老年患者稳定期COPD的中医辨证及康复措施治疗的临床观察  

Comprehensive Optimization of Rehabilitation Measures of Traditional Chinese Medicine to Elderly Patients with COPD at Stable Period

作　　者：程怡 范良 林月华 陈荣 赵海玲 黄惠芬 CHENG Yi;FAN Liang;LIN Yue-hua;CHEN Rong;ZHAO Hai-ling;HUANG Hui-fen(Haikou Traditional Chinese Medicine Hospital,Haikou 570216,China)

机构地区：[1]海口市中医医院

出　　处：《中国实验方剂学杂志》2019年第24期48-53,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：海南省自然科学基金项目(817389)

摘　　要：目的:探讨中医综合优化康复措施治疗老年COPD稳定期患者的临床疗效及对免疫功能和炎症因子的影响。方法:将144例患者随机按数字表法分为对照组和观察组各72例。对照组采用异丙托溴铵气雾剂,40~80μg/次,2~4次/d,及沙美特罗替卡松粉吸入剂,1吸/d,2次/d;并给健康教育、氧疗和进行呼吸肌锻炼的综合西医治疗措施。观察组基础治疗同对照组,并给予中成药辨证内服、中药足浴和中医呼吸功能锻炼的中医综合优化康复措施。两组疗程均连续治疗6个月,并进行6个月随访。进行慢阻肺的综合评估;进行治疗前后改良版英国医学研究委员会呼吸问卷(m MRC),慢阻肺患者自我评估测试(CAT),第1秒用力呼气容积(FEV1),FEV1占预计值百分比(FEV1%),圣乔治呼吸问卷(SGRQ)和6 min步行距离(6 MWD)评价;检测治疗前后T淋巴细胞亚群CD3^+,CD4^+,CD8^+,CD4^+/CD8^+水平;检测治疗前后血清白细胞介素-6(IL-6),IL-8,肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hs-CRP)水平。结果:治疗后两组患者慢阻肺的综合评估均明显好转(P<0.05),观察组的效果好于对照组(Z=2.066,P<0.05);观察组m MRC和CAT评分均低于对照组(P<0.01);观察组FEV1和FEV1%均高于对照组(P<0.05);观察组SGRQ评分低于对照组,6 MWD多于对照组(P<0.01);观察组CD3^+,CD4^+,CD4^+/CD8^+水平均高于对照组,CD8^+水平低于对照组(P<0.05);观察组hs-CRP,IL-6,IL-8和TNF-α水平均低于对照组(P<0.01)。结论:中医综合优化康复措施治疗稳定期慢阻肺患者,能抑制炎性因子,提高免疫功能,可减轻临床症状,改善肺功能,提高患者运动耐力和生活质量,促进了肺的康复。Objective:To discuss the clinical efficacy of comprehensive optimization of rehabilitation measures of traditional Chinese medicine(TCM)on elderly patients with COPD at stable period,in order to study its effect on immune function and inflammatory factors.Method:One hundred and forty-four patients were randomly divided into control group and observation group by random number table.Patients in control group got ipratropium bromide,40-80μg/time,2-4 times/days,salmeterol roticasone powder,1 suction/time,2 times/days,as well as comprehensive western medical treatment measures of healthcare education,oxygen therapy and respiratory muscle exercise.In addition to the basic therapy of ipratropium bromide and salmeterol roticasone powder,patients in observation group was added with syndrome differentiation therapy of TCM,foot bath with TCM and respiratory function exercise with TCM.The course of treatment was 6 months,and 6-month follow-up were recorded.Comprehensive assessment of COPD was recorded.Before and after treatment,respiratory questionnaire(m MRC),self-assessment test for patients with chronic obstructive pulmonary disease(CAT),forced expiratory volume in the first second(FEV1),FEV1%,St George’s respiratory questionnaire(SGRQ),6-minute walking distance(6 MWD)were scored.And levels of CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-alpha(TNF-alpha)and hypersensitive C-reactive protein(hs-CRP)were detected.Result:Comprehensive assessment of COPD in the two groups were better than those before treatment(P<0.05),and that in observation group was better than that in control group(Z=2.066,P<0.05).And scores of m MRC,CAT,SGRQ,hs-CRP,IL-6,IL-8 and TNF-αwere lower than those in control group(P<0.01),and level of CD8^+was lower than that in control group(P<0.05).And levels FEV1 and FEV1%were higher than those in control group(P<0.05),and levels of CD3^+,CD4^+,CD4^+/CD8^+and 6-minute walking distance were more than those in control group(P<0.01).Conclusion:Comprehensive opti

关 键 词：慢性阻塞性肺疾病 稳定期 玉屏风颗粒 百令胶囊 慢支固本颗粒 百合固金丸 免疫功能 炎症因子 

分 类 号：R5[医药卫生—内科学] R56[医药卫生—临床医学]