清肺化痰汤联合NIPPV治疗对痰热郁肺型AECOPD患者临床疗效、中医证候积分及炎性细胞因子的影响
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摘要
目的:探讨清肺化痰汤联合无创正压通气(NIPPV)治疗对痰热郁肺型慢性阻塞性肺疾病急性加重期(AECOPD)患者临床疗效、中医证候积分及炎性细胞因子的影响。方法:选取2014年10月—2017年10月医院收治的AECOPD患者100例作为研究对象,辨证为痰热郁肺型,采用随机数字表法将患者分为观察组和对照组,每组各50例。对照组给予NIPPV治疗,观察组在对照组基础上加用清肺化痰汤治疗,两组均用药14d。观察两组近期疗效及治疗前后主要临床体征评分、血气指标、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、白介素8(IL-8)水平变化。出院后随访6个月,记录2组患者内COPD急性加重后再入院率。结果:观察组治疗有效率为92.0%,高于对照组的78.0%(P<0.05);观察组治疗后咳嗽、咳痰、胸闷评分均低于对照组,差异有统计学意义(P<0.05);观察组治疗后二氧化碳分压(PaCO_2)低于对照组,氧分压(PaO_2)高于对照组,差异有统计学意义(P<0.05);观察组治疗后TNF-α、IL-6、IL-8水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后6个月内COPD急性加重后再入院率为8.0%,低于对照组的24.0%,差异有统计学意义(P<0.05)。结论:清肺化痰汤联合NIPPV治疗AECOPD,可改善咳嗽、咳痰等症状,减轻炎症程度,提高临床疗效,降低COPD急性加重后再入院率。
Objective:To investigate the effect of Qingfei Huatan Decoction combined with non-invasive positive pressure ventilation(NIPPV),TCM syndrome scores and inflammatory cytokines in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) due to phlegm-heat obstructing lung.Methods:Totally 100 patients with AECOPD due to phlegm-heat obstructing lung who were admitted to the hospital from October 2014 to October 2017 were selected as the subjects.They were divided into the observation group and the control group by random number table method,with 50 cases in each group.The control group was treated with NIPPV,while the observation group was treated with Qingfei Huatan Decoction combined with NIPPV.The two groups were given 14 d treatment.The short-term curative effect,changes in scores of main clinical signs,blood gas indexes,tumor necrosis factor alpha(TNF-α),interleukin 6(IL-6) and interleukin 8(IL-8) in the two groups before and after treatment were observed.After 6 months of follow-up after discharge,the readmission rates of the two groups were recorded.Results:The effective rate of treatment in the observation group was higher than that in the control group(92.0% vs 78.0%)(P<0.05).Scores of cough,expectoration and chest tightness in the observation group were lower than those in the control group(P<0.05).After treatment,the partial presssure of carbon dioxide(PaCO_2) of the observation group was lower than that of the control group,while the partial pressure of oxygen(PaO_2) was higher than that of the control group(P<0.05).After treatment,TNF-α,IL-6 and IL-8 in the observation group were lower than those in the control group(P<0.05).The readmission rate of the observation group in 6 months after treatment was lower than that of the control group(8.0% vs 24.0%)(P<0.05).Conclusion:Qingfei Huatan Decoction combined with NIPPV can relieve symptoms such as cough and expectoration,alleviate the inflammatory degree,improve the clinical curative effect and reduce the readmission rate after acute exacerbation of COPD.
Objective:To investigate the effect of Qingfei Huatan Decoction combined with non-invasive positive pressure ventilation(NIPPV),TCM syndrome scores and inflammatory cytokines in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) due to phlegm-heat obstructing lung.Methods:Totally 100 patients with AECOPD due to phlegm-heat obstructing lung who were admitted to the hospital from October 2014 to October 2017 were selected as the subjects.They were divided into the observation group and the control group by random number table method,with 50 cases in each group.The control group was treated with NIPPV,while the observation group was treated with Qingfei Huatan Decoction combined with NIPPV.The two groups were given 14 d treatment.The short-term curative effect,changes in scores of main clinical signs,blood gas indexes,tumor necrosis factor alpha(TNF-α),interleukin 6(IL-6) and interleukin 8(IL-8) in the two groups before and after treatment were observed.After 6 months of follow-up after discharge,the readmission rates of the two groups were recorded.Results:The effective rate of treatment in the observation group was higher than that in the control group(92.0% vs 78.0%)(P<0.05).Scores of cough,expectoration and chest tightness in the observation group were lower than those in the control group(P<0.05).After treatment,the partial presssure of carbon dioxide(PaCO_2) of the observation group was lower than that of the control group,while the partial pressure of oxygen(PaO_2) was higher than that of the control group(P<0.05).After treatment,TNF-α,IL-6 and IL-8 in the observation group were lower than those in the control group(P<0.05).The readmission rate of the observation group in 6 months after treatment was lower than that of the control group(8.0% vs 24.0%)(P<0.05).Conclusion:Qingfei Huatan Decoction combined with NIPPV can relieve symptoms such as cough and expectoration,alleviate the inflammatory degree,improve the clinical curative effect and reduce the readmission rate after acute exacerbation of COPD.
