小陷胸汤合千金苇茎汤加减治疗慢性阻塞性肺疾病伴肺炎临床研究

Clinical study on the treatment of chronic obstructive pulmonary disease with pneumonia by Xiaoxianxiong decoction combined with Qianjin Weijing decoction

目的:探究小陷胸汤合千金苇茎汤加减治疗慢性阻塞性肺疾病(COPD)伴肺炎的效果及对临床症状改善、炎症因子水平的影响。方法:选取82例COPD伴肺炎患者作为研究对象,简单随机(抽签法)分为常规组(n=41)和中西联合组(n=41),常规组患者接受常规治疗,中西联合组在常规组的基础上加用小陷胸汤合千金苇茎汤加减。比较两组患者临床疗效、中医症状积分、COPD严重程度(CAT)、肺功能[第一秒用力呼气容积(FEV1)、每分钟最大通气量(MVV)、FEV1/FVC]、血气指标(SaO_(2)、PaO_(2)、PaCO_(2))、血清炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)]及不良反应。结果:中西联合组治疗总有效率高于常规组(P<0.05)。治疗后,两组咳嗽痰多、喘息气急、胸闷、胸痛、发热评分下降,且治疗后中西联合组低于常规组(均P<0.05)。治疗后,两组CAT评分下降,且中西联合组低于常规组(均P<0.05)。治疗后,两组FEV1、MVV、FEV1/FVC升高,且治疗后中西联合组高于常规组(均P<0.05)。治疗后,两组SaO_(2)、PaO_(2)升高,PaCO_(2)下降(均P<0.05);且治疗后中西联合组SaO_(2)、PaO_(2)高于常规组(均P<0.05)。治疗后,两组IL-6、CRP、PCT下降,且中西联合组低于常规组(均P<0.05)。常规组出现2例恶心、头晕,中西联合组出现3例恶心、头晕,1例腹胀,组间不良反应比较差异无统计学意义(χ2=0.213,P>0.05)。结论:在常规治疗基础上加用小陷胸汤合千金苇茎汤加减治疗COPD伴肺炎患者临床疗效显著,能有效改善患者肺功能、血气指标,并降低炎性因子水平,同时具备较好的安全性。

Objective:To explore the effect of modified Xiaoxianxiong decoction with Qianjin Weijing decoction in the treatment of chronic obstructive pulmonary disease(COPD)with pneumonia and its influence on clinical symptom improvement and levels of inflammatory factors.Methods:82 patients with COPD complicated with pneumonia were selected as the research subjects,and were divided into conventional group(n=41)and Chinese-western combination group(n=41)by simple randomization(lottery method).The patients in the conventional group received conventional treatment,while the patients in the Chinese-western combination group were added with modified Xiaoxianxiong decoction with Qianjin Weijing decoction on the basis of the conventional group.The clinical efficacy,TCM symptom scores and COPD severity(CAT),pulmonary function(FEV1,MVV,FEV1/FVC),blood gas indicators(SaO_(2),PaO_(2),PaCO_(2))and serum inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT)]before and after treatment and adverse reactions were compared between both groups.Results:The total effective rate of treatment in Chinese-western combination group was higher than that in conventional group(P<0.05).After treatment,the scores of cough and excessive phlegm,wheezing and shortness of breath,chest tightness,chest pain and fever in the two groups were decreased,and the above scores in Chinese-western combination group were lower than those in conventional group(all P<0.05).The CAT score in the two groups was decreased after treatment,and the CAT score in Chinese-western combination group after treatment was lower than that in conventional group(all P<0.05).After treatment,the FEV1,MVV and FEV1/FVC were enhanced in both groups,and the indicators were higher in Chinese-western combination group after treatment(all P<0.05).After treatment,SaO_(2)and PaO_(2)in the two groups were risen,while PaCO_(2)was reduced(all P<0.05);SaO_(2)and PaO_(2)in Chinese-western combination group were higher than those in conventional group after treatment(all P<0.05).The levels of IL-6,CRP and PCT were decreased in the two groups after treatment,and the levels in Chinese-western combination group were lower than those in conventional group(all P<0.05).There were two cases of nausea and dizziness in conventional group,and there were three cases of nausea and dizziness and one case of abdominal distension in Chinese-western combination group(χ2=0.213,P>0.05).Conclusion:On the basis of conventional treatment,the addition of modified Xiaoxianxiong decoction with Qianjin Weijing decoction has significant clinical efficacy in the treatment of COPD patients with pneumonia,and it can effectively improve the pulmonary function and blood gas indicators,and reduce the levels of inflammatory factors,and has good safety.