加味升陷汤联合体外膈肌起搏器对宗气亏虚、痰瘀互结型AECOPD患者的疗效评价

Evaluation of the Therapeutic Effect of Jiaweishengxian Decoction Combined with External Diaphragm Pacemaker on AECOPD Patients with Deficiency of Zongqi and Intercombination of Phlegm and Blood Stasis

目的研究加味升陷汤联合体外膈肌起搏器(EDP)对宗气亏虚、痰瘀互结型慢性阻塞性肺疾病急性加重期(AECOPD)的疗效。方法收集108例患者,按分层随机法分别纳入试验组(西医常规治疗联合EDP、内服加味升陷汤)、对照组1(西医常规治疗组)和对照组2(西医常规治疗联合EDP)各36例。比较治疗前后患者肺功能(FVC、FEV_(1)%、FEV_(1)/FVC%)、血清中T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD8^(+))、6 min步行试验(6-MWT)、呼吸困难评分指数“Borg评分”及血气分析(PaO_(2)、PaCO_(2))、CAT评分、证候积分的变化情况。结果在症状改善方面,治疗后试验组CAT评分、中医证候总积分、6-MWT及Borg评分均优于对照组1、对照组2,差异有统计学意义(P<0.01);在免疫功能改善方面,试验组CD3^(+)、CD4^(+)上调情况较对照组1和对照组2更明显,差异有统计学意义(P<0.05);在肺功能改善方面,3组患者治疗前后组内比较FEV_(1)%、FVC均有明显改善,差异有统计学意义(P<0.01),3组患者治疗前后组间比较无明显差异,差异无统计学意义(P>0.05);在血气分析的改善方面,3组患者治疗前后组间比较PaO_(2)无明显差异,差异无统计学意义(P>0.05),PaCO_(2)较治疗前均显著降低,差异有统计学意义(P<0.01),但3组患者治疗前后组内比较PaO_(2)、PaCO_(2)均有明显变化,差异有统计学意义(P<0.05)。结论加味升陷汤联合EDP增加了宗气亏虚、痰瘀互结型AECOPD患者的CD3^(+)、CD4^(+),从而提高免疫力;改善PaO_(2)、PaCO_(2)值,使患者通气增加;降低CAT评分及中医证候总积分,增加6 min步行试验距离,改善临床症状,提高患者的生活质量。

Objective To study the therapeutic effect of Jiaweishengxian Decoction combined with external diaphragm pacemaker(EDP)on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with deficiency of Zongqi and phlegm blood stasis.Methods 108 patients were collected and randomly divided into three groups,the test group(routine western medicine treatment combined with EDP,oral administration of Jiaweishengxian Decoction),the control group 1(routine western medicine treatment group)and the control group 2(routine western medicine treatment combined with EDP).The changes of pulmonary function(FVC,FEV_(1)%,FEV_(1)/FVC%),T-lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+),CD8^(+)),6-minute walking test(6-MWT)and dyspnea score index"Brog score",blood gas analysis(PaO_(2),PaCO_(2)),CAT score,and syndrome score were compared before and after treatment.Results In terms of symptom improvement,the CAT score,total score of TCM syndromes,6-MWT and Borg score in the test group were better than those in control group 1 and control group 2 after treatment,with significant difference(P<0.01).In terms of immune function improvement,the up regulation of CD3^(+)and CD4^(+)in test group was more obvious than that in control group 1 and control group 2,with a statistically significant difference(P<0.05).In terms of improvement of pulmonary function,FEV_(1)%and FVC in the three groups were significantly improved before and after treatment,with a statistically significant difference(P<0.01).There was no significant difference between the three groups before and after treatment,with no statistically significant difference(P>0.05).In terms of the improvement of blood gas analysis,there was no significant difference in PaO_(2) between the three groups before and after treatment(P>0.05),PaCO_(2) was significantly lower than that before treatment,the difference was statistically significant(P<0.01),PaO_(2) and PaCO_(2) were significantly changed in the three groups before and after treatment,the difference was statistically significant(P<0.05).Conclusion Jiaweishengxian Decoction combined with EDP can increase the CD3^(+)and CD4^(+)of AECOPD patients with Zongqi deficiency and phlegm blood stasis,thus improving their immunity.The PaO_(2),PaCO_(2) value is improved and the patient's ventilation is increased.The CAT score and the total score of TCM syndromes were reduced,the 6-minute walking test distance was increased,the clinical symptoms were improved,and the quality of life of patients was improved.