引文
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[18]俞静静,苏洁,吕圭源.陈皮抗心脑血管疾病相关药理研究进展[J].中草药,2016,47(17):3127-3132.
[19]任丽花,辛蕊华,彭文静,等.紫菀不同极性段提取物的药效比较[J].南方农业学报,2015,46(4):675-679.
[20]徐旭,窦德强.茯苓对免疫低下小鼠免疫增强的物质基础研究[J].时珍国医国药,2016,27(3):592-593.
[21]汤杰,张静灏,李海燕,等.蠲饮泄肺方联合西药治疗慢性阻塞性肺疾病急性加重期随机对照双盲研究[J].中医杂志,2015,56(5):387-391.
[22]李新玲,吴振国,朱颀峰.慢性阻塞性肺疾病急性加重期血清白介素-6表达变化与肺炎衣原体感染的相关性[J].中华医院感染学杂志,2015,25(2):247-249.
[2] Lange P,Celli B,Agustí A,et al.Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease[J].New England Journal of Medicine,2015,373(2):111-122.
[3] Schreiber A,Esquinas A.Clarifying aspects of noninvasive mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease[J].Turkish Journal of Medical Sciences,2016,46(1):241-242.
[4] 柳涛,蔡柏蔷.慢性阻塞性肺疾病诊断、处理和预防全球策略2013年版介绍[J].中华结核和呼吸杂志,2013,36(11):805-807.
[5] 李建生,李素云,余学庆.慢性阻塞性肺疾病中医诊疗指南(2011版)[J].中医杂志,2012,53(1):80-84.
[6] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:58-60.
[7] 鲁西亮,黄相增.无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效观察[J].实用医学杂志,2015,31(17):2842-2844.
[8] 潘宜,黄晓颖.布地奈德联合沙丁胺醇和异丙托溴铵治疗慢性阻塞性肺疾病急性发作期的临床研究[J].中国临床药理学杂志,2016,32(15):1347-1349.
[9] 钟杨,曲妮妮.从肺主治节分析慢性阻塞性肺疾病中医致病机理[J].辽宁中医药大学学报,2015,17(3):143-145.
[10] 许贵军,李志军,王琦,等.鱼腥草的抗炎活性成分[J].中国药科大学学报,2016,47(3):294-298.
[11] 王翰华,杨晓春,崔明超,等.浙贝母花配伍宁海白枇杷花的止咳化痰作用[J].中成药,2017,39(9):1921-1923.
[12] 李航,李建峰,张宇,等.瓜蒌皮对高血脂合并急性心肌缺血大鼠保护作用[J].辽宁中医药大学学报,2016,18(7):22-25.
[13] 袁嘉瑞,汪春飞,宋捷,等.淫羊藿醇提物抑制肺癌生长及调节免疫作用研究[J].中国中药杂志,2016,41(1):112-117.
[14] 刘思源,张舜,任丽颖,等.桑类药材多羟基生物碱分离的研究进展[J].中国实验方剂学杂志,2015,21(15):221-225.
[15] 郑勇凤,王佳婧,傅超美,等.黄芩的化学成分与药理作用研究进展[J].中成药,2016,38(1):141-147.
[16]罗放,尹平平,李珍.杏仁核注射U0126对芬太尼诱发大鼠痛觉过敏的镇痛效应[J].临床麻醉学杂志,2016,32(8):794-797.
[17]孙慧玲,彭琳娜,周娟,等.苏子油药理作用研究进展[J].中成药,2016,38(3):630-633.
[18]俞静静,苏洁,吕圭源.陈皮抗心脑血管疾病相关药理研究进展[J].中草药,2016,47(17):3127-3132.
[19]任丽花,辛蕊华,彭文静,等.紫菀不同极性段提取物的药效比较[J].南方农业学报,2015,46(4):675-679.
[20]徐旭,窦德强.茯苓对免疫低下小鼠免疫增强的物质基础研究[J].时珍国医国药,2016,27(3):592-593.
[21]汤杰,张静灏,李海燕,等.蠲饮泄肺方联合西药治疗慢性阻塞性肺疾病急性加重期随机对照双盲研究[J].中医杂志,2015,56(5):387-391.
[22]李新玲,吴振国,朱颀峰.慢性阻塞性肺疾病急性加重期血清白介素-6表达变化与肺炎衣原体感染的相关性[J].中华医院感染学杂志,2015,25(2):247-249.