中西医结合综合治疗方案对肺心病急性发作期疗效观察及对肺动脉压影响的临床研究

【作者】 成玉；

【导师】 陈绍宏；

【作者基本信息】 成都中医药大学 ， 中医内科学， 2005， 博士

【摘要】 目的: 以肺心病发病的重要环节肺动脉高压为研究切入点,制订一个优于目前国内单纯西医及中西医结合治疗方案的,适合中国国情的中西医结合对肺心病急性发作期的综合治疗方案,达到提高临床疗效的目的。 方法: (1)回顾中医典籍有关肺心病的记载,总结近20年现代中医学家对肺心病的研究。 (2)对现代医学慢性阻塞性肺病所致肺动脉高压的发病机制及临床研究进展进行综述。 (3)系统总结导师陈绍宏教授中西医结合治疗肺心病急性发作期临床经验。 (4)采用前瞻性、多中心、随机、对照、平行临床试验的方法,将66例肺心病急性发作期患者随机分为治疗组(中西医综合治疗方案组)和对照组(西医综合治疗组)。治疗组在常规西医综合治疗方案(除降低肺动脉压药物)的基础上,以宣肺平喘,化痰止咳法为主,脾气亏虚者兼以健脾益肺,阳虚水泛者兼以温阳利水,辨证后口服中药复方煎剂(协定处方1、2或3)。评价两组病人14天病死率,以及综合疗效、主要症状、次要症状、体征、自我生活能力评定,以及两组PAPs等方面的恢复情况。结果: (1)祖国医学虽未有肺心病之病名,但对本病从症状、病因病机,到治法方药、预后转归均有丰富的论述。现代中医对肺心病的治疗取得了一定的成绩,但研究多集中在一方一法上,且无统一认识。 (2)慢性阻塞性肺病所致肺动脉高压发生机制复杂,单纯西医治疗有限。目前用于肺动脉高压的扩血管药物除NO具有选择性肺血管扩张作用外,其余药物均为非选择性的,而NO又是一种对机体有害的气体。 (3)肺心病急性发作期主要病因病机为痰浊蕴肺、肺气闭郁,治疗应以宣肺平喘,化痰止咳法为主,脾气亏虚者兼以健脾益肺,阳虚水泛者兼以温阳利水。 (4)两组14天病死率无明显差异,治疗组在综合疗效评定、主要症状、次要更多还原

【Abstract】 Objective:To provide an integrated Traditional Chinese and Western Medicine treatmentprogram for the acute onset period of chronic pulmonary heart disease(CPHD),study the effect of the program on the acute onset period of CPHD. This program isbetter than pure Western medicine program and other plans which combination ofChinese medicine and Western medicine at the present time. It not only suitssituation in our country , but also can raise the clinical curative effect.Methods:(l)Reviewing TCM ancient works about CPHD and summarizing the TCMachievements of the CPHD in the latest twenty years.(2)Generalizing the onset mechanism and clinical researches progress of PAH whichdue to chronic obstructive pulmonary disease(COPD).(3)Systematically summarizing the clinical experience on acute onset of CPHD ofProfessor Chen Shaohong.(4)With prospective multi center randomized controlled trial, 66 patients with acuteonset CPHD were randomized divided in two groups. One is the control group andthe other is the cure group. Both groups were treated with Western medicine therapyexcept the anti-pulmonary-hypertensive drugs. In additional, the patients in the curegroup were treated with decoction 1 or 2 or 3, which based on differentiation.Analysed the 14 days fatality rate, the curative effect, the Pulmonary arteria systolicpressure (PAPs), and the symptom, the sign etc.Results:(l)The CPHD is one of a diseases of Western medicine, but there were abundance ofrecords about it in TCM ancient books. Although a great progress was achieved bythe modern TCM doctors on the study of CPHD, yet most of the research was abouta herb , a decoction ,or a therapeutic method. Otherwise ,the understanding of thedisease CPHD is not having been unified in TCM.(2)The mechanism of PAH because of COPD is complexity, only western medicinetherapy can not get satisfactory curative effect. All anti-pulmonary-hypertensivedrug except NO is not-selective-drugs which not only can reduce the pulmonaryartery pressure , but also systemic circulation. In addition NO is a toxic drug.更多还原