疏风宣肺为主辨证治疗感冒后咳嗽的临床研究
|
摘要
目的：本论文以中医学关于外感咳嗽的理论为指导,论述了中医疏风宣肺法在治疗感冒后咳嗽(外感咳嗽)中可能具有的优势。本论文的主要目的如下：感冒后咳嗽在临床中越来越多见,但目前尚缺乏有效的治疗方法,本文目的在于探求一种较好的治疗感冒后咳嗽的方法,同时感冒后咳嗽也缺乏特异性的诊断方法,所以另一个目的为寻找一种检测的有效手段。
方法：即本论文的实际操作过程,主要内容如下：病例收集主要在门诊,拟收集病例45例,将病例随机分为中药组及对照组,分别采用中药疏风宣肺法及西医对症止咳法治疗感冒后咳嗽。治疗前进行相关检查,如血常规、胸片、肺功能、气道阻力、呼出气一氧化氮检测,治疗第一天随访一次,了解症状、询问病情变化及用药情况,治疗第十天检查相关症状、询问病情、用药情况、气道阻力检测、呼出气NO检测,并建立数据库,对数据进行录入,并进行相关统计分析。
结果：经研究后,中药组及对照组总有效率经统计学分析,P<0.05,说明中药组总体疗效优于对照组,中医药在治疗感冒后咳嗽总体疗效方面优于对照组。主要症状(咳嗽)临床疗效方面,两组在治愈率、显效率、有效率、无效率方面经统计学分析,P<0.05,具有统计学意义,中医药在治疗咳嗽疗效方面优于对照组。主要症状(咳痰)临床疗效方面,两者总有效率与无效率经相关统计学分析,P<0.05,可以认为中药组在治疗咳痰总体疗效方面仍优于对照组。两组Zrs方面,中药组治疗前后经检验得P<0.05,治疗前后有差异,对照组治疗前后P<0.05,治疗前后有差异,均具有统计学意义。两组治疗后检验得P>0.05,治疗后两组未见明显差异。两组R5方面,中药组治疗前后经检验得P<0.05,治疗前后有差异,具有统计学意义,对照组治疗前后经统计学分析P>0.05,治疗前后无差异,不具有统计学意义。R20中药组治疗前后P<0.05,治疗前后有差异,具有统计学意义,对照组治疗前后P>0.05,治疗前后无差异,不具有统计学意义。两组NO呼气测定方面,治疗前后所得P值分别为中药组P<0.05,对照组P>0.05,中药组疗效优于对照组。
结论：中药组在治疗咳嗽、咳痰方面优于对照组；气道阻力方面,治疗前后中药组在呼吸总阻抗、总气道阻力、外周气道阻力方面均有明显改善；对照组呼吸总阻抗有改善两组外周气道弹性阻力方面改善均不明显；呼出气NO方面,中药组疗效优于对照组。
Objective:The thesis is based on the traditional Chinese medical (TCM) about the the theory of post infectious cough (PIC),and it discusses the method of Dredging-Wind-and-Dispersing-Lung that may have more advantages than the other methods. The main purpose of this paper are as follows:PIC has become more common in the clinical, but there are no effective methods. The purpose of this text lies in seeking a more useful method of PIC. The specificity diagnostic method about PIC is still lack,so the other purpose is to find a testing effective means.
Methods:This thesis actual operation processes are as follows:the case is collected in the outpatient,and will collect about 45cases. The cases will be divided into Chinese medicine group and control group.we will adopt the methods of Dredging-Wind-and-Dispersing-Lung and the modern medicine of cough treatment.We should do some related inspection before treatment,such as Routine blood,X-ray, pulmonary function test and airway resistance,FENO and so on.At the first day, we should know about the patient's symptoms, ask their condition changes and the resoures.At the end of the treatment,we should inspect the related symptoms, ask their condition changes, the resoures,airway resistance,FENO.The databases should be established, and we should analysis the databases.
