莫西沙星联合银翘散加减方治疗医院获得性肺炎的临床价值
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摘要
目的：选择湖北省中医院呼吸内科部分住院病人,观察比较治疗组与对照组病人,探讨莫西沙星联合银翘散加减方治疗医院获得性肺炎(HAP)的临床价值。
方法：湖北省中医院患医院获得性肺炎患者35例,中医诊断咳嗽、喘证。从中筛选符合下列条件的患者：无合并其它基础疾病,非孕妇或哺乳期妇女,均无对喹诺酮类及大环内酯类药物过敏史。可评价病例共31例。随机分成治疗组和对照组,治疗组15例,对照组16例。对照组常规治疗。治疗组和对照组在性别、年龄、体质量、既往病史、病情、心电图、检查结果和痰培养等方面,无统计学差异,具有可比性。
治疗组对症常规治疗并给予莫西沙星片(拜复乐,德国Bayer公司拜尔药厂生产,规格400mg/片。口服,400mg/次,1次/天。),银翘散加减方(连翘、银花、苦桔梗、薄荷、竹叶、生甘草、荆芥穗、淡豆豉、牛蒡子。临证加减：热夹混浊,胸膈满闷,加藿香、郁金；津伤渴甚,加花粉；热毒较甚、项肿咽痛,加元参；肺气不利,咳甚,加杏仁；热渐入里,加细生地、麦冬；再不解,加知母、黄芩)。对照组常规治疗(对症治疗、随后根据痰培养选用抗生素)。
疗效评定：根据卫生部颁发《抗菌药物临床研究指导标准》,根据临床症状、体征、实验室检查和细菌学检查进行综合评价以确定临床疗效,按痊愈、显效、进步和无效4级评定。
结果：
治疗组与对照组在年龄、性别、治疗前症状评分、感染的细菌种类上均无统计学差异,具有可比性。
治疗后,治疗组与对照组在治疗后症状评分、所感染的细菌清除率上均有统计学差异,且治疗组细菌清除率为90.6%>对照组71.0%,,故可说明治疗组的临床治疗效果较对照组好。
治疗后,治疗组与对照组在疗效等级、总有效率上无统计学差异,但治疗组有效率[总有效/总数]68.8%>对照组有效率48.4%。
治疗后,治疗组与对照组,均出现了2例较轻症状的不良反应,且无统计学差异。
结论：
可认为：莫西沙星联合银翘散加减方在临床治疗医院获得性肺炎(HAP)上有较为可靠的价值。
Purpose:To select some of Respiratory Medicine, Hubei Province, Chinese medicine hospital in-patients, observed and compared the treatment group and control group patients, of moxifloxacin combined Yinqiaosan Treatment of Modified Hospital acquired pneumonia (HAP) of clinical value.
Method:Hubei Province Chinese Medicine Hospital suffering from hospital-acquired pneumonia in 35 patients, diagnosis of cough medicine, Asthma. Selected from patients meeting the following requirements: None combined with other underlying diseases, non-pregnant or lactating women, no to quinolones and macrolides history of drug allergy.31 patients evaluable patients. Randomly divided into treatment group and control group, treatment group 15 cases,16 cases of the control group. Routine treatment control group. Treatment and control groups in gender, age, body weight, past medical history, disease, electrocardiogram, examination results, and sputum culture and so on, no significant difference between comparable.
Symptomatic treatment group given routine treatment and moxifloxacin tablets (thanks to complex music, the German Bayer Corporation Bayer Pharmaceuticals production, specifications 400mg/tablet. Oral,400mg/ times,1 time/day.), Plus or minus side Yinqiaosan (Forsythia, Silver Flower, bitter Campanulaceae, mint, bamboo leaves, raw licorice, Schizonepeta spike, SSP, Arctium. Clinical Modified:hot clip is poor, mediastinoscopy full nausea, plus Agastache rugosa, turmeric; Tianjin injury very thirsty, plus pollen; heat rather than toxicity, entry swollen sore throat, Canadian participation; lung negative, cough and even, Almond; heat gradually into the years, plus fine habitat, Ophiopogon japonicus; further understand, plus Zhimu, skullcap). Routine treatment control group (symptomatic treatment, then use antibiotics according to sputum culture).
Efficacy Evaluation:According to the Ministry of Health issued "Guidance on Clinical Investigation of antibiotics standards", based on clinical symptoms, signs, laboratory tests, and bacteriology comprehensive assessment to determine the clinical efficacy, according to recover markedly, progress and assessment invalid 4.
Results:Treatment and control groups in age, gender, symptom score before treatment, the infection had no significant difference between the types of bacteria, comparable.
