益肺化痰定喘汤对慢性阻塞性肺疾病急性加重期血气指标、肺功能及凝血功能的影响

Clinical Effect of Yifei Huatan Dingchuan Decoction on Blood Gas Index,Lung Function and Coagulation Function in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨益肺化痰定喘汤联合西医治疗方案对慢性阻塞性肺疾病急性加重期(AECOPD)患者血气指标、肺功能及凝血功能的影响。方法选取2019年2月—2020年2月期间于驻马店市中心医院就诊的AECOPD患者86例,随机分为对照组和观察组,每组各43例。对照组给予常规西医治疗,观察组在对照组基础上给予益肺化痰定喘汤,两组均治疗7 d。对比两组患者治疗前后中医证候积分,临床疗效,呼吸改善和生活质量评分(mMRC评分和CAT评分),肺功能[最大呼气流速(PEF)、1 s用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC],血气分析指标[动脉血氧分压(PaO_(2))、血二氧化碳分压(PaCO_(2))、血pH值],凝血功能指标[血浆比黏度、全血黏度(高切与低切)、红细胞聚集指数、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)]变化以及安全性。结果治疗后两组患者中医证候积分、mMRC评分和CAT评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者各项肺功能指标高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后血PaO_(2)值和血pH值高于治疗前,血PaCO_(2)值低于治疗前,差异有统计学意义(P<0.05);观察组患者血PaO_(2)值和血pH值高于对照组,血PaCO_(2)值则低于对照组,差异有统计学意义(P<0.05)。观察组治疗后的血浆比黏度、全血低切黏度、全血高切黏度、红细胞聚集指数、血浆FIB和D-D水平均低于治疗前和对照组,差异有统计学意义(P<0.05);APTT和PT水平高于治疗前和对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论在西医治疗的基础上给予益肺化痰平喘汤可改善AECOPD患者的肺功能和血气指标,降低血液高凝状态,进而显著控制临床症状,且安全性良好。

Objective To investigate the effects of Yifei Huatan Dingchuan Decoction combined with western medicine treatment on blood gas indexes,lung function and coagulation function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 86 AECOPD patients who were treated in the Zhumadian centeral hospital from February 2019 to February 2020 were selected and randomly divided into a control group and an observation group,with 43 cases in each group.The control group was given conventional western medicine treatment,and the observation group was given Yifei Huatan Dingchuan Decoction on the basis of the control group for 7 days.Comparison of TCM syndrome scores before and after treatment,clinical efficacy,respiratory improvement and quality of life(mMRC score and CAT score),lung function[maximum expiratory flow rate(PEF),1 s forced expiratory volume(FEV1),forced vitalcapacity(FVC),FEV1/FVC],blood gas analysis indexes[arterial blood oxygen partial pressure(PaO_(2)),blood carbon dioxide partial pressure(PaCO_(2)),blood pH value],blood coagulation function indexes[plasma specific viscosity,whole blood viscosity(high cut and Low cut),red blood cell aggregation index,activated partial thrombin time(APTT),thrombin time(TT),prothrombin time(PT),fibrinogen(FIB),D-dimer(DD)]changes and the adverse reactions were recorded during treatment.Results After treatment,the scores of TCM syndromes,mMRC scores and CAT scores of the two groups of patients were lower than before treatment,and the observation group was lower than the control group,the difference was statistically significant(P<0.05).The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the lung function indexes of the two groups were higher than those before treatment,and the observation group was higher than the control group,the difference was statistically significant(P<0.05).The blood PaO_(2) value and blood pH value of the two groups of patients after treatment were higher than before treatment,and the blood PaCO_(2) value was lower than before treatment,the difference was statistically significant(P<0.05).The blood PaO_(2) value and blood pH value of the observation group were higher than those of the control group.The blood PaCO_(2) value was lower than the control group,the difference was statistically significant(P<0.05).The plasma specific viscosity,whole blood low-shear viscosity,whole blood high-shear viscosity,red blood cell aggregation index,plasma FIB and DD levels after treatment in the observation group were lower than those before treatment and the control group,the difference was statistically significant(P<0.05).The levels of APTT and PT were higher than those before treatment and the control group,and the difference was statistically significant(P<0.05).During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion On the basis of western medicine treatment,Yifei Huatan Pingchuan Decoction can improve the lung function and blood gas indexes of patients with AECOPD,reduce the blood hypercoagulable state,and then significantly control the clinical symptoms with good safety.