中医特色肺康复在COPD稳定期肺肾气虚证治疗中的作用

摘要

目的 观察中医特色肺康复在慢性阻塞性肺疾病(COPD)稳定期肺肾气虚证治疗中的作用.方法 选择安徽中医药大学第一附属医院2017年6月至8月收治的60例肺肾气虚证COPD稳定期患者.将患者按随机数字表法分为常规治疗组和中医肺康复治疗组,每组30例.常规治疗组给予沙美特罗/氟替卡松干粉吸入剂(舒利迭)吸入治疗;中医肺康复治疗组在常规治疗组基础上给予中医特色肺康复(穴位贴敷+中药离子导入+中药口服,因时制宜,分段给药);两组疗程均为2个月.观察治疗前后两组患者中医证候积分、西医症状积分、急性加重次数、COPD评估测试量表(CAT)评分及肺功能指标1 s用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)的变化.结果 两组患者治疗后中医证候积分、西医症状积分、CAT评分较治疗前明显降低,急性发作次数较治疗前明显减少,且中医肺康复治疗组治疗后上述指标明显低于常规治疗组〔中医证候积分(分):11.93±1.80比14.27±2.88,西医症状积分(分):14.20±2.75比11.93±4.23,CAT评分(分):14.87±2.60比16.23±4.39,急性加重次数(次):0.63±0.49比0.95±0.83,均P＜0.05〕.两组治疗前后FEV1改善不明显;但中医肺康复治疗组治疗后FEV1/FVC较治疗前改善明显,中医肺康复治疗组治疗后FEV1/FVC明显高于常规治疗组〔(57.93±7.27)%比(52.49±6.61)%,P＜0.05〕.结论 在使用支气管扩张剂和糖皮质激素治疗基础上,运用中医特色肺康复治疗COPD稳定期肺肾气虚证患者,可减少患者COPD急性加重发作次数,改善患者临床症状和生活质量,但肺功能的改善作用不明显.%Objective To observe the clinical effect of traditional Chinese medicine (TCM) characteristic lung rehabilitation in treatment of patients with chronic obstructive pulmonary disease (COPD) and TCM syndrome of lung and kidney qi deficiency at stable period. Methods Sixty patients with stable COPD and lung and kidney qi deficiency syndrome admitted to the First Affiliated Hospital of Anhui University of Chinese Medicine from June to August 2017 were enrolled, and they were divided into routine treatment group and lung rehabilitation treatment group according to the random number table method, each group 30 cases. The routine treatment group was given Seretide (serevent/futicasone) dry powderi nhalation therapy; on the basis of therapy in the routine treatment group, the lung rehabilitation treatment group was treated with TCM characteristic lung rehabilitation technology (acupoint application + Chinese medicine ionic induction + oral administration of Chinese medicine Liuweibuqi granules, delivery at appropriate intervals); both groups were treated for 2 months. The changes of TCM syndrome score, western medicine symptom score, the times of acute exacerbation of COPD, COPD assessment test (CAT) score, lung function indexes: forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) were observed before and after treatment in two groups. Results After treatment, TCM syndrome score, western medicine symptom score, CAT score, and after treatment the times of acute exacerbation of COPD in both groups were significantly lower than those before treatment, and the above indexes in the lung rehabilitation treatment group were markedly lower than those in routine treatment group [TCM syndrome score:11.93±1.80 vs. 14.27±2.88, western medicine symptom score: 14.20±2.75 vs. 11.93±4.23, CAT score: 14.87±2.60 vs. 16.23±4.39, the times of acute exacerbation of COPD (times): 0.63±0.49 vs. 0.95±0.83, all P < 0.05]. The improvement of FEV1 in the two groups was not significant; but FEV1/FVC in lung rehabilitation treatment group was obviously higher than that before treatment, FEV1/FVC in lung rehabilitation treatment group was significantly higher than that in the routine treatment group [(57.93±7.27)% vs. (52.49±6.61)%, P < 0.05]. Conclusion The application of TCM characteristic lung rehabilitation in the treatment of COPD patients with stable lung and kidney qi deficiency syndrome based on bronchodilators and glucocorticoids can reduce the number of acute exacerbation, improve the patients' clinical symptoms and living quality, but the improvement of lung function is not significant.