冬病夏治穴位贴敷法合补益肺肾法对慢性阻塞性肺疾病稳定期的疗效观察

【作者】 龚容；

【导师】 苏惠萍；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 目的：观察冬病夏治穴位贴敷法合补益肺肾法对慢性阻塞性肺疾病(COPD)稳定期的疗效。方法：采用前瞻性临床对照研究方法,设计了2×2的析因试验,其中的两个干预因素分别是：冬病夏治穴位贴敷法(外治法)、补益肺肾法(内治法)；两个水平是：用与不用。将2008年7月至2008年12月在北京中医药大学东直门医院呼吸科就诊的符合纳入标准的COPD患者共160例随机分为四组,每组40例：①常规治疗组；②常规治疗+穴位贴敷组；③常规治疗+补益肺肾组；④常规治疗+穴位贴敷+补益肺肾组。穴位贴敷药物为东直门医院制剂室提供的冬病夏治止咳平喘膏,贴敷时间为2008年“三伏”入伏第一天,共贴3次,每次贴2-4小时,贴敷部位取双侧定喘、肺俞、肾俞共3组穴位。补益肺肾法选取“金水宝胶囊”,一次3粒,一日3次,连续服用一年。观察治疗前后各单项症状和体征(咳嗽、咯痰、喘息、哮鸣、易感冒、气短)、证候积分、肺功能、呼吸困难分级评分、生活质量评分的变化。结果：在基线上,四组的各项指标,除“易感冒”外,均具有良好的一致性,故除“易感冒”外,其余指标均为后期疗效观察指标。在后期疗效观察方面,针对各项指标,穴位贴敷组除“肺功能”、“咯痰”外,均具有统计学意义,补益肺肾组除“肺功能”外均具有显著统计学意义。在二者的交互作用方面,从统计学的角度看,除“气短”和“呼吸困难”显示出存在交互效应外,其余均无交互效应,但二者合用的效果从描述性的统计数据上看是最佳的。结论：研究结果很好地证明了穴位贴敷法和补益肺肾法在COPD稳定期的治疗中的有效性,表明二者在改善症状和生活质量上是有意义的。二者合用在“气短”和“呼吸困难”这两个指标上的改善上较单用其中任何一种方法效果更好。在肺功能的改善方面,未得出阳性结果,可能与COPD肺功能进行性下降,患者一般状态、气候、时间的影响等因素有关。更多还原

【Abstract】 Objective:To observe the clinical efficiency of the method that combine Winter disease treated in summer and Acupoint application and Invigorating lung and kidney in treatment of patients with chronic obstructive pulmonary disease (COPD) of stable stage.Method:Using the method of prospective clinical controlled study, this study designed a 2 x 2 factorial experiment. The two intervention factors were:Winter disease treated in summer and Acupoint application, Invigorating lung spleen and kidney. The two levels were:use and not use. The 160 patients came from the Respiratory Department of Dongzhimen Hospital from July 2008 to December 2008. They were randomly divided into four groups with 40 cases in each one:①he conventional therapy group;②the conventional therapy+Acupoint application group;③the conventional therapy+Invigorating lung and kidney group;④the conventional therapy+Acupoint application+Invigorating lung and kidney group. The drug for Acupoint application was provided by the preparation room of Dongzhimen Hospital. The time was the first day of "Dog Days" in 2008. The places for paste were Feishu (BL13), Shenshu(BL23),Dingchuan(EX-B1). Each time pasted 2～4 hours. Invigorating lung and kidney selected "Jin Shui Bao capsule". Taking the medicine accorded to the instruction and lasted for one year. At last observing the change of outcome measures which included individual symptoms (cough, expectoration, gasp, wheezing, frequency of cold, short of breath), total symptoms scores, lung function, dyspnea score, SGRQ score.Results:In baseline, all the outcome measures except "frequency of cold" had good consistency. So all the outcome measures except "frequency of cold" acted as the final observation indexes. The results showed that:The group of Acupoint application had statistically significant in all the final observation indexes except "lung function" and "expectoration"; The group of Invigorating lung and kidney had statistically significant in all the final observation indexes except "lung function"; The interactive effect was only founded in "short of breath" and "dyspnea score" through statistical analysis. But according to description statistics the effect of combined treatment was the best.Conclusions:The results demonstrate the effectiveness of Acupoint application and Invigorating lung and kidney in the treatment of stable COPD. They both could improve symptoms and quality of life. The combine of both treatments had the best effect in the improvement in "short of breath" and "dyspnea score". In "lung function", the result of the 4 groups was not positive. It may be related with the following factor:①Progressive decline in lung function in COPD;②The affect of general state of patients, climate and time.更多还原