咳喘宁方联合西药治疗痰热壅肺证AECOPD的疗效及对炎性因子的影响

Efficacy of Kechuanning combined with western medicine in the treatment of phlegm-heat obstructing lung syndrome AECOPD and its effects on inflammatory factors

目的探讨咳喘宁方联合西药治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效及对患者血清淀粉样蛋白A(SAA)、白细胞介素1β(IL-1β)、降钙素原(PCT)水平的影响。方法选取永康市中医院2019年1月至2020年12月收治的AECOPD患者104例为观察对象,采用随机数字表法分为观察组和对照组,每组52例。对照组采用西药对症治疗,观察组在对照组基础上联合咳喘宁方治疗。观察两组患者的治疗效果、临床症状缓解时间,治疗前后肺功能、血清炎性因子及血气分析指标的变化情况。结果观察组治疗总有效率[86.54%(45/52)]高于对照组[67.31%(35/52)](χ^(2)=4.99,P<0.05)。观察组啰音消失时间[(8.25±1.38)d]、咳嗽消失时间[(10.05±1.53)d]、住院时间[(12.65±2.28)d]均短于对照组[9.41±1.46)d、(12.19±1.61)d、(14.36±2.14)d](t=4.16、6.98、3.61,均P<0.05)。治疗后,观察组用力肺活量(FVC)[(1.88±0.5)L]、第1秒用力呼气容积(FEV_(1))[(64.13±5.72)%pred]、FEV_(1)/FVC值[(59.43±5.57)%]均高于对照组[(1.65±0.51)L、(60.22±5.60)%pred、(54.16±5.19)%](t=2.17、3.52、4.99,均P<0.05);观察组动脉血氧分压(PaO2)[(9.18±0.89)kPa]、血氧饱和度(SpO2)[(96.26±2.13)%]水平均高于对照组[8.74±0.76)kPa、(94.07±2.08)%](t=2.71、5.305,均P<0.05),二氧化碳分压(PaCO_(2))[(7.32±0.27)kPa]水平低于对照组[(7.63±0.32)kPa](t=5.34,P<0.05);观察组SAA[(43.84±6.15)mg/L]、IL-1β[(3.24±0.51)μg/L]、PCT[(1.55±0.37)ng/L]均低于对照组[(55.26±3.46)mg/L、(4.19±0.56)μg/L、(2.03±0.46)ng/L](t=9.23、9.04、5.86,均P<0.05)。结论咳喘宁方辅助治疗AECOPD能明显改善患者肺功能及缺氧状态,缓解临床症状,减轻炎性反应,临床疗效确切。该研究具备显著创新性和科学性,值得临床借鉴。

Objective To investigate the efficacy of Kechuanning combined with western medicine on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its effects on serum amyloid A,interleukin 1βand procalcitonin levels.Methods A total of 104 patients with AECOPD who received treatment in Yongkang Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were included in this study.They were randomly assigned to receive either symptomatic treatment with western medicine alone(n=52,control group)or symptomatic treatment with western medicine combined with Kechuanning(n=52,observation group).Therapeutic effects,latency to clinical symptom relief,pre-and post-treatment pulmonary function,serum inflammatory factor levels,and blood gas analysis indexes were compared between the two groups.Results Total response rate in the observation group was significantly higher than that in the control group[86.54%(45/52)vs.67.31%(35/52),χ^(2)=4.99,P<0.05].Latency to rale disappearance,latency to cough disappearance,length of hospital stay in the observation group were(8.25±1.38)days,(10.05±1.53)days,and(12.65±2.28)days,which were significantly shorter than those in the control group[(9.41±1.46)days,(12.19±1.61)days,(14.36±2.14)days,t=4.16,6.98,3.61,all P<0.05].After treatment,forced vital capacity(FVC),forced expiratory volume in the first second(FEV_(1)),and FEV_(1)/FVC value in the observation group were(1.88±0.5)L,(64.13±5.72)%pred,(59.43±5.57)%,respectively,which were significantly higher than those in the control group[(1.65±0.51)L,(60.22±5.60)%pred,(54.16±5.19)%,t=2.17,3.52,4.99,all P<0.05].Arterial partial pressure of oxygen(PaO2)and blood oxygen saturation(SpO2)in the observation group were(9.18±0.89)kPa and(96.26±2.13)%,respectively,which were significantly higher than those in the control group[(8.74±0.76)kPa,(94.07±2.08)%,t=2.71,5.305,both P<0.05].Partial pressure of carbon dioxide(PaCO_(2))in the observation group was significantly lower than that in the control group[(7.32±0.27)kPa vs.(7.63±0.32)kPa,t=5.34,P<0.05].Serum amyloid protein,interleukin-1βand procalcitonin levels in the observation group were(43.84±6.15)mg/L,(3.24±0.51)μg/L,(1.55±0.37)ng/L,respectively,which were significantly lower than those in the control group[(55.26±3.46)mg/L,(4.19±0.56)μg/L,(2.03±0.46)ng/L,t=9.23,9.04,5.86,all P<0.05].Conclusion Kechuanning as an adjuvant therapy for AECOPD can greatly improve lung function and hypoxia,alleviate clinical symptoms,reduce inflammatory reactions,and have a definite clinical effect.The study is innovative and scientific and is worthy of clinical reference.