王有鹏教授治疗寒地儿童荨麻疹的临证经验

王有鹏教授基于对寒地地域特点及小儿生理病理特点认识,立足临床实践,对寒地儿童荨麻疹的诊疗具有独到见解。王有鹏教授从发病邪气、脏腑、体质三个层面总结其病因病机为风邪主导,寒、热、湿邪兼杂为患;肺脾肾三脏虚损,心肝亢盛为本;同时受先天禀赋及体质因素的影响。根据寒地儿童荨麻疹发病特点将其分为风邪袭表证、湿热蕴肤证、肺脾气虚证,治疗以调和脏腑为本,祛除病邪为标,运用合方随证施治,同时兼顾调体养护,防患于未然,可取得较好疗效。

Clinical Effect of Yinma Zhisou Decoction Combined with Western Medicine in the Treatment of Acute COPD(Stagnation of PhlegmDampness in Lung)

[Objectives]To explore the effectiveness and safety of Yinma Zhisou Decoction in the treatment of AECOPD with phlegm-heat obstructing lung syndrome,and observe the symptoms of Yinma Zhisou decoction in the treatment of AECOPD patients with phlegm-heat stagnation lung syndrome improvement,inflammatory indicators,lung function,blood gas analysis,etc.[Methods]A total of 92 cases who met the inclusion criteria and exclusion criteria were included in the study according to 1∶1 were randomly divided into treatment group and control group,control group with conventional Western medicine treatment,the treatment group on the basis of control group with Yinma Zhisou decoction treatment,a course of 10 d.The changes in TCM syndrome score,arterial blood gas analysis,pulmonary function,serum inflammatory indicator,mMRC score,and the CAT scores between the two groups after treatment were observed.All collected data were statistically analyzed with SPSS 26.0.[Results](i)Comparison of the curative effect between the two groups.After treatment,the total effective rate of the treatment group was 93.5%,which was higher than that of the control group(76.1%,P<0.05).The curative effect of the treatment group was better than that of the control group(P<0.05).(ii)Comparison of single TCM symptom scores.After treatment,the single TCM symptom scores of the two groups were lower than before(P<0.05),but the improvement of wheezing,cough,phlegm and chest pain in the treatment group was better than that in the control group(P<0.05).There was no significant difference in the improvement of wheezing sound(P>0.05),but there was a trend of difference.(iii)Comparison of mMRC score and CAT score between the two groups.After treatment,the mMRC score and CAT score of the two groups were significantly improved(P<0.05),and the difference was statistically significant.(iv)Comparison of blood gas analysis indicators between the two groups.Intra-group comparison after treatment:PaOof the control group and the treatment group after treatment was significantly improved compared with that before treatment(P<0.05),and the difference was statistically significant.Comparison between the two groups after treatment:PaOand PaCOof the two groups after treatment(P>0.05),and the difference was not statistically significant.It indicated that Yinma Zhisou decoction had more advantages in improving hypoxia.(v)Comparison of pulmonary function between the two groups.After treatment,the FEV1/FVC of the treatment group and the control group was significantly different(P<0.05),and there was a statistical difference(P<0.05).(vi)Comparison of inflammatory indicators between the two groups.Intra-group comparison after treatment:the inflammatory indicators WBC,CRP and PCT in the control group and the treatment group were significantly lower than before treatment(P<0.05),and the differences were statistically significant.It indicated that Yinma Zhisou decoction could effectively control inflammation and reduce inflammation reaction.[Conclusions]Compared with the control group,Yinma Zhisou decoction has obvious advantages in improving cough,expectoration and wheezing,and can significantly improve the total effective rate.Compared with Western medicine alone,Yinma Zhisou decoction can significantly improve patients’hypoxia,reduce mMRC and CAT scores,improve body activity tolerance,improve airway symptoms,and significantly reduce WBC,CRP,PCT and other serum inflammatory indicators.It can be seen that Yinma Zhisou decoction combined with Western medicine treatment is obviously better than simple Western medicine treatment,the curative effect is better,and the safety is better,and there are no serious adverse reactions in the course of the trial.

