中西医结合综合治疗方案对肺心病急性发作期临床疗效研究

【作者】 肖玮；

【导师】 陈绍宏；

【作者基本信息】 成都中医药大学 ， 中医内科学， 2006， 博士

【摘要】 通过多中心、随机、对照、单盲、平行临床试验，研究中西医结合综合治疗方案治疗肺心病急性发作期的临床疗效性，从而制定一个适合我国国情、可广泛推广应用的肺心病急性发作期治疗方案，以提高临床疗效。 方法： (1) 查阅中医历代古典医籍中关于肺心病的记载，并对近20多年来中医学家对肺心病的认识进行综述。 (2) 检索近年来现代医学有关肺心病研究的报道，进行分析、总结。 (3) 采用前瞻性、多中心、随机、对照、单盲、平行临床试验的方法，将156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)和对照组(西医综合治疗)。治疗组在常规西医综合治疗方案的基础上，采用宣肺平喘、化痰止咳法为主，方选三拗汤、括蒌薤白半夏汤及桔梗汤，兼见脾气亏虚者在前方基础上加用香砂六君子汤以健脾益肺，阳虚水泛者兼以温阳利水，方用三拗汤、括蒌薤白半夏汤、桔梗汤合苓桂术甘汤。对照组给予西医常规治疗。两组均治疗14天，评价两组病人14天病死率，以及综合疗效、主要症状积分、次要症状积分、体征积分、自我生活能力评分、血气分析、血液白细胞及中性粒细胞分类等疗效性指标以及卫生经济学指标。 结果： 两组患者14天病死率无明显差异，治疗组在综合疗效评定、主要症状积分、次要症状积分、体征积分、自我生活能力评分、血气分析、血液白细胞及中性粒细胞分类等方面的恢复情况显示出一定的优势。治疗组住院费用低于对照组，平均住院天数短于对照组。 结论： (1) 祖国医学虽无肺心病之说，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，值得深入挖掘，以继承和发展。现代中医对肺心病的治疗取得了一定的成绩，但研究多集中于一方一法，对综合治疗方案的研究有限。 (2) 中西医结合综合治疗方案能提高临床综合疗效，改善症状、体征，改善患者自我更多还原

【Abstract】 Objective:To value the curative effect of the combination treatment project of Chinese and Western Medicine during the acute attack stage period of chronic pulmonary heart disease(CPHD) by a multi-center,randomized controlled,single-blined,paralleled clinical trial.Try to study the optimized remedial project to adapt the China situation during the acute attack stage period of pulmonary heart disease.Methods:(1)Reviewing TCM ancient works about CPHD and summarizing the TCM achievements of the CPHD in the latest twenty years.(2)Generalizing the resarches progresses of the diagnosis,treatment and prevention of CPHD. (4)With prospective,multi-center,randomized,single-blined,paralleled controlled trial,156 patients with acute attack stage period of CPHD were randomized divided in two groups.One is the control group and the other is the cure group.The patients in the cure group were treated with combination treatment project of Chinese and western medicine.Therapeutic methods are following:dispersing the Lung to relieve asthma,resolving phlegm and checking cough.Prescriptions used are San Ao Decoction,Gua Luo Xie Bai Ban Xia Decoction and Jie Geng Decoction.Modification:For patients with Lung and Spleen deficienc,Xiang Sha Liu Jun Zi Decoction was added to strengthen the Spleen and nourish the Lung.For patients with edema due to Yang deficiency,Ling Gui Shu Gan Decoction was added to warm Yang and induce diuresis.The patients in the control group were treated with Western therapy.All the patients were cured for 14 days.Indexes evaluated were following: effect indexes (the whole effect,integra of main and secondary symptoms in TCM,signs integra in modern medicine,Ieucocyte sum and classification,arterial blood gas analysis,personal living ability evaluation and so on).Results:No significant differences among two groups with 14 days fatality rate.It seemed that the cure group has the better curative effect,the symptom,and the sign etc,shortening revival更多还原