【作者】 刘晓丹；

【导师】 金宏柱；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 目的：本文从系统文献的理论研究及临床研究两方面验证健身气功养肺处方对COPD稳定期患者的防治作用,并进一步探讨其发挥作用的机理。方法：本研究选用2008年10月—2010年10月期间江苏省省级机关医院门诊及病房出院后符合2007年《慢性阻塞性肺疾病诊治指南标准》中诊断标准及分级标准中Ⅰ级和Ⅱ级COPD稳定期患者118例作为实验对象,其中,Ⅰ级患者57例,随机分为对照1组17例,对照2组15例,实验组25例。三组均不服用药物,对照2组执行缩唇呼吸+步行处方,实验组执行健身气功养肺处方。Ⅱ级患者61例,随机分为对照1组18例,对照2组17例,实验组26例。三组均服用药物舒利迭,对照2组在服用药物基础上执行缩唇呼吸+步行处方,实验组在服用药物基础上,加练健身气功养肺处方。执行处方时间为6个月,观察经过6个月健身气功养肺处方治疗前后肺功能、运动耐力、临床症状积分、生活质量评分、动脉血气分析、急性发作次数、疗效、用药量变化、不良反应等指标的变化情况。结果：Ⅰ级患者：1)三组在实验前后FEV1(%)及FEV1/FVC(％)比较无明显差异,组间比较无差异。2)对照1组在实验前后6min步行距离无差异；对照2组及实验组实验后与实验前比较有明显差异,与对照1组组间比较有明显差异。3)对照1组在实验前后临床症状积分无差异；对照2组实验后与实验前比较咳嗽、咳痰、喘息、气短症状积分明显下降；自汗、易感冒、哮鸣音症状积分无差异;与对照1组组间比较喘息、气短症状积分明显下降；咳嗽症状积分有下降；咳痰、自汗、易感冒、哮鸣音症状积分无差异。实验组实验后与实验前比较咳嗽、咳痰、喘息、易感冒、气短症状积分明显下降；自汗、哮鸣音症状积分无改变；与对照1组组间比较喘息、易感冒症状积分明显下降；咳嗽、气短症状积分有下降；咳痰、自汗、哮鸣音症状积分无差异；与对照2组组间比较易感冒症状积分明显下降。4)对照1组生活质量评分实验后与实验前比较无差异。对照2组日常生活能力、焦虑心理症状评分与实验前比较评分有明显下降；抑郁心理症状与实验前比较评分有下降；社会活动项目评分与实验前比较无统计学意义。与对照1组组间比较焦虑心理症状评分有下降,其它无差异。实验组生活质量评分中日常生活能力、焦虑心理症状、抑郁心理症状与实验前比较评分有明显下降;社会活动项目评分与实验前比较无统计学意义。实验后与对照1组组间比较焦虑心理症状有显著差异,日常生活能力、抑郁心理症状有差异；与对照2组组间比较无差异。三组实验前组间比较无差异。5)对照1组实验后PaO2、PaC02与实验前比较无差异；对照2组实验后与实验前比较PaO2明显上升,PaCO2无差异；与对照1组组间比较PaO2上升,PaCO2无差异。实验组实验后与实验前比较PaO2明显上升,PaCO2无差异;与对照1组组间比较PaO2上升,PaCO2无差异；与对照2组组间比较无差异。6)对照1组实验前后急性发作次数比较无差异；对照2组实验前后急性发作次数比较无差异；实验组实验前后急性发作次数比较有差异。7)综合疗效三组实验后比较无差异,中医症候疗效实验后比较：对照2组与对照1组有明显差异；实验组与对照1组有明显差异；实验组与对照2组无差异。8)三组患者的肿瘤坏死因子、白细胞介素-8、白细胞介素-6指标变化比较无论是实验前后对比还是组间对比均无差异。Ⅱ级患者：1)三组在实验后与实验前比较FEV1(%)及FEV1/FVC(%)均明显上升,实验前后组间比较均无差异。2)对照1组实验后与实验前比较6min步行距离有明显升高；对照2组实验后与实验前比较6min步行距离有明显升高,与对照1组组间比较有升高；实验组实验后与实验前比较6min步行距离有明显升高；与与对照1组组间比较有升高,与对照2组组间比较无差异。实验前各组组间比较无差异。3)对照1组实验后与实验前比较：咳嗽、气短症状积分明显下降；喘息、易感冒症状积分有下降。对照2组实验后与实验前比较：咳嗽、自汗症状积分明显下降；喘息、易感冒、气短症状积分有下降。实验组实验后与实验前比较：咳嗽、喘息、易感冒、气短症状积分明显下降。4)对照1组生活质量评分实验后与实验前比较：日常生活能力评分明显下降,其它无统计学意义。对照2组生活质量评分实验后与实验前比较：日常生活能力评分明显下降,其它无统计学意义。实验组生活质量评分实验后与实验前比较：日常生活能力、焦虑心理症状评分明显下降,抑郁心理症状评分有下降；与对照1组组间比较日常生活能力评分明显下降,抑郁心理症状评分有下降,其它无变化。实验前组间比较无差异。5)对照1组实验后与实验前比较：PaO2无差异,PaCO2有下降。对照2组实验后与实验前比较：PaO2有升高,PaCO2有下降。实验组实验后与实验前比较：PaO2有升高,PaCO2有明显下降。实验前后组间比较无差异。6)三组实验后与实验前比较急性发作次数均有差异。7)三组在实验后综合疗效及中医症候疗效比较均无差异。8)用药量实验后对照2组与对照1组比较有减少,实验组与对照1组比较有减少；实验组与对照2组比较无差异。9)对照1组实验后与实验前比较肿瘤坏死因子、白细胞介素-8、白细胞介素-6均有下降,对照2组实验后与实验前比较：肿瘤坏死因子、白细胞介素-8有明显下降,白细胞介素-6均有下降；与对照1组组间比较无差异。实验组实验后与实验前比较：肿瘤坏死因子、白细胞介素-8有明显下降,白细胞介素-6有下降；与对照1组组间比较肿瘤坏死因子有下降,其它无差异。实验前各组组间比较无差异。结论：(1)慢性阻塞性肺疾病属于中医“咳嗽、喘证、肺胀”等范畴,早期临床表现与中医学中的咳嗽相似,随着病情的发展,肺功能损伤的进一步加重,临床表现与喘证类似,当疾病进一步发展,表现为严重肺气肿或肺心病时,临床表现即为中医肺胀的范畴。(2)对于慢性阻塞性肺疾病稳定期的防治应以固本为主,即补益肺脾肾之虚衰以固其本。(3)健身气功养肺处方对慢性阻塞性肺疾病的发生具有良好的预防和辅助治疗作用,是一种简便易行、有效并适宜推广的肺康复方法；(4)健身气功养肺处方是通过调神、气功态呼吸方法、属中小强度的有氧运动、对肺、脾、肾等脏的调节、“三调”合一等方面对慢性阻塞性肺疾病起到较好的防治作用。更多还原

【Abstract】 Objective:To make the verification of therapeutic efficiency on Chinese Health Qigong Lung Prescription treating patients with stable COPD through a systematic literature review and clinical research,and further explore the mechanism of its role.Method:The subjects was came from Provincial Authorities of Jiangsu Province in October 2008 to October 2010 during the month of outpatient and hospital wards after discharge line with 2007, "Diagnosis and treatment of chronic obstructive pulmonary disease guidelines standards " in the standard diagnostic criteria and classification of gradeⅠandⅡ118 cases of patients with stable COPD. Which,Ⅰgrade were randomly divided into control group 1 in 17 cases,15 cases were 2, the experimental group of 25 patients. Three groups are not taking the drugs, the implementation of the control group 2 reduced lip breathing + walking prescription, the experimental group perform Chinese Health Qigong Lung Prescription prescription. GradeⅡ61 patients were randomly divided into control a group of 18 patients,17 patients in control group 2, the experimental group 26 cases. Three groups were taking medication Seretide, control group 2 drugs on the basis of the implementation of reduced lip breathing + walking prescription, the experimental group on the basis of taking the drug, plus practicing Chinese Health Qigong Lung Prescription prescription. The implementation of prescriptions for 6 months, and observed after 6 months of treatment before and after Chinese Health Qigong Lung Prescription pulmonary function, exercise capacity, clinical symptom scores, quality of life score, arterial blood gas analysis, the number of acute onset, efficacy, dosage changes, adverse reactions Changes in other indicators.Result:Grade I:1)There was no difference between three groups