After treatment, the treatment group and control group in symptom score after treatment, the infection rate of bacterial clearance were statistically significant, and the treatment of the bacterial eradication rate was 90.6%> 71.0% in control group, and therefore may explain the clinical treatment group better treatment than the control group.
After treatment, the treatment group and control group in efficacy levels, the total effective rate was not statistically significant, but the efficiency of the treatment group [total effective/total] 68.8%> control group was 48.4%.
After treatment, the treatment group and control group, there were two cases of minor symptoms of adverse reactions, and no significant difference.
Conclusion:Can be considered:joint Yinqiaosan moxifloxacin plus or minus side in the clinical treatment of hospital-acquired pneumonia (HAP) have a more reliable value.
方法：湖北省中医院患医院获得性肺炎患者35例,中医诊断咳嗽、喘证。从中筛选符合下列条件的患者：无合并其它基础疾病,非孕妇或哺乳期妇女,均无对喹诺酮类及大环内酯类药物过敏史。可评价病例共31例。随机分成治疗组和对照组,治疗组15例,对照组16例。对照组常规治疗。治疗组和对照组在性别、年龄、体质量、既往病史、病情、心电图、检查结果和痰培养等方面,无统计学差异,具有可比性。
治疗组对症常规治疗并给予莫西沙星片(拜复乐,德国Bayer公司拜尔药厂生产,规格400mg/片。口服,400mg/次,1次/天。),银翘散加减方(连翘、银花、苦桔梗、薄荷、竹叶、生甘草、荆芥穗、淡豆豉、牛蒡子。临证加减：热夹混浊,胸膈满闷,加藿香、郁金；津伤渴甚,加花粉；热毒较甚、项肿咽痛,加元参；肺气不利,咳甚,加杏仁；热渐入里,加细生地、麦冬；再不解,加知母、黄芩)。对照组常规治疗(对症治疗、随后根据痰培养选用抗生素)。
疗效评定：根据卫生部颁发《抗菌药物临床研究指导标准》,根据临床症状、体征、实验室检查和细菌学检查进行综合评价以确定临床疗效,按痊愈、显效、进步和无效4级评定。
结果：
治疗组与对照组在年龄、性别、治疗前症状评分、感染的细菌种类上均无统计学差异,具有可比性。
治疗后,治疗组与对照组在治疗后症状评分、所感染的细菌清除率上均有统计学差异,且治疗组细菌清除率为90.6%>对照组71.0%,,故可说明治疗组的临床治疗效果较对照组好。
治疗后,治疗组与对照组在疗效等级、总有效率上无统计学差异,但治疗组有效率[总有效/总数]68.8%>对照组有效率48.4%。
治疗后,治疗组与对照组,均出现了2例较轻症状的不良反应,且无统计学差异。
结论：
可认为：莫西沙星联合银翘散加减方在临床治疗医院获得性肺炎(HAP)上有较为可靠的价值。
Purpose:To select some of Respiratory Medicine, Hubei Province, Chinese medicine hospital in-patients, observed and compared the treatment group and control group patients, of moxifloxacin combined Yinqiaosan Treatment of Modified Hospital acquired pneumonia (HAP) of clinical value.
Method:Hubei Province Chinese Medicine Hospital suffering from hospital-acquired pneumonia in 35 patients, diagnosis of cough medicine, Asthma. Selected from patients meeting the following requirements: None combined with other underlying diseases, non-pregnant or lactating women, no to quinolones and macrolides history of drug allergy.31 patients evaluable patients. Randomly divided into treatment group and control group, treatment group 15 cases,16 cases of the control group. Routine treatment control group. Treatment and control groups in gender, age, body weight, past medical history, disease, electrocardiogram, examination results, and sputum culture and so on, no significant difference between comparable.
Symptomatic treatment group given routine treatment and moxifloxacin tablets (thanks to complex music, the German Bayer Corporation Bayer Pharmaceuticals production, specifications 400mg/tablet. Oral,400mg/ times,1 time/day.), Plus or minus side Yinqiaosan (Forsythia, Silver Flower, bitter Campanulaceae, mint, bamboo leaves, raw licorice, Schizonepeta spike, SSP, Arctium. Clinical Modified:hot clip is poor, mediastinoscopy full nausea, plus Agastache rugosa, turmeric; Tianjin injury very thirsty, plus pollen; heat rather than toxicity, entry swollen sore throat, Canadian participation; lung negative, cough and even, Almond; heat gradually into the years, plus fine habitat, Ophiopogon japonicus; further understand, plus Zhimu, skullcap). Routine treatment control group (symptomatic treatment, then use antibiotics according to sputum culture).