Results:We found that the traditional Chinese medicine group and the control group total effectiveness by statistical analysis P<0.05, and in the asfect of overall efficacy Traditional Chinese medicine group is better than control group.Traditional Chinese medicine in treating PIC is better than control group.In the aspects of cough, two groups in cure rate, significant efficiency, efficient, inefficiency of statistical analysis P<0.05, there is a statistically significant,so in traditional Chinese medicine in treating cough curative is more effective than control group. Both total effectiveness and inefficient by related statistical analysis about sputum P<0.05, we can think that Chinese medicine in treatment of sputum is still better than control.In the aspect of Zrs, traditional Chinese medicine group before and after the treatment is P<0.05, there is difference before and after treatment. The control group before and after treatment is P<0.05,there is still different before and after the treatment. But the two groups after treating is P>0.05, so after treatment, the two groups did not see obvious difference. In the aspect of R5,traditional Chinese medicine group before and after the treatment is P<0.05,it is different before and after treatment, there is a statistically significant.The control group by statistical analysis before and after treatment is P>0.05, there is no differences before and after treatment. In the aspect of R20,traditional Chinese medicine group before and after treatment is P<0.05, there is a statistically significant difference. The control group before and after treatment is P>0.05, there is no difference,so there is no statistical significance. In the aspect of FENO,Before and after treatment Chinese medicine group is P<0.05, control group P>0.05, so the curative effect of Chinese medicine is better than control group.
Conclusion:The traditional Chinese medicine in treating cough and sputum is better than the control group. In the aspect of the airway resistance, before and after the treatment of Chinese medicine,Zrs,R5,R20 be improved obviously,and the control group's Zrs has improved.Both groups in X5 changs are not obvious.At the aspect of the FENO curative effect of Chinese medicine is more obvious than control group.
方法：即本论文的实际操作过程,主要内容如下：病例收集主要在门诊,拟收集病例45例,将病例随机分为中药组及对照组,分别采用中药疏风宣肺法及西医对症止咳法治疗感冒后咳嗽。治疗前进行相关检查,如血常规、胸片、肺功能、气道阻力、呼出气一氧化氮检测,治疗第一天随访一次,了解症状、询问病情变化及用药情况,治疗第十天检查相关症状、询问病情、用药情况、气道阻力检测、呼出气NO检测,并建立数据库,对数据进行录入,并进行相关统计分析。
结果：经研究后,中药组及对照组总有效率经统计学分析,P<0.05,说明中药组总体疗效优于对照组,中医药在治疗感冒后咳嗽总体疗效方面优于对照组。主要症状(咳嗽)临床疗效方面,两组在治愈率、显效率、有效率、无效率方面经统计学分析,P<0.05,具有统计学意义,中医药在治疗咳嗽疗效方面优于对照组。主要症状(咳痰)临床疗效方面,两者总有效率与无效率经相关统计学分析,P<0.05,可以认为中药组在治疗咳痰总体疗效方面仍优于对照组。两组Zrs方面,中药组治疗前后经检验得P<0.05,治疗前后有差异,对照组治疗前后P<0.05,治疗前后有差异,均具有统计学意义。两组治疗后检验得P>0.05,治疗后两组未见明显差异。两组R5方面,中药组治疗前后经检验得P<0.05,治疗前后有差异,具有统计学意义,对照组治疗前后经统计学分析P>0.05,治疗前后无差异,不具有统计学意义。R20中药组治疗前后P<0.05,治疗前后有差异,具有统计学意义,对照组治疗前后P>0.05,治疗前后无差异,不具有统计学意义。两组NO呼气测定方面,治疗前后所得P值分别为中药组P<0.05,对照组P>0.05,中药组疗效优于对照组。
结论：中药组在治疗咳嗽、咳痰方面优于对照组；气道阻力方面,治疗前后中药组在呼吸总阻抗、总气道阻力、外周气道阻力方面均有明显改善；对照组呼吸总阻抗有改善两组外周气道弹性阻力方面改善均不明显；呼出气NO方面,中药组疗效优于对照组。
Objective:The thesis is based on the traditional Chinese medical (TCM) about the the theory of post infectious cough (PIC),and it discusses the method of Dredging-Wind-and-Dispersing-Lung that may have more advantages than the other methods. The main purpose of this paper are as follows:PIC has become more common in the clinical, but there are no effective methods. The purpose of this text lies in seeking a more useful method of PIC. The specificity diagnostic method about PIC is still lack,so the other purpose is to find a testing effective means.
Methods:This thesis actual operation processes are as follows:the case is collected in the outpatient,and will collect about 45cases. The cases will be divided into Chinese medicine group and control group.we will adopt the methods of Dredging-Wind-and-Dispersing-Lung and the modern medicine of cough treatment.We should do some related inspection before treatment,such as Routine blood,X-ray, pulmonary function test and airway resistance,FENO and so on.At the first day, we should know about the patient's symptoms, ask their condition changes and the resoures.At the end of the treatment,we should inspect the related symptoms, ask their condition changes, the resoures,airway resistance,FENO.The databases should be established, and we should analysis the databases.
