【作者】 冯艳；

【导师】 张伟；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 [目的]：观察通腑泄热法治疗慢性阻塞性急性加重期临床疗效及对IL-8的影响,从而探讨“肺与大肠相表里”理论的临床应用与治疗作用的机理。[方法]：将60例中医辨证属痰热郁肺型慢性阻塞性肺疾病(COPD)急性加重期患者随机分为治疗组和对照组。治疗组方案为常规西医治疗基础上加用桑白皮汤和承气汤加减；对照组方案为常规西医治疗基础上加用桑白皮汤；疗程均为7天,比较两组对中医辨证属痰热郁肺型COPD急性加重期患者临床症状体征,血气分析及血清IL-8的影响。[结果]：1.在证候疗效方面,治疗组总有效率为96.7%,对照组总有效率70%,治疗组其治疗后总有效率与对照组相比较具有显著性差异(P<0.05)。治疗组治疗前后的各项主要症状和体征相比较,均有显著性差异(p<0.01),说明治疗组可以改善患者的症状体征；对照组在咳嗽、咯痰、喘息、发热、腹胀、便干、溲赤及哮鸣音方面,同治疗前相比,有显著性差异(p<0.01),其余指标无显著性差异,说明在有些方面,对照组亦可改善患者的症状体征；治疗组与对照组治疗后相比较,除了咳嗽、咯痰、哮鸣音指标外,余指标有显著性差异(P<0.05)。2.血气分析方面：治疗组与对照组均可改善患者的缺氧及二氧化碳潴留情况；治疗组在改善缺氧及二氧化碳潴留方面,明显优于对照组(P<0.01)3.IL-8方面,治疗组与对照组IL-8指标治疗前后均差异显著(P<0.01)；治疗组与对照组的治疗后IL-8相比,差异显著(P<0.01),说明治疗组与对照组通过降低患者的血液中IL-8的含量改善急性期患者的气道炎症症状,且治疗组明显优于对照组(P<0.01)。[结论]：以“肺与大肠相表里”的中医理论为指导,采用常规西医治疗加通腑泄热法治疗中医辨证属痰热郁肺型的慢性阻塞性肺疾病急性加重期患者,与常规西医治疗加单纯清热化痰相比,可以更好的改善患者的症状体征及患者缺氧和二氧化碳潴留的情况,从而缩短急性加重的进程,改善患者的生活质量。更多还原

【Abstract】 ObjectiveThe aim of the study was to assess the clinical effect and the influence and meanings to IL-8 of the Fu leaks a hot method to chronic obstuctive pulmonary disease in acute exacerbation.The other aim of the study was to study the clinical research and the mechanism of cure of the lung and the large intestine being interior-exteriorly related.Method60 patients AECOPD according to the retention of Obstruction of Lung by Phlegm and heat syndrome in TCM were selected from the outpatient clinic. Patients were randomly assigned to the treating group(group T)or to the control group(group C)on a single—blind basis. Group T was treated by routine westem medicine combination with The Fu leaks a hot method for 7days and group C was treated by routine westem medicine combination with the management of clear away heat and disperse phlegm. Comparing the clinical symptom, IL-8, blood gas analysis of the patients with mild or moderate COPD in acute exacerbation condition according to the Obstruction of Lung by Phlegm and heat syndrome in TCM.Result 1. The total effective rate of the therapeutic group and the control group were 96.7% and 70% respectively, The clinical symptoms and sign of the treating group have significant difference (p<0.05) after 7days comparing with the pre-treatment which showed the management of the treating group could improve the clinical symptoms and sign of AECOPD patients. Compared with the pre-treatment, the control group have significant difference (p<0.01)in some symptoms and signs, such as cough, sputum, gasp, fever, abdominal distention, constipation, souchi, chest distress, rhonchus. It showed that the therapy of control group also could improve some of the clinical symptoms and sign of COPD patients. The clinical symptoms and sign of the treating group have significant difference (p<0.01)after 7days comparing with the control group except for cough, sputum, rhonchus, chest distress. Main syndrome had been improved significantly in group T(P<0.01)which has significant difference compared with group C(P<0.01)2. As for the result of blood gas analysis, group T and group C could both improve the PO2 and reduce the PCO2. And there was significant difference in group T compared with group C(P<0.01)about anoxia and carbon dioxide retention,3. According to IL—8, there was significant difference in two group(P<0.01). There was significant difference compared group T with groupC after treatment(P<0.01). It showed that the therapy of group T and group C could improve signs and symptoms of Airway Inflammation of AECOPD, in which it would be involved in the decrease of IL-8 level in mechanism. And there was significant difference in group T compared with group C(P<0.01).ConclusionTake the chinese medicine theory of "the lung and the large intestine being interior-exteriorly related" as instruction, routine westem medicine combination with the Fu leaks a hot method reduced syndrome、improved anoxia and carbon dioxide retention and debased the level of IL-8 relative to group C(by routine westem medicine combination with the management of clear away heat and disperse phlegm) in clinical trials on patients with AECOPD by Phlegm and heat syndrome in TCM.更多还原