【作者】 黄清玉；

【导师】 杨周瑞；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 研究背景：肺源性心脏病是呼吸系统的常见病,根据全国各省、市、自治区14岁以上5254822人群的调查显示,近10年来随着社会老龄化因素的影响,患病率有着不断增长的趋势,本病在各种住院病人器质性心脏病的构成中占5%-37%。许多地区如东北、西南等地慢性肺心病已经由器质性心脏病的第二位上升到首位,己引起各中西医专家的高度重视,而目前,单纯西医治疗慢性肺心病的副作用逐渐暴露出来,如：长期大量应用抗生素治疗,引起免疫功能紊乱、菌群失调。而且,使用杀菌药治疗伴随内毒素释放及细菌耐药等情况的出现又明显加强了抗感染的难度、延长住院时间,给慢性肺心病急性发作期的治疗提出了挑战。因此,在西医常规治疗的基础上,我们的前辈专家们正在积极的寻求一种最优的中西医结合治疗方案,以最大程度阻止疾病的进展速度,逆转疾病的发展趋势,减轻患者痛苦。本课题在中医基础理论的指导下,结合导师杨周瑞近三十年的临床经验,运用参蛭明党汤加减(益气活血化痰法)治疗气虚痰瘀互结型慢性肺心病。研究目的：本研究主要通过观察中医参蛭明党汤加减(益气活血化痰法)配合西医常规治疗对比单纯西医常规用药治疗气虚痰瘀互结型慢性肺心病患者的临床疗效、血气分析、心酶及血液黏稠度等方面的变化情况,来探求中西医结合治疗本病的临床优势,同时验证益气活血化痰法在治疗慢性肺心病中的重要性,为临床中医药的运用提供循证医学依据。研究方法：本课题选用小样本的前瞻、随机、平行对照研究方案,选取2010年4月至2012年3月期间50例广州市中医医院住院病人(主要为呼吸内科住院患者),按1：1对照原则分为治疗组和对照组各25例,治疗组以参蛭明党汤(1剂/日)配合西医治疗：常规抗感染(以药敏结果为准,药敏结果未回复前使用经验用药头孢曲松3.0配0.9%氯化钠100m1静滴,一日一次)、营养支持、低流量吸氧及控制呼吸衰竭和心力衰竭、控制并发症；对照组单纯西医治疗：常规抗感染(以药敏结果为准,药敏结果未回复前使用经验用药头孢曲松3.0配0.9%氯化钠100m1静滴,一日一次)、营养支持、低流量吸氧及控制呼吸衰竭和心力衰竭、控制并发症。两组均连续用药15天。主要观察临床征候疗效、血气分析、心酶、血液流变学等,并统计分析两组之间的差别。研究结果：1、治疗组总有效率为92%,对照组总有效率为64%,两组疗效经卡方检验证实有统计学意义(P<0.05)2、两组患者咳嗽、咯痰、气促、心悸、唇甲紫绀、肺部罗音、球结膜水肿等症状体征评分均有好转,提示两组治疗均有效果。而治疗组与对照组症状体征评分经统计学分析有统计学意义,具有显著差异,说明治疗组在改善上述症状体征方面的效果较对照组好。3、治疗组与对照组之间数据对比,在治疗中期PaCO2下降幅度经统计学分析无统计学意义,治疗组在改善PaCO2方面与对照组相比无明显差别。治疗后期PaCO2下降幅度经统计学分析有统计学意义,说明治疗组在完成一个疗程后其改善PaCO2方面效果明显优于对照组。4、两组间在改善Pa02方面经统计学分析有统计学意义,说明治疗组在改善慢性肺心病气虚痰瘀互结型缺氧状态方面效果比对照组好。5、治疗组在治疗后血液流变学较前明显改善,而对照组改善不明显,说明参蛭明党汤在改善慢性肺心病气虚痰瘀互结型患者血液流变学即血液黏稠度方面效果较单纯西医要好。研究结论：运用参蛭明党汤(益气活血化痰法)配合西医常规治疗气虚痰瘀互结型慢性肺心病急性发作期患者,其临床疗效明显优于对照组,能够明显改善患者的通气(降低PaCO2)及缺氧状态、减少抗菌素药物副作用,降低血液黏稠度及改善心肺功能,从而达到改善患者的预后的目的。更多还原

【Abstract】 Background:Chronic pulmonary Heart Disease is a common disease and frequently encountered disease of respiratory apparatus.A survey about provinces、 municipalities、autonomous regions of5254822people over the age of14shows that the morbidity is a growing trend because of the social Aging factors in the recent10years. The disease take up5%～37%in all kinds of organic heart disease patients hospitalized. chronic pulmonary heart disease has rised from second to the first place on the organic cardiopathy in mang areas such as the northeast and southwest, has caused the attention of the Western and Chinese medicine experts. And at present,the side effects of only use wester routine treatment to cure Chronic Pulmonary heart Disease began to show up. such as the immune disorders and dysbacteriosis because of Long-term and many use antimicrobial therapy,Also, the situation of use sterilization drug therapy with endotoxin release and the emergence of bacteria resistant, It increased the difficulty of the fight infection、extended the time in hospital and raised a challenge about the treatment of chronic pulmonary Heart Disease acute pisode. Therefore, based on the western conventional treatment, our predecessors experts are actively searching for an optimal combine traditional Chinese and western medicine treatment to stop the progress of the disease rate for their best、changover the trend of the development of the disease and reduce the patients’ pain.with the basic theory of TCM and the guidance of teachers with YangZhouRui nearly thirty years of clinical experience.Objective:This topic using yiqi huoxue phlegm method (shenzhi mingdangtang) to treat chronic pulmonary Heart Disease about the type of insufficiency qi、Phlegm and stasis mutual. Methods:This topic select a small sample of prospectie、randomized、controlled parallel research plan. Select50inpatients (mainly for respiratory medicine) in Hospital of TCM in Guangzhou between April2010and March2012.50patients were randomly divided into2groups. The comprehensive therapy which combined Western routine treatment and shenzhi mingdang tang; while, control group were offered only western routine treatment. The experimental course was15days. Afterwards, the patients’ overall efficacy assessment、the main symptoms and signs、blood gas analysis、cardiac function、blood rheology index notably and patients’quality of life.Results:1、The treatment group’s total effective rate was92%, and control group’s total effective rate was64%, the curative effect of two chi-square test proved to be statistically significant (P<0.05).2、The outcomes of the main symptons and signs、blood gas analysis、 cardiac function、blood rheology index notably of treatment group were superior to control group,showing statistical significance(P<0.05). Conclusion:The comprehensive therapy of shenzhi mingdang tang to Treat and western medicine for pulmonary heart disease at acute stage proved to improve the overall efficacy symptons、signs、cardiac function、blood gas analysis results、blood rheology index notably and patients’ quality of life.更多还原