Results:We found that the traditional Chinese medicine group and the control group total effectiveness by statistical analysis P<0.05, and in the asfect of overall efficacy Traditional Chinese medicine group is better than control group.Traditional Chinese medicine in treating PIC is better than control group.In the aspects of cough, two groups in cure rate, significant efficiency, efficient, inefficiency of statistical analysis P<0.05, there is a statistically significant,so in traditional Chinese medicine in treating cough curative is more effective than control group. Both total effectiveness and inefficient by related statistical analysis about sputum P<0.05, we can think that Chinese medicine in treatment of sputum is still better than control.In the aspect of Zrs, traditional Chinese medicine group before and after the treatment is P<0.05, there is difference before and after treatment. The control group before and after treatment is P<0.05,there is still different before and after the treatment. But the two groups after treating is P>0.05, so after treatment, the two groups did not see obvious difference. In the aspect of R5,traditional Chinese medicine group before and after the treatment is P<0.05,it is different before and after treatment, there is a statistically significant.The control group by statistical analysis before and after treatment is P>0.05, there is no differences before and after treatment. In the aspect of R20,traditional Chinese medicine group before and after treatment is P<0.05, there is a statistically significant difference. The control group before and after treatment is P>0.05, there is no difference,so there is no statistical significance. In the aspect of FENO,Before and after treatment Chinese medicine group is P<0.05, control group P>0.05, so the curative effect of Chinese medicine is better than control group.
Conclusion:The traditional Chinese medicine in treating cough and sputum is better than the control group. In the aspect of the airway resistance, before and after the treatment of Chinese medicine,Zrs,R5,R20 be improved obviously,and the control group's Zrs has improved.Both groups in X5 changs are not obvious.At the aspect of the FENO curative effect of Chinese medicine is more obvious than control group.
引文
[1]周仙瑛.中医内科学[M].中国中医药出版社,2005,71-77.
[2]黄梓平.分型辨治感冒后咳嗽体会[J].实用中医药杂志,2008,24(3)：177.
[3]肖立成.疏风宣肺法治疗感冒后咳嗽110例[J].山西中医,2008,24(10)：10.
[4]林琳.感染后咳嗽的病因病机及辨治思路[J].江苏中药,2008,40(7)：13-14.
[5]季红燕,胡国俊,张念志,等.金宁饮对上呼吸道感染后咳嗽疗效观察[J].中国中医急症,2007,16(5)：513-514.
[6]史利卿,刘志国,席宁,等.宣肺止咳方治疗呼吸道病毒感染后咳嗽临床观察[J].北京中医药大!学学报,2004,11(3)：9-10.
[7]张天嵩,杨蓓林.定咳汤治疗感染后咳嗽的临床研究[J].辽宁中医杂志,2007,3(9)：1275-1276.
[8]戴珍.固本宣肺汤治疗感冒后咳嗽56例[J].陕西中医,2009,30(8)：954.
[9]邓屹琪,戴洁琛,江耀广.温肺疏风法治疗感染后咳嗽临床疗效观察[J].四川中医,2010,28(10)：77-78.
[10]杨小乐.感咳灵汤治疗外感咳嗽120例的体会[J].现代医药卫生,2005,21(8)：993-994.
[11]于瑞萍,李新民,马慧.止嗽散加减治疗感冒后咳嗽80例[J].长春中医药大学学报,2009,2(4)：524-525.
[12]何培芸.麻杏石甘汤加减治疗感冒后咳嗽46例[J].陕西中医,2008,29(8)：956-957.
[13]向国符.宣肺化痰汤治疗外感咳嗽80例[J].国医论坛,2001,16(4)：30.
[14]孙钢,浦明之,陈宇,等.宣清降逆法辨治感冒后咳嗽55例[J].上海中医药杂志,2007,41(12)：27-28.
[15]常建锋.中医治疗感冒后咳嗽体会[J].现代中西医结合杂志,2008,17(35)：5427.
[16]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(草案)[J].中华结核和呼吸杂志,2005,28(11)：738-744.
[17]廖明,肖正军,董尚雄.爱喘乐、沐舒坦雾化吸入治疗感冒后咳嗽疗效观察[J].中国误诊学杂志,2007,7(9)：2001-2002.
[18]陈庆,杨巍.奥亭加普米克令舒雾化吸入治疗上呼吸道感染后咳嗽的疗效观察[J].西南军医,2008,10(3)：9-10.
[19]刘志文,盂东亮,王琦.不同抗组胺药治疗感冒后咳嗽的疗效比较[J].中国现代医药杂志,2008,10(9)：74-75.
[20]冷荣柏.沙丁胺醇联合酮替酚治疗感冒后顽固性咳嗽102例疗效观察[J].中国医药指南,2009,7(3)：59-60.