before and after experiment on FEV1 (%) and FEV1/FVC (%) no significant difference between the two groups no difference.2)Control group 1 before and after the 6min walking distance of the experiment no difference; the control group and experimental group 2 and experimental before and after the experiment were significantly different, with the control group 1 were significantly different between groups.3)Control group 1 before and after the experiment was no difference in clinical symptom score; the control and experimental group 2 before and after the experiment cough, sputum, wheezing, shortness of breath symptom scores decreased significantly; spontaneous, easy cold, wheeze was no difference in symptom score; and control Group 1 between the two groups breathing, shortness of breath symptom scores decreased significantly; cough symptom score had decreased; sputum, spontaneous, easy cold, wheeze was no difference in symptom scores. Experimental group before and after the experiment and experimental cough, sputum, wheezing, easy to cold, shortness of breath symptom scores decreased significantly; spontaneous, wheeze symptom scores did not change; with the control group 1 between the two groups breathing, easy cold symptom scores decreased significantly; cough, shortness of breath symptom score had decreased; sputum, spontaneous, wheeze was no difference in symptom score; and control group 2 between the two groups easy cold symptom scores decreased significantly.4) Quality of life scores in control group 1 and experimental before and after the experiment was no different. Control group 2 activities of daily living and anxiety symptom scores compared with scores before the experiment significantly decreased; psychological symptoms of depression compared with rates before the experiment to decrease; social activities scores were not significantly before the experiment. With the control group 1 between the two groups have decreased anxiety symptom scores, the other no difference. Quality of life scores in the experimental group, activities of daily living, anxiety symptoms, depressive symptoms and psychological test scores were significantly decreased compared with that before; social activities scores were not significantly before the experiment. After the experiment group and control group 1 between the psychological symptoms of anxiety were significantly different, daily living skills, psychological symptoms of depression are different; with the control group 2 no significant difference between the two groups. Three groups before the experiment was no difference between the two groups.5) Control group 1 after the experiment PaO2, PaCO2 and no difference before the experiment; the control and experimental group 2 before and after the experiment significantly increased PaO2, PaCO2 no difference; with the control group 1 between the two groups increased PaO2, PaCO2 no difference. Experimental group before and after the experiment and the experiment significantly increased PaCCO2 no difference; with the control group 1 between the two groups increased PaCO2, PaCCO2 no difference; with the control group 2 no significant difference between the two groups.6) The control group 1 before and after experiment no difference between the number of acute attacks; control group 2 before and after the experiment was no difference between the number of acute attacks; the experimental group compared before and after experiment with different number of acute attack.7) After three sets of experiments Integrated efficacy was no difference in efficacy of TCM symptoms comparison experiment:the control group 2 and control group 1 were significantly different; the experimental group and control group 1 were significantly different; the experimental group and control group 2 was no different.8) Three groups of tumor necrosis factor, interleukin -8, interleukin -6 indexes in both experiments before and after comparison or contrast there was no difference between the groups.Grade II1) Three groups before and after the experiment and experimental FEV1 (%) and FEV1/FVC (%) were significantly increased, there was no experimental difference between the two groups before and after.2) The control group 1 before and after the experiment 6min walk distance significantly increased; the control and experimental group 2 before and after the experiment 6min walk distance increased significantly with the control group 1 between the