【作者】 洪两；

【导师】 汪受传；

【作者基本信息】 南京中医药大学 ， 中医儿科学， 2009， 博士

【摘要】 支气管哮喘(简称哮喘)是一种反复发作的痰鸣气喘性疾病,是儿童时期最常见的呼吸道慢性疾病之一,也是一种世界性难治性疾病。随着社会的发展,其发病率有越来越高的趋势,在新加坡,平均每5个儿童中就有一个罹患哮喘。哮喘已成为一种严重的公共卫生问题而引起世界各国的高度重视。西医学对于哮喘的防治主要是遵循《全球哮喘防治的创议》即GINA方案。中医在防治哮喘方面具有一定的优势和特色。本研究以儿童支气管哮喘缓解期为研究对象,结合新加坡哮喘患儿的特点,因地、因质制宜,在对哮喘缓解期病因病机的传统认识基础上,提出新加坡哮喘患儿缓解期多以肺脾气虚兼痰热内蕴为病机特点,拟定补肺健脾、清热化痰为主的治法,在此基础上,筛选药物,制定补肺健脾、清热化痰方运用于临床。观察表明:新加坡哮喘患儿的发病年龄以3～5岁和6～10岁为主,首次发病年龄以3～6岁为最多见,大多数哮喘患儿有其他过敏性疾病史,部分具有与哮喘发作相关的家族史,临床引起哮喘发作的诱因主要是呼吸道感染。本研究对120例(试验组80例,对照组40例)临床病例进行治疗前后的临床疗效观察,试验组采用补肺健脾、清热化痰方治疗、对照组采用丙酸倍氯米松气雾剂(必可酮)雾化吸入治疗。结果:试验前两组患儿在年龄、性别、首发年龄均无显著性差异,两组具有可比性。研究结果显示:试验组经治疗后,在哮喘发作次数、哮喘发作持续时间、平均感染次数、咳嗽程度、咳嗽次数、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、出汗、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分等情况改善方面明显优于治疗前。对照组经治疗后,在哮喘发作次数、哮喘发作持续时间、平均感染次数、咳嗽程度、咳嗽次数、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、出汗、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分等情况改善方面明显优于治疗前。两组间对比,经治疗后,试验组在哮喘发作次数、哮喘发作持续时间、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分、主要结局指标、中医症候综合疗效等情况改善方面优于对照组,两组在平均感染次数、咳嗽程度、咳嗽次数、出汗情况改善方面无明显差异。两组均未见临床不良反应。结论:新加坡哮喘患儿缓解期以肺脾气虚兼痰热内蕴证为多,治疗应当在传统扶正固本之外佐以清热化痰,补虚泻实并举。补肺健脾、清热化痰法能够有效减少哮喘发作次数和呼吸道感染次数,一定程度上缩短哮喘每次发作持续的时间,并能有效改善小儿哮喘缓解期的相关症状,疗效优于西药对照组。补肺健脾、清热化痰方是治疗新加坡哮喘缓解期患儿肺脾气虚兼见痰热内蕴证的有效方药。更多还原

【Abstract】 Bronchial asthma (asthma) is a worldwide disease manifested by repeated onset wheeze. It is one of the most common chronic airway diseases in childhood. In Singapore, there is one child suffering from asthma in every five children. With the development of the society, asthma has become a serious public health problem with high morbidity in the world and been concerned widely and highly. For west medicine, the prevention and treatment of asthma mainly follow Global Intiative for Asthma-GINA.Chinese medicine has certain advantages and characteristics in the prevention and treatment of asthma. In this research, main pathogenesis of Qi deficiency in lung and spleen with phlegm heat accumulation in children asthma in clinical remission stage has been brought up and the prescription of tonifying the lung and Spleen with clearing heat and resolving phlegm has been made according to characteristics of the asthmatic children in Singapore based on the traditional pathogenesis of asthma and suit treatment in terms of locality and constitution.The observation of 120 clinical cases(80 cases in the test group and 40 cases in the control group)showed that the suffering age of children asthma in Singapore was ranged from 3 to 5 years old and from 6 to 10 years old, the first attacking age from 3 to 6 years, most children with asthma had other allergic disease history,while part of children with asthma had related family history, and respiratory infection was the main reason.Results of clinical research showed that the difference between two groups was statistically insignificant (P<0.05) in terms of sex,age and initiating of diseases. After treatment, the analysis showed statistical significance of the difference in two groups between pre and post-treatment in aspects of the asthmatic attack times, attack duration, respiratory infection times, cough seriousness score, cough frequency score, sputum score, sputum colour score, spirit, appetite, stool, urine, sweating score,tongue and tongue fur score,fingerprint or pulse score and main, secondary and total symptom. The comparison between the two groups showed significant difference in aspects of the asthmatic attack times, attack duration, sputum score, sputum colour score, spirit, appetite, stool, urine, tongue and tongue fur score, fingerprint or pulse score and main, secondary and total symptom score, effect analysis of main end indexes and integrate effect analysis of syndrome of Chinese medicine, except respiratory infection times, cough seriousness score, cough frequency score and sweating score aspects. Both groups displayed no side effects.In conclusion,the treatment method of Bufeijianpi and Qingrehuatan and Bufeijianpi and Qingrehuatan decoction are effective for asthmatic children in the remission stage manifested by Qi deficiency in lung and spleen with phlegm heat accumulation in Singapore.更多还原