【作者】 唐毅；

【导师】 孙志佳；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 目的：本研究目的为观察中医药在COPD稳定期的综合作用以及从药物经济学角度评价中医药在COPD稳定期治疗方案的应用价值。方法：本研究选择90例符合标准COPD稳定期患者纳入观察,将其随机分成西医组、中医辨证组及中西结合组各30例,展开为期半年的既定方案治疗(西医组按照西医规范化治疗,中医辨证组给予中医辨证分型治疗,中西结合组在西医规范化治疗基础上合并中医辨证分型治疗),以治疗效果、急性加重住院次数、治疗成本作为主要观察指标,比较各组治疗前后上述各项观察指标的变化情况,观察记录各项数据并进行统计学分析处理,分别计算出各组疗效及治疗成本并进行成本效果分析。成果：本研究结果表明：经过6个月的治疗,三组的总症状积分均较治疗前有改善；其中西医组咳痰、气喘、气短、哮鸣音积分及总症候积分治疗后有改善,经检验有统计学意义(P<0.05),咳痰、自汗、易感冒积分治疗后改善不明显(P>0.05)；中医辨证组与中西结合组治疗后各项症候积分均较治疗前有改善,经检验有统计学意义(P<0.05)；西医组和中西结合组治疗前后总症候积分差值比较有统计学意义(P<0.05)。中西结合组急性加重住院次数及住院天数最少,与西医组及中医辨证组比较有统计学意义(P<0.05),西医组的平均急性加重住院次数及平均住院天数与中医辨证组比较无统计学意义(P>0.05)。对三种治疗方案费用进行分析,中西结合组急性加重住院次数及造成的费用低于西医组和中医辨证组。三组经过半年的治疗,治疗总有效率分别为西医组80%、中医辨证组52%、中西结合组100%；总费用分别为西医组5207元、中医辨证组4365元、中西结合组5603元；三组的成本-效果比分别为西医组65、中医辨证组84、中西结合组56。以中医组的疗效为参照,西医组与中西结合组的增量成本分别为30和26,即每增加1个疗效单位,西医组需要增加费用30元,中西结合组增加费用26元。敏感度分析也证明了结果的可靠性。结论：中西结合组疗效优于中医辨证组和西医组。中西结合组及中医辨证组药物不良反应少于西医组,在咳嗽、自汗、易感冒等症状改善上亦优于西医组。从药物经济学角度分析,中西结合组是三种治疗方案中的最合理方案。更多还原

【Abstract】 ObjectiveAccording to analyze the cost-effectiveness of three treatments for Alleviation Term of Chronic Obstructive Pulmonary Disease, observed the functions of Traditional Chinese Medicine treatment in the Alleviation Term of Chronic Obstructive Pulmonary Disease(COPD). Using the method of medicine economics to evaluate the applying value of TCM into the Alleviation Term of Chronic Obstructive Pulmonary Disease.Methods90qualified cases were divided into three groups randomly:group1(the patients were treated with western medicine),group2(the patients were treated with TCM), group3(the patients were treated with TCM combined with western medicine).The treatment period is three courses, one month per course. The symptoms and the number of times suffered from acute exacerbation were observed, and compared with the costs of the treatments of three courses.ResultsThe effectiveness on total symptom decrement of three groups were better than pretherapy, and the total effective rate of group3is the best and is significantly different from the other two groups(P<0.05). The smyptoms such as expectoration, gasp and wheeze of group1decreased obviously after treatment and is significantly different from pretherapy(P<0.05). The scores on symptoms in group2and group3are improved after treatment, especially the scores on symptoms of cougP, easy to catch cold and spontaneous perspiration, and is significantly different from group1(P<0.05). There were fewer cases that suffered from acute exacerbation and untoward effect in group3than in the other two groups(P<0.05). The costs of group2was lowest. The costs of group3was highest. The total treatment effects of group, group2and group3were80%、52%and100%. And thd cost-effectiveness ratio were65,84and56. Compared with group2, to increase one unit of cost-effectiveness, the costs would increase30RMB in group1and26RMB in group3. The sensitivity analysis also proved those results.ConclusionChinese herbs combined western medicine could improve the effect of the treatment for Alleviation Term of COPD. Chinese herbs could decreased the symptom of cough、easy to catch cold and spontaneous perspiration, and had fewer untoward effect. The cost-effectiveness ratio of group3was the most reasonable and from the analysis of drug economy, the treatment of group3was the best among the three groups.更多还原