【作者】 李君君；

【导师】 林东红；

【作者基本信息】 福建中医学院 ， 中医儿科学， 2007， 硕士

【摘要】 目的：通过对由鼻后滴漏所引起的慢性咳嗽患儿在中药汤剂口服的基础上，加用香丹注射液经皮穴位离子导入治疗，观察其治疗前后症状及体征的变化，并与对照组比较疗效，以探寻更有效的治疗途径，提高临床疗效。方法：按中华医学会呼吸病学分会哮喘学组2005年制定的《咳嗽的诊断与治疗指南》(草案)中鼻后滴漏综合征的诊断标准，选择慢性咳嗽鼻后滴漏综合征患儿60例，采取简单随机方法，分治疗组A、对照组B、C三组，每组各20例。其中治疗组A及对照组B采用自拟方通窍止咳汤加减，A组配合香丹注射液经皮穴位离子导入，1日1次，每次20分钟；B组加氯雷他定口服；C组为西药激素鼻喷剂、氯雷他定口服并配合止咳对症治疗。三组治疗均为7天1个疗程，共观察2个疗程。治疗过程中因各种原因不能规律用药者5例，失访2例，疗程结束后，资料完整的仅53例，其中A组18例、B组20例、C组15例，比较三组临床疗效。结果：1．总有效率，A组94.4％，B组85％，C组80％，A组疗效与C组比较有显著差异(P＜0.05)，A组与B组、B组与C组比较均无显著差异(P＞0.05)。2．对症状、体征积分进行比较：三组治疗前后各自组内分值比较，均有非常显著差异(P＜0.01)，三组治疗后分差比较，A组与C组比较，差异非常显著(P＜0.01)，A组与B组比较，差异显著(P＜0.05)。3．疗程结束后1个月随访情况：总有效率，A组88.9％，B组70％，C组60％，A组疗效与C组比较有非常显著的差异(P＜0.01)，A组与B组、B组与C组比较均无显著差异(P＞0.05)，说明A组疗效较确切、稳定。在鼻部症状上，三组疗程结束后1个月随访与疗程结束时比较，治疗组鼻塞疗效优于B、C组，差异非常显著(P＜0.01)，说明离子导入治疗对鼻塞疗效较突出；鼻痒方面，B组与A、C组比差异显著(P＜0.05)，说明中药加氯雷他定治疗对鼻痒改善疗效较稳定。结论：中药配合经皮穴位离子导入治疗慢性咳嗽鼻后滴漏综合征疗效较好。由于香丹注射液经皮穴位离子导入，能迅速改善局部微循环状态，较快减轻鼻充血肿胀、有效缓解鼻塞，减少鼻咽部分泌物；同时中药宣肺通窍又调理善后，所以咳嗽症状得到较好控制，且停止治疗后病情稳定。经观察，治疗过程中无一例不良反应。经皮穴位离子导入操作简便，患儿无痛苦，依从性好，可作为治疗小儿鼻后滴漏所致慢性咳嗽的局部给药方法在临床应用。更多还原

【Abstract】 Objectives:By treating the children in chronic cough of postnasal drip syndrome (PNDs) with XiangDan injection by iontophoresis through acupuncture points on the basis of decoction herbalmedicine to observe the changes of signs and symptoms before and after treatment andcompare the clinical effect with control groups to search for a more efficient way to improveclinical effect.Methods:According to the standard of PNDs in the Guideline for Diagnosis of Cough andTreatment established by the asthma panel of the pneumologie branch of Chinese MedicalUnion in 2005, sixty children suffering from chronic cough of PNDs were randomly dividedinto the Treatment Group A and the Control Groups B and C in which there are 20 ratesrespectively. Both of the Treatment Group A and the Control Group B were andled withdecoction of my tutor who designs the prescription—Freeing opening and relieving coughprescription. Then Group A receives therapy of Xiang Dan injection by iontophoresis throughacupuncture points. Additionally, the patients in Group B were given Lorata-dine pills orally,and the Group C was treated with Budesonide aqueous nasal spray as well as Lorata-dine pillsorally combined with relieving cough. There is no significant deviation between the data ofthree groups with Homogeneity-of-variance Test (P＞0.05). Then the therapeutic groupreceived therapy of iontophoresis once a day, 20minutes each time and 7 times constituted acourse of treatment and 2 courses were given. There are 5 cases using medicine irregularlyand 2 cases failed to follow up during lamivudine therapy and there are 53 cases ofinformation completely with 18 cases in Group A, 20 in Group B, 15 in Group C after the endof treatment. Then the curative effects among three groups were compared.Result:1. the side of total effective rate: The total of effective rate of Group A was 94.4% and that of Group B was 85% and C was 80%. There was significant difference between Group Aand Group C(P＜0.05) and no significant difference between Group A and B as well as GroupB and C(P＞0.05).2. comparing the scores of symptomatic with those of physical sign: There wassignificant difference in comparison of scores of before and after therapy in each group(P＜0.01) and after the treatments the scores difference was Remarkable between Group A andC(P＜0.01) and there was significant difference between Group A and B(P＜0.05).3. following up after one month of the end of treatment: There was no significantdifference in the total effective rate between the time of the following up after one month ofthe end of treatment and the very time of the therapy finished in Group A as well asB(P＞0.05). Otherwise, significant difference existed in Group C (P＜0.05), which indicatedthat the symptomatic in Group C often recurred when the treatment was stopped. It is relatedto the period of treatment that was short (only 2 weeks). As the number of cases is small, theconclusion can just be treated as reference. There was Remarkbale difference in the curativeeffect of symptomatic recovery of nasal obstruction between the treatment group and thecontrol groups B and C (P＜0.01), which indicated that the effect of iontophoresis waspredominant in the nasal obstruction. As regards the effect of rhinocnesmus, there wassignificant difference between Group B and A, as well as between Group B and C(P＜0.05),which improved that efficacy in rhinocnesmus symptomatic of Group B with therapeuticmethods of Lorata-dine pills on the basis of decoction herbal was more stable than the othertwo groups.Conclusion:The clinical effect is good to treat chronic cough of PNDs in children withiontophoresis through acupuncture points on the basis of decoction herbal medicine. Owing totherapy with compound injection of red sage root by iontophoresis, delivery can improvelocal microcirculation quickly and alleviate nasal mucosa’s hyperemia more rapidly toreliving nasal obstruction effectively, reducing secretion of nasopharynx, meanwhile herbalmedicine percolating the lung to open the orifices as well as conditioning prognosis, whichcan control the symptomatic of cough better and by which the patients’ conditions were stableafter treatment and recurred less. There was no adverse reactions during this therapy afterobserving. The therapy of being operated by iontophoresis through acupuncture points is easy; meanwhile, children don’t sufer affliction and compliance of children is good, so it can beregarded as therapeutic methods of topical administration in chronic cough of PNDs inchildren in clinical applications.更多还原