中西医序贯疗法治疗小儿毛细支气管炎33例临床研究

A clinical study on the sequential treatment of 33 cases of pediatric bronchiolitis by stages of traditional Chinese and Western medicine

目的观察中西医序贯疗法治疗小儿毛细支气管炎的临床疗效。方法选取2018年10月至2019年10月在河南中医药大学第一附属医院儿科呼吸病区住院治疗的66例毛细支气管炎风寒闭肺型患儿,按照随机数字表法分为治疗组和对照组,各33例。对照组急性期予布地奈德混悬液联合特布他林混悬液雾化吸入,缓解期予布地奈德混悬液(减量)雾化吸入。治疗组在对照组治疗方法的基础上,急性期(风寒闭肺证)予小青龙汤加减口服,缓解期(肺脾气虚证)予加味玉屏风散口服。2组均急性期连续治疗1周,缓解期连续治疗2周后统计疗效。结果治疗1周后,治疗组的总有效率为96.97%(32/33),显著高于对照组的90.91%(30/33),2组比较,差异有统计学意义(P<0.05)。治疗前2组的主症(气喘、咳嗽、咳痰、喉间喘鸣)及次症(咳痰清稀、鼻塞、流涕、面色少华、纳差、便溏/干结)积分比较,差异均无统计学意义(P>0.05),具有可比性;治疗1周后,2组的主症和次症积分及总积分均较同组治疗前显著降低,差异均有统计学意义(P<0.01),且治疗组的主症积分和次症的咳痰清稀、流涕及总积分降低更显著(P<0.05或P<0.01),而治疗组的次症鼻塞、面色少华、纳差及便溏/干结评分与对照组比较,差异无统计学意义(P>0.05)。经恢复期治疗后,2组的总有效率比较,差异无统计学意义(P>0.05),但治疗组的临床控制率为90.91%(30/33),显著高于对照组的39.40%(13/33),2组比较,差异有统计学意义(P<0.01)。2组患儿出院后1年内,治疗组的喘息复发率为18.18%(6/33),对照组为46.88%(15/32),2组比较,差异有统计学意义(P<0.05)。2组患儿在治疗期间的血、尿、便常规,肝肾功等指标均未见异常,均未发生明显不良反应。结论中西医序贯疗法治疗毛细支气管炎,可明显缓解临床症状及体征,显著降低中医证候积分,且复发率低,安全性高,值得临床推广应用。

Objectivee To observe the clinical efficacy of sequential treatment of pediatric bronchiolitis using traditional Chinese and Western medicine.Methods 66 children with bronchiolitis wind cold closed lung type who were hospitalized in the Pediatric Respiratory Ward of the The First Affiliated Hospital of Henan University of Chinese Medicine from October 2018 to October 2019 were selected.They were randomly divided into a treatment group and a control group,with 33 cases in each group,using a random number table method.The control group received nebulized inhalation of budesonide suspension combined with terbutaline suspension during the acute phase,and budesonide suspension(reduced dosage)during the remission phase.On the basis of the treatment method in the control group,the treatment group was given modified Xiaoqinglong Tang(小青龙汤)oral administration in the acute phase(wind cold closed lung syndrome),and modified Yupingfeng San(玉屏风散)oral administration in the remission phase(lung spleen qi deficiency syndrome).Both groups were treated continuously for one week during the acute phase,and the efficacy was evaluated after two weeks of continuous treatment during the remission phase.Results After one week of treatment,the total effective rate of the treatment group was 96.97%(32/33),significantly higher than the control group's 90.91%(30/33).The difference between the two groups was statistically significant(P<0.05).Before treatment,there was no statistically significant difference(P>0.05)in the scores of the main symptoms(asthma,cough,sputum,and wheezing between the two groups)and the secondary symptoms(clear and sparse sputum,nasal congestion,runny nose,pale complexion,poor appetite,loose stools/dry knot between the two groups),indicating comparability.After one week of treatment,the main and secondary symptom scores and total scores of the two groups were significantly reduced compared to the same group before treatment,and the differences were statistically significant(P<0.01).The main symptom scores and secondary symptom scores of the treatment group were more significantly reduced(P<0.05 or P<0.01),while the secondary symptom scores of nasal congestion,pale complexion,poor appetite,and loose/dry stools in the treatment group were not statistically significant compared to the control group(P>0.05).After recovery period treatment,there was no statistically significant difference in the total effective rate between the two groups(P>0.05),but the clinical control rate of the treatment group was 90.91%(30/33),significantly higher than the control group's 39.40%(13/33),with a statistically significant difference(P<0.01).Within one year after discharge,the recurrence rate of wheezing in the treatment group was 18.18%(6/33),while in the control group it was 46.88%(15/32).The difference between the two groups was statistically significant(P<0.05).During the treatment period,there were no abnormalities in blood,urine,stool routine,liver and kidney function and other indicators in both groups of children,and no significant adverse reactions occurred.Conclusion The sequential therapy of traditional Chinese and Western medicine for staged treatment of bronchiolitis can significantly alleviate clinical symptoms and signs,significantly reduce traditional Chinese medicine syndrome scores,low recurrence rate,and high safety.It is worthy of clinical promotion and application.