二陈汤合三子养亲汤加味治疗职业性尘肺病的疗效观察

目的:观察二陈汤合三子养亲汤加味治疗职业性尘肺病,辨证为痰湿蕴肺型咳嗽的临床疗效。方法:将已明确诊断尘肺病,经辨证为痰湿蕴肺型咳嗽的60例患者,随机分为两组,每组30例。对照组运用西医治疗方法。治疗组在对照组的基础上联合二陈汤合三子养亲汤加味口服,观察疗效。结果:对照组总有效率73.3%,治疗组总有效率93.3%。两者比较差异有统计学意义(P<0.05)。结论:二陈汤合三子养亲汤加味治疗职业性尘肺病痰湿蕴肺型咳嗽有较好疗效。

生半夏与制半夏对寒饮蕴肺型大鼠祛痰疗效比较

目的比较生半夏和其炮制品法半夏对寒饮蕴肺型大鼠祛痰的疗效差异,并比较不同剂量生半夏的化痰疗效。方法将70只大鼠随机分为正常对照组、寒饮蕴肺组、寒饮蕴肺沐舒坦组、寒饮蕴肺法半夏组、寒饮蕴肺生半夏低剂量组、中剂量组和高剂量组,每组10只。采取寒冷环境中喂养,烟熏联合冷水浴造模,中药干预组按照不同剂量给药,观察记录各组大鼠一般情况、体质量、痰液分泌量。结果造模后各组较正常对照组大鼠活动减少,体温降低,气促,唇鼻青紫并有分泌物,喷嚏(咳嗽)现象明显,与寒饮蕴肺证相似。与正常对照组相比,造模后第15天,各组大鼠体质量明显下降,差异有统计学意义(P <0.01)。与造模沐舒坦组和法半夏组相比,造模生半夏中剂量组、高剂量组排痰量更多,差异均有统计学意义(P <0.05,P <0.01)。结论生半夏中剂量组、高剂量组对寒饮蕴肺型大鼠祛痰疗效优于制半夏组。

桂龙咳喘宁片联合西药治疗慢性支气管炎急性发作期痰湿蕴肺证临床疗效分析

目的:观察桂龙咳喘宁片联合西药治疗慢性支气管炎急性发作期痰湿蕴肺证的临床疗效。方法:将纳入的慢性支气管炎急性发作期痰湿蕴肺证患者随机分为对照组和观察组。对照组59例服用盐酸氨溴索片,合并感染者加用阿莫西林胶囊,喘息严重者加用氨茶碱口服溶液。观察组58例在对照组治疗的基础上加用桂龙咳喘宁片。2组疗程均为10天。治疗前后评价咳嗽症状积分、痰湿蕴肺证积分、咳嗽视觉模拟评分法(VAS)评分,记录咳嗽缓解时间,评价2组的临床疗效。采用莱塞斯特咳嗽生命质量问卷(LCQ)评定生活质量。结果:愈显率观察组为82.76%,对照组为66.10%,组间比较,差异有统计学意义(P<0.05)。2组白天咳嗽积分、夜间咳嗽积分、总分和咳嗽VAS评分均较治疗前降低(P<0.01),观察组咳嗽积分、总分和咳嗽VAS评分均低于对照组(P<0.01);观察组咳嗽缓解时间短于对照组(P<0.01)。2组LCQ(生理、心理、社会)3个维度评分和总分均较治疗前升高(P<0.01),痰湿蕴肺证积分均较治疗前下降(P<0.01);观察组LCQ各维度评分和总分均高于对照组(P<0.01),痰湿蕴肺证积分低于对照组(P<0.01)。结论:在常规西药基础上加用桂龙咳喘宁片治疗慢性支气管炎急性发作期痰湿蕴肺证患者,可进一步控制咳嗽等症状,提高患者的生活质量,临床疗效优于单纯西药治疗。

清金止咳解痉汤治疗老年慢性支气管炎急性发作痰湿蕴肺证

目的探讨清金止咳解痉汤治疗老年慢性支气管炎急性发作痰湿蕴肺证的临床疗效。方法将老年慢性支气管炎急性发作患者102例随机分为对照组和观察组,各51例。对照组予常规西药治疗,观察组在对照组基础上联合清金止咳解痉汤治疗,2组疗程均为7 d,对比2组中医证候积分,炎症指标C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6),血气分析指标血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、二氧化碳分压(PCO_(2)),肺功能指标最大肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC,SF-36评分及临床疗效,记录2组不良反应发生情况。结果治疗后观察组中医证候积分、CRP、TNF-α、IL-6、PCO_(2)指标水平均低于对照组(P<0.05),SaO_(2)、PaO_(2)、FVC、FEV_(1)、FEV_(1)/FVC指标水平及生活质量各维度评分均高于对照组(P<0.05);观察组总有效率(92.16%,47/51)高于对照组(76.47%,39/51)(P<0.05);2组均未发生严重不良反应,不良反应发生率组间比较差异无统计学意义(P>0.05)。结论清金止咳解痉汤结合常规西药治疗老年慢性支气管炎急性发作疗效良好,能够调节患者血气指标,抑制炎症反应,改善肺功能。