揿针联合中药治疗慢性阻塞性肺疾病急性加重期肺心病功能失代偿期合并冠心病水瘀互结证的临床疗效研究

Clinical study on the clinical efficacy of acute exacerbation of chronic obstructive pulmonary disease and decompensated stage of pulmonary heart disease combined with coronary heart disease with water stasis syndrome by thumbtack needle combined with traditional Chinese medicine

目的观察揿针联合中药治疗慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)肺源性心脏病(肺心病)功能失代偿期合并冠状动脉粥样硬化性心脏病(冠心病)水瘀互结证的临床疗效。方法40例AECOPD肺心病功能失代偿期合并冠心病水瘀互结证的住院患者,按照随机分配原则分为对照组和观察组,每组20例。对照组给予包括消炎、解痉、利尿、化痰、改善冠状动脉痉挛、营养支持、纠正水电解质紊乱等西医常规治疗,观察组在西医常规治疗基础上联合揿针及中药治疗。比较两组患者急性生理学及慢性健康状况(APACHEⅡ)评分、临床疗效、氧合指数、二氧化碳分压、D-二聚体、N末端B型利钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、三尖瓣环收缩期位移(TAPSE)、治疗周期内额外增加呋塞米注射液剂量和雾化液使用次数。结果治疗7 d,两组患者APACHEⅡ评分较治疗前下降,且观察组患者APACHEⅡ评分(8.10±1.65)分低于对照组的(10.30±1.08)分,有显著性差异(P<0.05)。观察组临床总有效率为85%,略高于对照组的75%,但无显著性差异(P>0.05)。治疗7 d,两组患者氧合指数较治疗前升高,二氧化碳分压、D-二聚体、NT-proBNP水平较治疗前均降低,且观察组患者二氧化碳分压(53.00±6.06)mm Hg(1 mm Hg=0.133 kPa)、D-二聚体(0.82±0.14)μg/ml、NT-proBNP(801.70±130.19)pg/ml均低于对照组的(58.55±5.05)mm Hg、(1.12±0.24)μg/ml、(945.15±248.94)pg/ml,有显著性差异(P<0.05);但两组患者氧合指数比较,无显著性差异(P>0.05)。治疗7 d,对照组LVEF(47.35±4.34)%高于治疗前的(43.90±3.97)%,有显著性差异(P<0.05),TAPSE(9.65±1.90)mm与治疗前的(9.85±1.84)mm比较,无显著性差异(P>0.05)。观察组治疗7 d LVEF(51.80±5.13)%、TAPSE(12.95±2.65)mm均高于治疗前的(43.15±3.15)%、(9.05±1.36)mm,且高于同期对照组,有显著性差异(P<0.05)。治疗7 d内,观察组额外增加呋塞米注射液剂量(40.75±11.04)mg和雾化液使用次数(5.55±1.90)次均低于对照组的(51.50±19.00)mg、(7.25±3.11)次,有显著性差异(P<0.05)。结论揿针联合中药治疗AECOPD肺心病失代偿期合并冠心病水瘀互结证作用机制有缓解气道痉挛、增强心脏收缩功能、加强利尿等作用,疗效确切,临床运用方面值得推广。

Objective To observe the clinical efficacy of thumbtack needle combined with traditional Chinese medicine in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and decompensated stage of pulmonary heart disease combined with coronary heart disease with water stasis syndrome.Methods A total of 40 inpatients with AECOPD,decompensated stage of pulmonary heart disease and CHD with water stasis syndrome were divided into a control group and an observation group according to the principle of random allocation,with 20 cases in each group.The control group was given conventional Western medicine treatment,including anti-inflammatory,antispasmodic,diuretic,phlegm reduction,improvement of coronary artery spasm,nutritional support,correction of water-electrolyte imbalance,etc.,while the observation group was combined with thumbtack needle and traditional Chinese medicine on the basis of conventional Western medicine treatment.Patients in both groups were compared in terms of acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,clinical efficacy,oxygenation index,partial pressure of carbon dioxide,D-dimer,N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),tricuspid annular plane systolic excursion(TAPSE),additional dosage of furosemide injection,and times of atomizing solution in the therapeutic cycle.Results After 7 d of treatment,APACHEⅡscores in both groups decreased compared with before treatment,and APACHEⅡscore of(8.10±1.65)points in the observation group was lower than(10.30±1.08)points in the control group.There was a significant difference(P<0.05).The clinical effective rate of the observation group was 85%,which was slightly higher than 75%of the control group,but there was no significant difference(P>0.05).After 7 d of treatment,the oxygenation index in both groups was higher than tha before treatment,and the levels of partial pressure of carbon dioxide,D-dimer and NT-proBNP were lower than those before treatment;the observation group had PCO2 of(53.00±6.06)mm Hg,(1 mm Hg=0.133 kPa),D-dimer of(0.82±0.14)μg/ml and NT-proBNP of(801.70±130.19)pg/ml,which were lower than(58.55±5.05)mm Hg,(1.12±0.24)μg/ml and(945.15±248.94)pg/ml in the control group;there was a significant difference(P<0.05).There was no significant difference in oxygenation index between the two groups(P>0.05).After 7 d of treatment,LVEF of(47.35±4.34)%in the control group was higher than(43.90±3.97)%before treatment,there was a significant difference(P<0.05);the control group had TAPSE of(9.65±1.90)mm,and there was no significant difference compared with(9.85±1.84)mm before treatment(P>0.05).After 7 d of treatment,the observation group had LVEF of(51.80±5.13)%and TAPSE of(12.95±2.65)mm,which were higher than(43.15±3.15)%and(9.05±1.36)mm before treatment,and the observation group was higher than the control group;there were significant differences(P<0.05).Within 7 d of treatment,the observation group had additional dosage of furosemide injection of(40.75±11.04)mg and times of atomizing solution of(5.55±1.90)times,which were lower than(51.50±19.00)mg and(7.25±3.11)times in the control group,and there was a significant difference(P<0.05).Conclusion In the treatment of AECOPD and decompensated stage of pulmonary heart disease combined with coronary heart disease with water stasis syndrome,the combination of thumbtack needle and traditional Chinese medicine has the role of relieving airway spasm,enhancing cardiac systolic function and enhancing diuresis,which is effective and worthy of promotion in clinical application.