咳喘定方中药贴敷治疗慢性阻塞性肺疾病痰湿阻肺证患者的临床观察

Clinical Observation on Treatment of Chronic Obstructive Pulmonary Disease(Syndrome of Phlegm-Dampness Obstructing Lung)with Kechuanding Prescription

目的探究咳喘定方中药贴敷治疗慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)痰湿阻肺证的临床价值。方法选取2021年1月—2022年10月期间海口市第三人民医院收治的COPD急性加重期痰湿阻肺证患者110例作为研究对象,依据简单随机数字表法分为对照组和试验组,每组各55例。对照组采取常规西医治疗,试验组在对照组基础上采取咳喘定方中药贴敷,两组患者均治疗10 d。观察比较两组患者临床疗效、治疗安全性、复发率,治疗前后中医证候积分、病情状况[COPD评估测试(COPD assessment test,CAT)、6 min步行距离(Six Minute Walk Distance,6MWT)]、肺功能[第1秒用力呼气量占预计百分比(Forced expiratory volume in one second,FEV1%)、第1秒用力呼气量占用力肺活量百分比(Forced expiratory volume in the first second as a percentage of forced lung capacity,FEV1/FVC)]及血气分析指标[血氧分压(Blood oxygen partial pressure,PaO_(2))、二氧化碳分压(Partial pressure of carbon dioxide,PaCO_(2))]水平。结果(1)临床疗效:治疗后试验组临床控制率62.96%(34/54)高于对照组43.40%(23/53),差异有统计学意义(P<0.05);试验组临床总有效率96.30%(52/54)与对照组92.45%(49/53)比较,差异无统计学意义(P>0.05)。(2)中医证候积分:治疗后两组患者咳嗽、喘息、痰多、胸闷、气短、食少纳呆、胃脘痞满积分均较治疗前降低,差异有统计学意义(P<0.05);且试验组低于对照组,差异有统计学意义(P<0.05)。(3)病情评估:治疗后两组患者病情指标CAT分值均较治疗前降低,6MWT分值较治疗前升高,差异有统计学意义(P<0.05);且试验组CAT分值低于对照组,6MWT分值高于对照组,差异有统计学意义(P<0.05)。(4)肺功能与血气状态:治疗后两组患者FEV1%、FEV1/FVC、PaO_(2)均较治疗前升高,PaCO_(2)均较治疗前降低,差异有统计学意义(P<0.05);且试验组FEV1%、FEV1/FVC、PaO_(2)均高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。(5)安全性:治疗期间,两组患者均未出现严重不良反应与并发症,仅试验组出现1例局部皮红,未给予特殊处理,1 d后自行消退,且该患者无主诉不适,未对治疗进展产生影响。(5)疾病复发率:随访期间,试验组疾病复发率3.77%(2/53)低于对照组14.81%(8/54),差异有统计学意义(χ^(2)=4.005,P=0.045)。结论常规西医基础上采取咳喘定方中药贴敷治疗痰湿阻肺证COPD效果显著,可缓解患者临床症状及病情程度,提升运动耐力,恢复肺功能与血气状态,利于提升整体治疗效果,减少疾病复发,且具有安全性。

Objective To explore the clinical value of Kechuanding Prescription in the treatment of chronic obstructive pulmonary disease(COPD)in the patients with the syndrome of phlegm-dampness obstructing lung.Method A total of 110 patients with acute exacerbation of COPD due to phlegm-dampness obstructing the lung treated in the Third People′s Hospital of Haikou from January 2021 to October 2022 were selected and randomized by the random number table method into control and test groups(n=55).The control group received conventional Western medical therapy,and the test group was treated with Kechuanding Prescription for external application on the basis of the therapy in the control group.Both groups were treated for 10 days.The clinical efficacy,treatment safety,and recurrence rate were compared between the two groups.The TCM symptom scores,disease status[COPD assessment test(CAT)and 6 min walk distance(6MWT)],lung function[forced expiratory volume in the first second(FEV1%)and forced expiratory volume in the first second/forced vital capacity(FEV1/FVC)],and blood gas analysis indicators[partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))]were determined before and after treatment.Results(1)Clinical efficacy:The clinical control rate in the test group was 62.96%(34/54),which was higher than that(43.40%,23/53)in the control group(P<0.05).The total clinical response rate in the test group was 96.30%(52/54),which was not significantly different from that(92.45%,49/53)in the control group(P>0.05).(2)TCM symptom score:After treatment,the scores of cough,wheezing,excessive phlegm,chest tightness,shortness of breath,lack of appetite,and stomach distention and fullness in the two groups decreased compared with those before treatment(P<0.05),and the test group had lower scores than the control group(P<0.05).(3)Disease status evaluation:The treatment in both groups decreased the CAT score and increased the 6MWT score(P<0.05),and the test group had lower CAT score and higher 6MWT score than the control group(P<0.05).(4)Lung function and blood gas status:The treatment in both groups increased FEV1%,FEV1/FVC,and PaO_(2)and decreased PaCO 2(P<0.05),and the test group had higher FEV1%,FEV1/FVC,and PaO_(2)and lower PaCO_(2)than the control group after treatment(P<0.05).(5)Safety:Neither group showed serious adverse reactions or complications during the treatment period.Only one case of local skin redness occurred in the test group,which subsided after 1 day without special treatment and did not affect the treatment progress,and the patient did not complain of discomfort.(5)Recurrence rate:The recurrence rate in the test group was 3.77%(2/53),which was lower than that(14.81%,8/54)in the control group(χ^(2)=4.005,P=0.045).Conclusion On the basis of conventional Western medical therapy,the external application of Kechuanding Prescription can alleviate clinical symptoms and disease degree,improve exercise endurance,and restore lung function and blood gas status in the COPD patients with the syndrome of phlegm-dampness obstructing lung.This therapy is conducive to the overall therapeutic effect,reduces disease recurrence,and has high safety.