[21]赵荣,朱建兵.舒利迭治疗感冒后顽固性咳嗽的疗效观察[J].中华医学实践杂志,2007,6(7)622-623.
[22]王剑梅.酮替酚联合氨茶碱治疗感冒后咳嗽临床分析[J].医学理论与实践杂志,2008,21(12)：1421-1422.
[23]刘群,庄其宏,郑超.感染后咳嗽85例临床分析[J].福建医科大学学报,2007,41(6)：505-508.
[24]唐猛.中西医结合治疗感冒后咳嗽疗效分析[J].现代中西医结合杂志,2003,12(21)：2307-2308.
[25]陈菊屏,熊瑛,李国平,等.脉冲振荡法在慢性咳嗽临床应用中的探讨[J].检验医学与临床,2007,4(8)：703-704.
[26]Sateh D, Ernst P, Lim S. Increased formation of the potent oxidant peroxynitrite in the airways of asthmatic patients is associated with induction of nitric oxide synthase:effect of inhaled glucocorticoid. FASEB J,1998,1 (2):929-937.
[27]Shelhamer JH, Levine SJ,W u T, etal, Ai rway inflammation. Ann Intern Med.1995,123:288-304.
[28]Berlyne GS, Parameswaran K, Kamada D, etal. A comparison of exhaled nitric oxide and induced sputum as markers of airway inflammation. J Aallergy Clin Immunol.2000.106:638-644.
[29]Payne, van den Toorn, Filsell S, etal. Nitric oxide and bronchial mucosal biopsies in inflammatory aspects of correlation. Am J Respir Crit Care Med,2001,161,691-692.
[30]徐端正,贡沁燕,杨藻宸.离体豚鼠气管对麻黄碱的脱敏及肾上腺素β受体的关系[J].中国药理学报.1987,8(4)：309-317.
[31]束怀德,张丽华,钟志端,等.麻黄碱对神经肌肉传递的作用[J].中国药理学报.1987.8(4)：313-317.
[32]徐秋萍.中药药理[M].贵州科技出版社,1994.239.
[33]刘青云.中药药理学[M].人民卫生出版社,2002,2：121,197-198,294-295.
[34]张宏武,邹忠梅,徐丽珍.国外医学中医中药分册[M].人民卫生出版社,2004,26(5)：269-270.
[35]王文杰.贝母[M].中国医药科技出版社,1990：203-213.
[36]徐树楠,王永梅,侯仙明,等.蝉蜕对豚鼠离体气管环的作用研究[J].中药药理与临床.2008,24(2)：4142.
[37]张建伟,窦昌贵,张勉,等.紫菀、款冬及其配伍的毒性及药效学研究[J].中国临床药理学与治疗学,2007,12(4)：405411.
[38]Jungsook CHO. NeuroProtective and antioxidant efects of the ethylacetate fraction Prepared from Tussilago farfara L. Biol. Pharm. Bull.2005,28(3):455-460.
[39]潘明.鼠曲草提取物抑菌作用初步研究[J].四川食品与发酵,2006,42(6)：53—56.
[40]李玉先,朱照静,刘晓东.半夏药理作用的研究述要[J].辽宁中医学院学报,2004,6(6)：459-460.
[2]黄梓平.分型辨治感冒后咳嗽体会[J].实用中医药杂志,2008,24(3)：177.
[3]肖立成.疏风宣肺法治疗感冒后咳嗽110例[J].山西中医,2008,24(10)：10.
[4]林琳.感染后咳嗽的病因病机及辨治思路[J].江苏中药,2008,40(7)：13-14.
[5]季红燕,胡国俊,张念志,等.金宁饮对上呼吸道感染后咳嗽疗效观察[J].中国中医急症,2007,16(5)：513-514.
[6]史利卿,刘志国,席宁,等.宣肺止咳方治疗呼吸道病毒感染后咳嗽临床观察[J].北京中医药大!学学报,2004,11(3)：9-10.
[7]张天嵩,杨蓓林.定咳汤治疗感染后咳嗽的临床研究[J].辽宁中医杂志,2007,3(9)：1275-1276.
[8]戴珍.固本宣肺汤治疗感冒后咳嗽56例[J].陕西中医,2009,30(8)：954.
[9]邓屹琪,戴洁琛,江耀广.温肺疏风法治疗感染后咳嗽临床疗效观察[J].四川中医,2010,28(10)：77-78.
[10]杨小乐.感咳灵汤治疗外感咳嗽120例的体会[J].现代医药卫生,2005,21(8)：993-994.
[11]于瑞萍,李新民,马慧.止嗽散加减治疗感冒后咳嗽80例[J].长春中医药大学学报,2009,2(4)：524-525.
