目的 探讨咳喘定穴位贴敷联合小柴胡汤合半夏厚朴汤治疗痰浊阻肺证慢性阻塞性肺疾病(Chro-nic obstructive pulmonary disease,COPD)患者的临床疗效.方法 选取2020年9月-2022年10月期间海南医学院第二附属医院收治的痰浊阻肺证COPD患者144例,按随机数字表法分为西药组、中药组、中药联合贴敷组,每组各48例.西药组采取常规西医治疗,中药组在西药基础上采取小柴胡汤合半夏厚朴汤治疗,中药联合贴敷组在常规西医基础上采取咳喘定穴位贴敷及小柴胡汤合半夏厚朴汤.治疗4周后,观察比较3组患者临床疗效、不良反应发生率、疾病复发率及治疗前后中医证候积分、肺功能[第1秒用力呼气容积(Forced expiratory volume for 1 second,FEV1)、用力肺活量(Forced vital capacity,FVC)、FEV1/FVC]、康复效果[慢性阻塞性肺疾病评估测试量表(Chronic obstructive Pulmonary Disease Assessment Test Scale,CAT)、呼吸困难程度评分(modified Medical Research Council,mMRC)、6 min步行距离试验(6 min walking distance test,6MWT)].结果 治疗后中药联合贴敷组总有效率93.75%(45/48)高于西药组77.08%(37/48)、中药组79.17%(38/48),差异有统计学意义(P<0.05).治疗后3组患者中医证候痰多、喘息、咳嗽、倦怠乏力、腹胀纳呆、下肢水肿积分均较治疗前降低,差异有统计学意义(P<0.05),且中药联合贴敷组中医证候痰多、喘息、咳嗽、倦怠乏力、腹胀纳呆、下肢水肿积分均明显低于西药组、中药组,差异有统计学意义(P<0.05).治疗后3组患者肺功能FEV1、FVC、FEV1/FVC指标均较治疗前升高,差异有统计学意义(P<0.05);且中药联合贴敷组肺功能FEV1、FVC、FEV,/FVC指标明显高于西药组、中药组,差异有统计学意义(P<0.05).治疗后3组患者康复效果CAT、mMRC评分较治疗前降低,6MWT较治疗前延长,差异有统计学意义(P<0.05);且中药联合贴敷组康复效果CAT、mMRC评分均明显低于西药组、中药组,6MWT明显优于西药组、中药组,差异有统计学意义(P<0.05).治疗期间,中药联合贴敷组不良反应发生率8.33%(4/48)与西药组6.25%(3/48)、中药组4.17%(2/48)比较,差异无统计学意义(P>0.05).治疗6个月后中药联合贴敷组疾病复发率4.17%(2/48)低于西药组18.75%(9/48)、中药组16.67(8/48),差异有统计学意义(P<0.05).结论 联合采取咳喘定穴位贴敷及小柴胡汤合半夏厚朴汤治疗痰浊阻肺证COPD效果显著,可有效缓解患者临床症状,改善肺功能及机体运动耐力,利于提升疾病整体干预效果,降低疾病复发率,且具有安全性.
Clinical Efficacy of Kechuan Dingxue Application and Xiaochaihu Decoction Com-bined with Banxia Houpu Decoction in the Treatment of Chronic Obstructive Pulmo-nary Disease with Syndrome of Turbid Phlegm Obstructing Lung
Objective To investigate the clinical efficacy of Kechuan Dingxue Application combined with Xi-aochaihu Decoction and Banxia Houpu Decoction for the treatment of chronic obstructive pulmonary disease(COPD)with syndrome of turbid phlegm obstructing lung.Methods A total of 144 COPD patients with syndrome of turbid phlegm ob-structing lung at the Second Affiliated Hospital of Hainan Medical University from September 2020 to October 2022 were randomly divided into three groups:Western medicine group,Chinese medicine group,and combination group,with 48 in each group.The Western medicine group received conventional Western medical treatment.The Chinese medicine group re-ceived Xiaochaihu Decoction combined with Banxia Houpu Decoction on the basis of Western medicine.The combination group was treated with Kechuan Dingxue Application in addition to the Chinese medicines and Western medical treatment.After a 4-week treatment,clinical efficacy,adverse reactions,disease recurrence,differences in traditional Chinese medi-cine(TCM)syndrome scores,lung function indicators[Forced Expiratory Volume in 1 second(FEV1),Forced Vital Capaci-ty(FVC),and FEV1/FVC ratio],and rehabilitation effects(Chronic obstructive Pulmonary Disease Assessment Test Scale(CAT),modified Medical Research Council dyspnea scale(mMRC),and 6-minute walk distance test(6MWT))were ob-served and compared across the three groups.Results After treatment,the total effective rate of the combination group was 93.75%(45/48),higher than the Western medicine group(77.08%,37/48)and the Chinese medicine group(79.17%,38/48)(P<0.05).The TCM syndrome scores for phlegm,wheezing,cough,fatigue,abdominal distension,and lower limb edema decreased after treatment in all groups(P<0.05),and the combination group showing the lowest scores compared with the Western and Chinese medicine groups(P<0.05).FEV1,FVC,and FEV1/FVC increased after treatment in all groups(P<0.05),with the combination group exhibiting higher lung function indicators than the other groups(P<0.05),and the rehabilitation effects(CAT,mMRC)decreased,and the 6MWT score increased in the three groups(P<0.05),with the combination group outperforming the Western and Chinese medicine groups(P<0.05).The incidence of adverse reac-tions during treatment had no significant difference between the combination group(8.33%,4/48)and the Western(6.25%,3/48)or Chinese medicine groups(4.17%,2/48)(P>0.05).The disease recurrence rate at 6 months post-treatment in the combination group(4.17%,2/48)was lower than that in the Western medicine group(18.75%,9/48)and the Chinese medicine group(16.67%,8/48)(P<0.05).Conclusion Kechuan Dingxue Application combined with Xi-aochaihu Decoction and Banxia Houpu Decoction significantly improves the treatment of COPD patients with turbid phlegm obstructing lung.It effectively relieves clinical symptoms,improves lung function and exercise tolerance,enhances the over-all intervention effect of the disease,and decreases the disease recurrence,with high safety.