益气活血法辅助治疗小儿肺炎恢复期的临床研究
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摘要
小儿肺炎是临床常见病、多发病,临床治疗以抗感染及对症处理为主,大部分患儿经治疗1周后,症状改善,症情趋愈。但仍有不少患儿恢复期出现啰音难消、咳嗽不止、汗多纳差等,病情迁延不愈,住院时间延长,极易造成二重感染,使病情反复。本研究回顾近年来中医学对肺炎恢复期的病机认识和治疗情况,结合小儿肺炎病机特点,认为肺炎恢复期诸症迁延难愈的主要病机为气虚血瘀,并提出益气活血法治疗小儿肺炎恢复期的治法。根据病机、治法,筛选药物,制定处方,进行临床研究。
在临床研究中,选出符合研究方案的60例病例作为观察对象,其中治疗组、对照组各30例。在肺炎恢复期,对照组继续原抗感染治疗方案,辅以西医对症治疗,治疗组在此基础上加用益气活血方。观察疗程均为3天,通过比较两组患儿主要症状体征、X线全胸片等观察指标积分改善情况,以评价两种不同治疗方案治疗肺炎恢复期的临床疗效。结果显示:治疗组痊愈、显效、进步、无效例数为1例(3.33%),13例(43.33%),16例(53.33%),O例(0%);对照组为1例(3.33%),2例(6.67%),16例(53.33%),11例(36.67%);治疗组总有效率为100%,对照组总有效率为63.33%,两组总有效率经卡方检验比较差异有高度统计学意义,P＜0.01,两组疗效经秩和检验比较差异有高度统计学意义,P＜0.01。在咳嗽、痰壅、肺部听诊等主要疗效指标的改善方面,治疗组均优于对照组;在次症食欲、汗出、舌象改善方面,对照组治疗前后积分差值无统计学意义,提示对照组治疗前后无明显改善,而治疗组治疗前后积分差值有高度统计学意义,治疗组具有明显优势;在次症精神改善方面,两组差异无统计学意义。
因此,我们认为益气活血法是小儿肺炎恢复期诸症迁延难愈的有效治法。
Pneumonia is a commonly-encountered disorder in pediatric,which is mainly treated by anti-infection and symptoms-releieving medicines.After treatment of 1 week,the majority of the patients recovered or the symptoms were relieved.Although,there are still many children accompanied with persistant pulmonary rales,lingering cough,spontaneous sweating,poor appetite and so on.Hence the disease was lingering and intractable.By reviewing a great quantity of tranditonal Chinese medicine literatures on the pathogenesis and treatment of pneumonia in recovery stage,this reseach comes to the conclusion that the main pathogenesis of the lingering symptoms in recovery stage of children pneumonia is qi deficiency and blood stagnation.And replenishing qi and promoting blood circulation is a effective therapeutic method in this stage.
In the clininical study,sixty patients with pneumonia in the rehabilitation stage were divideded into two groups.The 30 patients in control group were still treated by the antibiotic,or in combination with other morden medicines which to relieve symptoms. Meanwhile,except the modern medicine,the 30 patients in the treatment group needed to receive the decoctions of TCM which were prescribed under the therapeutic principle: replenishing qi and promoting blood circulation.The observation time of two groups were both 3 days.And the differences between two groups were caculated by the improvement of the scores of symptoms and signs,X-ray examination.
At the end of the treatment,the numbers of the cases that were cured,significant effective,improved,ineffective in the treatment group were separately 2(6.67%)),16(53.33%),11(36.67%),1(3.33%),While 0(0%),16(53.33%),1(3.33%),17(56.67%) in the control group;The response rate of the treatment was 96.67%,while 56.67%in the control group.With chi-square test,the difference of the response rate between two groups was statistically significant(P＜0.01).
About the improvement of major symptoms(cough,sputum,pulmonary auscultation and so on),the treatment group were superior to the control group.About the improvement of appetite、sweating、toungue fur,the score changes in the control group were not statistically significant(P＞0.05),while a high degree of ststistical significance(P＜0.01) in the treatment group with the rank sum test.But the difference of spirit between two groups had no ststistical significance.In the improvement of complextion,both two groups were effective,but the treatment group was superior.
