麻黄升麻汤治疗慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停低通气综合征临床研究

Clinical study of Mahuang Shengma Decoction in treatment of chronic obstructive pulmonary disease with obstructive sleep apnea-hypopnea syndrome

目的观察麻黄升麻汤治疗慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法将66例COPD合并OSAHS患者按照随机数字表法分为治疗组与对照组。对照组32例,给予一般治疗和常规西医对症治疗;治疗组34例,除对照组治疗方案外,加用麻黄升麻汤。两组均治疗12周,观察各组治疗前后的中医证候积分、呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSaO_(2))、最长呼吸暂停时间、呼吸暂停指数(AI)、第一秒用力呼气容积(FEV_(1))和第一秒用力呼气容积占用力肺活量比例(FEV_(1)/FVC)的变化,并进行组间比较。结果(1)治疗前后组内比较,治疗组咳痰积分、夜间睡眠打鼾伴呼吸暂停积分、憋醒积分和日间嗜睡积分差异有统计学意义(P<0.05);组间治疗后比较,咳痰积分、夜间睡眠打鼾伴呼吸暂停积分、憋醒积分和日间嗜睡积分差异有统计学意义(P<0.05);(2)治疗前后组内比较,治疗组AHI、LSaO_(2)、最长呼吸暂停时间和AI差异有统计学意义(P<0.05或P<0.01);组间治疗后比较,AHI、LSaO_(2)、最长呼吸暂停时间和AI差异有统计学意义(P<0.05或P<0.01);(3)治疗前后组内比较,治疗组FEV_(1)和FEV_(1)/FVC差异有统计学意义(P<0.05);组间治疗后比较,FEV_(1)和FEV_(1)/FVC差异有统计学意义(P<0.05)。结论麻黄升麻汤治疗COPD合并OSAHS可有效改善患者的临床症状,提高肺功能和LSaO_(2),降低AHI、最长呼吸暂停时间和AI,具有较理想的治疗效果。

Objective To study the clinical efficacy of Mahuang Shengma Decoction in treating patients with chronic obstructive pulmonary disease(COPD) and obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Totally 66 patients with COPD and OSAHS were randomly divided into two groups according to random number table method. Thirty-two patients in the control group were given general treatment and routine Western medicine therapy, and 34 cases in the treatment group were additionally given Mahuang Shengma Decoction besides the treatments in the control group. Both groups were treated for 12 weeks. After treatments, changes of traditional Chinese medicine(TCM) syndrome score, apnea hypopnea index(AHI), the lowest oxygen saturation at night(LSaO_(2)), the longest time of apnea, apnea index(AI), forced expiratory volume in one second(FEV_(1)), and FEV_(1)over forced vital capacity(FEV_(1)/FVC) in both groups were evaluated, and comparisons were made between groups. Results①The expectoration score, nocturnal snoring with apnea score, arousal score, and daytime sleepiness score in the treatment group were reduced significantly after treatment(P<0.05), and were remarkably lower than those in the control group(P<0.05).②In treatment group, AHI, LSaO_(2), the longest time of apnea and AI reduced significantly after treatment(P<0.05, or P<0.01). There were significant differences in AHI, LSaO_(2), longest apnea time and AI between the two groups after treatment(P<0.05, or P<0.01).③FEV_(1) and FEV_(1)/FVC in the treatment group increased significantly after treatment(P<0.05),and were remarkably higher than those in the control group( P<0.05). Conclusion Mahuang Shengma Decoction can effectively improve clinical symptoms,lung function and LSaO_(2),and reduce AHI,the longest time of apnea and AI in patients with COPD and OSAHS,having good therapeutic effect for COPD and OSAHS.