Efficacy Evaluation:According to the Ministry of Health issued "Guidance on Clinical Investigation of antibiotics standards", based on clinical symptoms, signs, laboratory tests, and bacteriology comprehensive assessment to determine the clinical efficacy, according to recover markedly, progress and assessment invalid 4.
Results:Treatment and control groups in age, gender, symptom score before treatment, the infection had no significant difference between the types of bacteria, comparable.
After treatment, the treatment group and control group in symptom score after treatment, the infection rate of bacterial clearance were statistically significant, and the treatment of the bacterial eradication rate was 90.6%> 71.0% in control group, and therefore may explain the clinical treatment group better treatment than the control group.
After treatment, the treatment group and control group in efficacy levels, the total effective rate was not statistically significant, but the efficiency of the treatment group [total effective/total] 68.8%> control group was 48.4%.
After treatment, the treatment group and control group, there were two cases of minor symptoms of adverse reactions, and no significant difference.
Conclusion:Can be considered:joint Yinqiaosan moxifloxacin plus or minus side in the clinical treatment of hospital-acquired pneumonia (HAP) have a more reliable value.
引文
[1]、中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案).中华结核和呼吸杂志.1999；22(4)：201-203
[2]、文细毛,任南,徐秀华,等.全国医院感染监控网医院感染病原菌分布与耐药性分析.中华医院感染学杂志.2002,12(4)：241-244
[3]、王辉,陈民均.1994年～2001年中国重症监护病房非发酵细菌的耐药变迁.中国医学杂志,2003,85(5)：385
[4]、PamelaAH.莫西沙星.中国实用内科杂志。2002。
[5]、崔德健。医院获得性肺炎药物治疗评价。中国医院用药评价与分析2008年第8卷第3期
[6]、何礼贤.应用莫西沙星治疗医院获得性肺炎的临床前景.中国实用内科杂志,2005,12(25)：148
[7]、卢宝珍。医院获得性肺炎的预防与控制。
[8]陈灏珠.实用内科学.第12版.北京：人民卫生出版社,2005.
[9]、杨华明,易滨.现代医院消毒学.北京：人民军医出版社,2002：36.
[10]、刘振声,金大鹏,陈增辉.医院感染管理学.北京：人民卫生出版社,2000：464.
[11]、李澎涛,张娜,朱晓磊,等痰热清注射液抗内毒素所致急性肺损伤的实验研究.中国医学杂志,2005 40(7)：518-521.
[12]、黄登鹏,潘速跃,邓虹,等.痰热清注射液治疗中枢性高热的疗效和机制探讨.中国中医急症,2006,15
[13]、熊旭东,赵敏.痰热清注射液治疗急性肺炎疗效研究(附60例临床对照观察).中华中西医结合杂志,2003
[14]、高立栋,王秀梅,齐连德,郭敏。中西医结合治疗医院获得性肺炎临床观察。实用中医药杂志,2007 12。
[2]、文细毛,任南,徐秀华,等.全国医院感染监控网医院感染病原菌分布与耐药性分析.中华医院感染学杂志.2002,12(4)：241-244
[3]、王辉,陈民均.1994年～2001年中国重症监护病房非发酵细菌的耐药变迁.中国医学杂志,2003,85(5)：385
[4]、PamelaAH.莫西沙星.中国实用内科杂志。2002。
[5]、崔德健。医院获得性肺炎药物治疗评价。中国医院用药评价与分析2008年第8卷第3期
[6]、何礼贤.应用莫西沙星治疗医院获得性肺炎的临床前景.中国实用内科杂志,2005,12(25)：148
[7]、卢宝珍。医院获得性肺炎的预防与控制。
[8]陈灏珠.实用内科学.第12版.北京：人民卫生出版社,2005.
[9]、杨华明,易滨.现代医院消毒学.北京：人民军医出版社,2002：36.
[10]、刘振声,金大鹏,陈增辉.医院感染管理学.北京：人民卫生出版社,2000：464.
[11]、李澎涛,张娜,朱晓磊,等痰热清注射液抗内毒素所致急性肺损伤的实验研究.中国医学杂志,2005 40(7)：518-521.
[12]、黄登鹏,潘速跃,邓虹,等.痰热清注射液治疗中枢性高热的疗效和机制探讨.中国中医急症,2006,15
[13]、熊旭东,赵敏.痰热清注射液治疗急性肺炎疗效研究(附60例临床对照观察).中华中西医结合杂志,2003
[14]、高立栋,王秀梅,齐连德,郭敏。中西医结合治疗医院获得性肺炎临床观察。实用中医药杂志,2007 12。