two groups had elevated; the experimental group and after the experiment 6min walk distance compared before the experiment significantly increased; and with the control group 1 group increased compared with the control group 2 no significant difference between the two groups. Each group before the experiment was no difference between the two groups.3) The control group 1 before and after the experiment:cough, shortness of breath symptom scores decreased significantly; wheezing, easy integration to decrease cold symptoms. Control and experimental group 2 before and after the experiment: cough, spontaneous symptom scores decreased significantly; wheezing, easy to cold, shortness of breath symptom scores have decreased. Experimental group before and after the experiment and the experiment:coughing, wheezing, easy to cold, shortness of breath symptom scores decreased significantly 4) Quality of life scores in control group 1 and experimental before and after the experiment:activities of daily living score was significantly decreased, the other not statistically significant. Control group 2 quality of life scores before and after the experiment and the experiment:activities of daily living score was significantly decreased, the other not statistically significant. Experimental group, the quality of life scores before and after the experiment and the experiment:daily living, symptom score decreased anxiety, depression and psychological symptom score had decreased; with the control group 1 between the two groups significantly decreased activities of daily living scores, psychological symptom score had decreased depression Other unchanged. Before the experiment was no difference between the two groups.5) Control group 1 before and after the experiment:PaO2 no difference, PaCO2 had decreased. Control and experimental group 2 before and after the experiment: PaO2 has increased, PaCO2 had decreased. Experimental group before and after the experiment and the experiment:PaO2 had increased, PaCO2 decreased significantly. Before and after experiment no difference between the two groups.6) Three groups before and after the experiment and the experimental number of acute attack are different.7) Three integrated effect and after the experiment showed no difference in efficacy of traditional Chinese medicine symptoms.8) Dosage experiment in control group 2 compared with the control group 1 decreased in the experimental group compared with the control group 1 decreased; the experimental group and control group 2 showed no difference.9) Control group 1 before and after the experiment and experimental tumor necrosis factor, interleukin -8, interleukin -6 were decreased in the control and experimental group 2 before and after the experiment:tumor necrosis factor, interleukin -8 decreased significantly, IL-6 were decreased; and control group 1 no significant difference between the two groups. Experimental group before and after the experiment and the experiment:tumor necrosis factor, interleukin -8 have significantly decreased, a decreasing interleukin-6; with the control group 1 between the two groups of tumor necrosis factor has dropped, the other no difference. Each group before the experiment was no difference between the two groups.Conclusion:(1) Chronic obstructive pulmonary diseases are among the Chinese, "cough, asthma card, lung inflation " and other areas, and in early clinical manifestations similar to cough medicine, as the disease progresses, further aggravating lung injury, clinical manifestations and asthma Card similar to the further development when the disease, manifested as severe emphysema or pulmonary heart disease, the clinical manifestations of lung inflation is the scope of traditional Chinese medicine. (2) for chronic obstructive pulmonary disease prevention and control should be based on coupon-based, that benefit of the virtual failure of lung, spleen and kidney to its present solid. (3) Chinese Health Qigong Lung Prescription for chronic obstructive pulmonary disease with good prevention and adjuvant therapy, is a simple, effective and appropriate ways to promote pulmonary rehabilitation; (4) Chinese Health Qigong Lung Prescription By adjusting God, qigong breathing state, is a medium intensity aerobic exercise, lung, spleen, kidney and other dirty regulation, the "three tune " One and other aspects of chronic obstructive pulmonary disease prevention and control play a better role.更多还原