补阳还五汤沐足对慢性阻塞性肺疾病稳定期患者肺功能的康复效果研究

Effect of Buyang Huanwu Decoction Foot Bath on Pulmonary Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease at Stable Phase

目的:探讨补阳还五汤沐足对稳定期慢性阻塞性肺疾病(COPD)患者肺功能及生活质量的影响,完善COPD患者临床治疗方案,为促进肺功能的康复提供依据。方法:招募福建中医药大学附属人民医院2020年6月—2021年2月收治的COPD稳定期患者,采用计算机SPSS 26.0软件随机序列生成模块按1∶1比例将纳入的研究对象60例分为试验组和对照组,每组各30例。对照组给予常规药物治疗、护理措施、指导功能锻炼和健康教育,试验组在对照组的基础上给予补阳还五汤中药沐足治疗,将配置好的补阳还五汤中药放于5000 mL水中浸泡20 min,用武火煮至沸腾后,改文火煮10 min,弃去残渣后将煎汁置于桶内,待温度降至40℃左右时进行沐足,要求水面高于踝关节上10 cm,每晚睡前1次,每次20 min,共治疗2周。在治疗前后分别采用第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)评定稳定期COPD患者肺功能的变化;采用6分钟步行距离(6MWD)观察患者运动能力的变化;采用改良英国医学研究委员会呼吸困难量表(mMRC)评定患者呼吸困难程度的变化;采用慢性阻塞性肺疾病生活质量评分(CAT)观察患者生活质量的变化;采用呼吸系统疾病焦虑量表(AIR)评定患者焦虑程度的变化。记录治疗前后生命体征及治疗过程中是否出现心悸心慌、呼吸困难等不良反应情况评估补阳还五汤沐足治疗稳定期COPD患者的安全性。结果:(1)治疗前,2组FEV1%pred、FEV1/FVC数值、6MWD、mMRC评分、CAT评分、AIR评分组间比较,差异均无统计学意义(P>0.05)。(2)治疗2周与治疗前相比,2组FEV1%pred、FEV1/FVC数值、6MWD较治疗前均有所升高(P<0.05),mMRC评分、CAT评分、AIR评分均较治疗前有所下降(P<0.05);经过2周治疗,试验组FEV1%pred、FEV1/FVC数值、6MWD均高于对照组(P<0.05),试验组mMRC评分、CAT评分、AIR评分均低于对照组(P<0.05)。(3)安全性结果,本研究在临床治疗期间均未出现不良事件,提示补阳还五汤沐足安全可靠。结论:对稳定期COPD患者进行补阳还五汤沐足治疗,可有效改善患者肺功能、运动能力、呼吸困难程度、生活质量等及焦虑程度,促进肺康复,疗效良好,可推广临床。

Objective:To observe the effect of Buyang Huanwu decoction foot bath on pulmonary function and quality of life of patients with chronic obstructive pulmonary disease(COPD)at stable phase,improving the clinical treatment plan for COPD patients and providing clinical evidence to promote pulmonary rehabilitation.Methods:A retrospective analysis of 60 patients with COPD at stable phase who were admitted to the Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine from June 2020 to February 2021 and met the inclusion criteria of this study were divided into treatment group and control group using the SPSS 26.0,with thirty cases in each group.The control group was given routine drug treatment,nursing therapy,guided exercise,and health education.The treatment group received the Buyang Huanwu decoction foot bath in addition to the treatment of the control group.To be specific,the prepared Buyang Huanwu decoction was immersed in 5,000 mL water for twenty minutes.After boiling,the decoction was changed to simmer for ten minutes.After discarding the residue,the decoction was placed in a bucket,and foot bath was conducted when the temperature dropped to about 40℃.Foot bath required the water surface to be 10 cm above the ankle joint,twenty minutes per time,and once per day before going to bed,seven times per week,continuous treatment for two weeks.At both the before treatment and after treatment for two weeks,the percentage of forced expiratory volume in 1 second to predicted value(FEV1%pred)and forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were used to evaluate the changes of pulmonary function in COPD patients at stable phase;the change of locomotor ability was observed by 6-minute walk distance(6 MWD);the changes in the degree of dyspnea were assessed using the dyspnea scale of modified British Medical Research Council(mMRC);the chronic obstructive pulmonary disease assessment test(CAT)was used to observe the changes of patients’quality of life;the anxiety inventory for respiratory disease(AIR)was used to evaluate the change of anxiety.To evaluate the safety of the Buyang Huanwu decoction foot bath in treating COPD patients at stable phase,the vital signs were recorded before and after the intervention,and recording the adverse reactions during the intervention,such as palpitations,and breathing difficulties.Results:1)Before treatment,there was no significant difference in FEV1%pred,FEV1/FVC value,6 MWD,mMRC score,CAT score,and AIR score between the two groups(P>0.05).2)Compared with the situation before treatment,the FEV1%pred,FEV1/FVC value,and 6 MWD of the two groups all increased(P<0.05),but the mMRC score,CAT score,and AIR score all decreased(P<0.05).After 2 weeks of treatment,the FEV1%pred,FEV1/FVC value,and 6 MWD of the treatment group were all higher than those of the control group(P<0.05);the mMRC score,CAT score,and AIR score of the treatment group were all lower than those of the control group(P<0.05).3)Safety results showed that no adverse events occurred during the clinical treatment,suggesting that the Buyang Huanwu decoction foot bath was safe and reliable.Conclusion:The Buyang Huanwu decoction foot bath could improve pulmonary function,athletic ability,dyspnea,anxiety level,and quality of life of COPD patients at stable phase.The clinical effect is good and can be promoted clinically.