Therefore,we considered that the method of replenishing qi and promoting blood circulation was effective in the patients with childhood Pneumonia in the rehabilitation stage.Compared to the control group which used the morden mendicine only,the method of replenishing qi and promoting blood circulation were more effective in relieving the cough,resolving the phlegm,activating the absorbtion of the rale,especially in the improvement of appetite、sweating、toungue fur.and it is worth clinical promotion.
在临床研究中,选出符合研究方案的60例病例作为观察对象,其中治疗组、对照组各30例。在肺炎恢复期,对照组继续原抗感染治疗方案,辅以西医对症治疗,治疗组在此基础上加用益气活血方。观察疗程均为3天,通过比较两组患儿主要症状体征、X线全胸片等观察指标积分改善情况,以评价两种不同治疗方案治疗肺炎恢复期的临床疗效。结果显示:治疗组痊愈、显效、进步、无效例数为1例(3.33%),13例(43.33%),16例(53.33%),O例(0%);对照组为1例(3.33%),2例(6.67%),16例(53.33%),11例(36.67%);治疗组总有效率为100%,对照组总有效率为63.33%,两组总有效率经卡方检验比较差异有高度统计学意义,P＜0.01,两组疗效经秩和检验比较差异有高度统计学意义,P＜0.01。在咳嗽、痰壅、肺部听诊等主要疗效指标的改善方面,治疗组均优于对照组;在次症食欲、汗出、舌象改善方面,对照组治疗前后积分差值无统计学意义,提示对照组治疗前后无明显改善,而治疗组治疗前后积分差值有高度统计学意义,治疗组具有明显优势;在次症精神改善方面,两组差异无统计学意义。
因此,我们认为益气活血法是小儿肺炎恢复期诸症迁延难愈的有效治法。
Pneumonia is a commonly-encountered disorder in pediatric,which is mainly treated by anti-infection and symptoms-releieving medicines.After treatment of 1 week,the majority of the patients recovered or the symptoms were relieved.Although,there are still many children accompanied with persistant pulmonary rales,lingering cough,spontaneous sweating,poor appetite and so on.Hence the disease was lingering and intractable.By reviewing a great quantity of tranditonal Chinese medicine literatures on the pathogenesis and treatment of pneumonia in recovery stage,this reseach comes to the conclusion that the main pathogenesis of the lingering symptoms in recovery stage of children pneumonia is qi deficiency and blood stagnation.And replenishing qi and promoting blood circulation is a effective therapeutic method in this stage.
In the clininical study,sixty patients with pneumonia in the rehabilitation stage were divideded into two groups.The 30 patients in control group were still treated by the antibiotic,or in combination with other morden medicines which to relieve symptoms. Meanwhile,except the modern medicine,the 30 patients in the treatment group needed to receive the decoctions of TCM which were prescribed under the therapeutic principle: replenishing qi and promoting blood circulation.The observation time of two groups were both 3 days.And the differences between two groups were caculated by the improvement of the scores of symptoms and signs,X-ray examination.
At the end of the treatment,the numbers of the cases that were cured,significant effective,improved,ineffective in the treatment group were separately 2(6.67%)),16(53.33%),11(36.67%),1(3.33%),While 0(0%),16(53.33%),1(3.33%),17(56.67%) in the control group;The response rate of the treatment was 96.67%,while 56.67%in the control group.With chi-square test,the difference of the response rate between two groups was statistically significant(P＜0.01).
About the improvement of major symptoms(cough,sputum,pulmonary auscultation and so on),the treatment group were superior to the control group.About the improvement of appetite、sweating、toungue fur,the score changes in the control group were not statistically significant(P＞0.05),while a high degree of ststistical significance(P＜0.01) in the treatment group with the rank sum test.But the difference of spirit between two groups had no ststistical significance.In the improvement of complextion,both two groups were effective,but the treatment group was superior.
Therefore,we considered that the method of replenishing qi and promoting blood circulation was effective in the patients with childhood Pneumonia in the rehabilitation stage.Compared to the control group which used the morden mendicine only,the method of replenishing qi and promoting blood circulation were more effective in relieving the cough,resolving the phlegm,activating the absorbtion of the rale,especially in the improvement of appetite、sweating、toungue fur.and it is worth clinical promotion.
引文
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[4]牛风云.小儿肺炎恢复期辨治体会[J].江苏中医药,2006,27(11):20.
[5]史竞懿.益气健脾化痰汤治疗小儿肺炎恢复期483例[J].湖北中医杂志,2004,26(10):38.
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