[12]何培芸.麻杏石甘汤加减治疗感冒后咳嗽46例[J].陕西中医,2008,29(8)：956-957.
[13]向国符.宣肺化痰汤治疗外感咳嗽80例[J].国医论坛,2001,16(4)：30.
[14]孙钢,浦明之,陈宇,等.宣清降逆法辨治感冒后咳嗽55例[J].上海中医药杂志,2007,41(12)：27-28.
[15]常建锋.中医治疗感冒后咳嗽体会[J].现代中西医结合杂志,2008,17(35)：5427.
[16]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(草案)[J].中华结核和呼吸杂志,2005,28(11)：738-744.
[17]廖明,肖正军,董尚雄.爱喘乐、沐舒坦雾化吸入治疗感冒后咳嗽疗效观察[J].中国误诊学杂志,2007,7(9)：2001-2002.
[18]陈庆,杨巍.奥亭加普米克令舒雾化吸入治疗上呼吸道感染后咳嗽的疗效观察[J].西南军医,2008,10(3)：9-10.
[19]刘志文,盂东亮,王琦.不同抗组胺药治疗感冒后咳嗽的疗效比较[J].中国现代医药杂志,2008,10(9)：74-75.
[20]冷荣柏.沙丁胺醇联合酮替酚治疗感冒后顽固性咳嗽102例疗效观察[J].中国医药指南,2009,7(3)：59-60.
[21]赵荣,朱建兵.舒利迭治疗感冒后顽固性咳嗽的疗效观察[J].中华医学实践杂志,2007,6(7)622-623.
[22]王剑梅.酮替酚联合氨茶碱治疗感冒后咳嗽临床分析[J].医学理论与实践杂志,2008,21(12)：1421-1422.
[23]刘群,庄其宏,郑超.感染后咳嗽85例临床分析[J].福建医科大学学报,2007,41(6)：505-508.
[24]唐猛.中西医结合治疗感冒后咳嗽疗效分析[J].现代中西医结合杂志,2003,12(21)：2307-2308.
[25]陈菊屏,熊瑛,李国平,等.脉冲振荡法在慢性咳嗽临床应用中的探讨[J].检验医学与临床,2007,4(8)：703-704.
[26]Sateh D, Ernst P, Lim S. Increased formation of the potent oxidant peroxynitrite in the airways of asthmatic patients is associated with induction of nitric oxide synthase:effect of inhaled glucocorticoid. FASEB J,1998,1 (2):929-937.
[27]Shelhamer JH, Levine SJ,W u T, etal, Ai rway inflammation. Ann Intern Med.1995,123:288-304.
[28]Berlyne GS, Parameswaran K, Kamada D, etal. A comparison of exhaled nitric oxide and induced sputum as markers of airway inflammation. J Aallergy Clin Immunol.2000.106:638-644.
[29]Payne, van den Toorn, Filsell S, etal. Nitric oxide and bronchial mucosal biopsies in inflammatory aspects of correlation. Am J Respir Crit Care Med,2001,161,691-692.
[30]徐端正,贡沁燕,杨藻宸.离体豚鼠气管对麻黄碱的脱敏及肾上腺素β受体的关系[J].中国药理学报.1987,8(4)：309-317.
[31]束怀德,张丽华,钟志端,等.麻黄碱对神经肌肉传递的作用[J].中国药理学报.1987.8(4)：313-317.
[32]徐秋萍.中药药理[M].贵州科技出版社,1994.239.
[33]刘青云.中药药理学[M].人民卫生出版社,2002,2：121,197-198,294-295.
[34]张宏武,邹忠梅,徐丽珍.国外医学中医中药分册[M].人民卫生出版社,2004,26(5)：269-270.
[35]王文杰.贝母[M].中国医药科技出版社,1990：203-213.
[36]徐树楠,王永梅,侯仙明,等.蝉蜕对豚鼠离体气管环的作用研究[J].中药药理与临床.2008,24(2)：4142.
[37]张建伟,窦昌贵,张勉,等.紫菀、款冬及其配伍的毒性及药效学研究[J].中国临床药理学与治疗学,2007,12(4)：405411.
[38]Jungsook CHO. NeuroProtective and antioxidant efects of the ethylacetate fraction Prepared from Tussilago farfara L. Biol. Pharm. Bull.2005,28(3):455-460.
[39]潘明.鼠曲草提取物抑菌作用初步研究[J].四川食品与发酵,2006,42(6)：53—56.
[40]李玉先,朱照静,刘晓东.半夏药理作用的研究述要[J].辽宁中医学院学报,2004,6(6)：459-460.