化痰穴组)、D组23例(常规药+常规穴组),疗程为30天,以中医症候积分、慢性阻塞性肺病评估测试(CAT)、呼吸困难指数(mMRC)、COPD临床问卷(CCQ)、肺功能(FVC、MVV)为观察指标,对4组患者在治疗前后进行两因素(穴位、药物)和两水平(常规、痰浊)的2×2析因设计研究。结果:总有效率A组为95.83%,B组为91.67%,C组为91.30%,D组为82.61%,4组患者治疗后各项临床症状评分(中医症候积分、CAT、mMRC、CCQ)及肺功能与同组治疗前比较,差异均具有统计学意义(P<0.01)。4组患者组间疗效经秩和检验,差异具有统计学意义(P<0.01)。A组治疗后各项临床症状评分及肺功能与B、C、D三组比较,差异具有统计学意义(P<0.05)。B组和C组治疗后总有效率、各项临床症状评分及肺功能与D组比较,差异均具有统计学意义(P<0.05)。B组和C组治疗后各项临床症状评分及肺功能与D组比较,差异均具有统计学意义(P<0.05)。B组治疗后各项临床症状评分及肺功能与C组比较,差异无统计学意义(P>0.05)。结论:穴位贴敷疗法治疗慢性阻塞性肺疾病(痰浊壅肺型)患者总有效率以化痰药+化痰穴组最高,药物和穴位两者具有交互作用,化痰药物配合化痰穴位可减轻患者的临床症状,改善肺功能,并提高患者生存质量。

Objective:To explore the optimal acupoint and medicine compatibility of acupoint application in patients with chronic obstructive pulmonary disease(phlegm turbidity obstructing lung type).Methods:Totally 94 COPD patients with phlegm-turbid obstruction of lung were randomly divided into group A(medicines plus acupoints for phlegm-resolving)(n=24),group B(medicines for phlegm-resolving plus conventional acupoints)(n=24),group C(conventional medicines plus acupoints for phlegm-resolving)(n=23),and group D(conventional medicines plus conventional acupoints)(n=23)for 30 days.The TCM syndrome score,COPD Assessment Test(CAT),dyspnea index(mMRC),Clinical COPD Questionnaire(CCQ)and Pulmonary Function(FVC,MVV)were adopted as the observation indexes,to conduct a two-factor(acupoint,medicine)twolevel(conventional,phlegm and turbid)2×2 factorial design.Results:The total effective rate was 95.83%in the group A,versus 91.67%in the group B,91.30%in the group C,and 82.61%in the group D.After treatment,the scores of clinical symptoms(TCM symptom score,CAT,mMRC,CCQ)and lung function of the four groups were significantly different from those before(P<0.01).And the differences among the four groups were statistically significant according to rank-sum test(P<0.01).The scores of clinical symptoms and pulmonary function of the group A was significantly different from that of the group B,C,and D(P<0.05).The total effective rate,clinical symptom scores and pulmonary function of the group B and the group C were significantly different from that of the group D(P<0.05).After treatment,the four groups all achieved significant changes in symptom scores(P<0.01).There were significant differences in clinical symptom scores and pulmonary function between the group B and the group C after treatment compared with the group D(P<0.05).There was no significant difference in clinical symptom scores and pulmonary function between the group B and the group C(P>0.05).Conclusion:With medicines and acupoints for phlegm-resolving,acupoint application produces the highest total effective rate in treating COPD due to retention of phlegm-dampness in lung.The medicines and acupoints work interactively to reduce the clinical symptoms,control the attack,and improve the quality of life.