清肺化痰逐瘀汤对COPD急性加重期合并胃肠功能障碍临床观察  

Clinical Observation of Qingfei Huatan Zhuyu Decoction in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)Complicated with Gastrointestinal Dysfunction

作　　者：寇育乐 谭曦舒 李向文 贺宏伟 史捷 喻敏 Kou Yule;Tan Xishu;Li Xiangwen;He Hongwei;Shi Jie;Yu Min(The Affiliated Hospital of Shaanxi University of Chinese Medicine,Shaanxi,Xianyang 712000,China)

机构地区：[1]陕西中医药大学附属医院,陕西咸阳712000 [2]陕西中医药大学,陕西咸阳712000

出　　处：《中国中医急症》2024年第10期1814-1818,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：陕西省中医药管理局中医药基础研究项目(2021-GJ-JC012);陕西省自然科学基础研究计划面上项目(2021JM-473)。

摘　　要：目的 观察清肺化痰逐瘀汤对慢性阻塞性肺疾病急性加重期(AECOPD)合并胃肠功能患者的临床疗效,进一步探讨其体现肺肠同治的深层次机制。方法 98例患者随机分为两组,对照组实施西医常规治疗,观察组加用清肺化痰逐瘀汤治疗,疗程2周,记录治疗前后中医证候积分、胃肠道症状分级评分量表(GSRS)评分、呼吸困难量表(m MRC)评分、慢性阻塞性肺疾病评估测试(CAT)评分;比较两组患者治疗前后[1秒用力呼气量容积(FEV1),用力肺活量(FVC),FEV1/FVC(%),FEV1/预计值(FEV1/Pred)];检测血清胃泌素(GAS)、胃动素(MTL),二胺氧化酶(DAO)、丙二醛(MDA)情况。结果 治疗组患者总有效率为91.49%,高于对照组的74.47%(P<0.05)。与本组治疗前比较,两组治疗后临床症状相关评分(中医证候积分、GSRS评分、m MRC评分、CAT评分)、血气(Pa CO_(2))和血清GAS、DAO、MDA水平均较治疗前降低(P<0.05),肺功能指标(FEV1、FVC、FEV1/FVC、FEV1%pred)、PaO_(2)和血清MTL水平较治疗前明显提高(P<0.05)。治疗后组间比较,治疗组临床症状相关评分(中医证候积分、GSRS评分、m MRC评分、CAT评分)、血气(PaO_(2)、PaCO_(2))、肺功能(FEV1、FVC、FEV1%pred)和血清GAS、MTL、DAO、MDA改善均优于对照组(P<0.05),肺功能指标FEV1/FVC有所改善,但组间差异无统计学意义(P>0.05)。结论 清肺化痰逐瘀汤加减能有效提高AECOPD患者的临床效果,改善肺功能及氧合,调节胃肠激素,促进肠黏膜屏障修复和胃肠功能恢复,减轻病情。Objective:To observe the clinical efficacy of Qingfei Huatan Zhuyu Decoction in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with gastrointestinal dysfunction,and to further explore its underlying mechanism that embodies the co-treatment of lung and intestine.Methods:A to-tal of 98 patients with AECOPD(syndrome of phlegm-heat obstructing lung)and gastrointestinal dysfunction were randomly divided into two groups.The control group received conventional western medicine treatment,while the observation group was additionally treated with Qingfei Huatan Zhuyu Decoction for a course of 2 weeks.The changes in traditional Chinese medicine syndrome scores,Gastrointestinal Symptom Rating Scale(GSRS)scores,mMRC scores,CAT scores,and pulmonary function indicators[1-second forced expiratory volume(FEV1),forced vital capacity(FVC),FEV1/FVC(%),FEV1/predicted value(FEV1/Pred)]were recorded before and after treat-ment.The changes in serum gastrin(GAS),motilin(MTL),diamine oxidase(DAO),and malondialdehyde(MDA)were also monitored.Results:After treatment,the total effective rate of the observation group was 91.49%,which was superior to the control group′s 74.47%(P<0.05).Compared with before treatment,the clinical symptom-relat-ed scores(TCM syndrome scores,GSRS scores,mMRC scores,CAT scores),blood gas(PaCO_(2)),and serum levels of GAS,DAO,and MDA were all reduced after treatment in both groups(P<0.05).Pulmonary function indicators(FEV1,FVC,FEV1/FVC,FEV1%pred),blood gas(PaO_(2)),and serum MTL levels significantly improved compared with before treatment(P<0.05).Inter-group comparisons showed that the observation group had better improve-ments in clinical symptom-related scores(TCM syndrome scores,GSRS scores,mMRC scores,CAT scores),blood gas(PaO_(2),PaCO_(2)),pulmonary function(FEV1,FVC,FEV1%pred),and serum levels of GAS,MTL,DAO,and MDA after treatment(P<0.05).The pulmonary function indicator FEV1/FVC improved,but there was no statistically sig-nificant difference between the groups(P>0.

关 键 词：慢性阻塞性肺疾病急性加重期 肺肠同治 痰热壅肺 肺功能 临床疗效 

分 类 号：R563.9[医药卫生—呼吸系统]