干咳、无痰、咽痒总不见好?关键是治疗没有对上路子

正秋风起兮百草黄。伴随着天气的逐渐寒凉,林林反复出现干咳,无痰、咽痒。到医院做了X光检查,肺部没有问题。自已到药店买了一大堆药治咳嗽和润喉的药物,还在网上找了N种偏方试用,枇杷、雪梨不断吃,但总是不见好转。无奈,林林找到中医,问这是什么原因?有什么好的方法?     

固本咳喘方治疗轻中度慢性阻塞性肺疾病30例临床研究

目的:观察固本咳喘方对轻中度慢性阻塞性肺疾病(COPD)稳定期的防治作用。方法:60例COPD患者随机分为治疗组与对照组,治疗组予以固本咳喘方,对照组给予西医规范治疗,均治疗6个月。观察2组患者治疗前后临床症状、6min行走距离(6MWD)、急性加重次数、呼吸困难分级、肺功能等变化情况。结果:治疗后治疗组患者咳嗽、咯痰、喘息、胸闷、气短、乏力、易汗、食少、畏寒、便溏等症状较治疗前明显改善(P0.01),在咳痰、喘息、胸闷、气短、易汗方面治疗组改善明显优于对照组(P0.05);治疗组的综合疗效优于对照组(P0.01)。2组治疗后6min行走距离、急性加重次数皆有明显改善(P0.05,P0.01);治疗组治疗后呼吸困难程度较治疗前明显减轻(P0.01)。治疗组治疗后的用力肺活量(FVC%)、1秒钟用力呼气量(FEV1%)较治疗前明显改善(P0.01),而对照组肺功能指标存在不同程度的下降,其中FEV1%下降明显(P0.01)。治疗组小气道功能指标最大呼气流速(PEF%)、PEF25%、PEF50%、PEF75%、MMEF75/25%存在不同程度的改善(P0.05,P0.01),而对照组小气道功能指标则存在不同程度的下降,其中PEF25%、PEF50%下降存在显著性差异(P0.05)。结论:固本咳喘方可以有效改善轻中度COPD稳定期患者临床症状,减少急性加重次数,改善6min行走距离、呼吸困难程度,改善肺通气功能及小气道功能,延缓病情进展。     

CCERW:一种预测中老年人社区获得性肺炎临床无效结局的工具

目的 建立一种预测中国中老年人社区获得性肺炎(CAP)临床无效结局的工具,并与其他工具进行对比.方法 前瞻性收集2006年12月17日至2008年12月22日3所高校教学医院呼吸内科住院部收治的年龄≥45岁并确诊为CAP患者的数据,按随机数字表法将其中75%的患者数据用于工具的建立(推导组),25%的患者数据用于工具内部真实性的检验(内部组).同期收集另外一所高校教学医院的患者数据用于工具外部真实性的检验(外部组).结局定义为患者入院14 d或未满14 d出院时的临床无效状态.观测指标包括社会人口学特征、基础疾病和既往情况、并发症、症状、体征、辅助检查结果共6个方面58个因素.采用单因素分析、多因素分析和受试者工作特征曲线(ROC曲线)分析结合的方法进行工具的建立和评价,并与肺炎严重度指数(PSI)、英国胸科协会评估标准(CURB65)及其修订版(CRB65)等预测工具对临床结局的判断能力进行比较.结果 3个中心共纳入539例CAP患者的资料用于数据分析,其中推导组400例,内部组139例;外部组159例.以推导组400例数据进行单因素分析显示,共6个方面33个变量在痊愈和临床无效两组间差异有统计学意义;并以此进行多因素分析显示,精神混乱(C)、肌酐(Cr)＜60 μmol/L、电解质紊乱(E)、呼吸衰竭(R)、白细胞计数(WBC)＞7.5×109/L 5个因素差异有统计学意义.以此5个变量建立预后工具,即CCERW,将患者分为3个危险级别:得0～1分者无效率为5.5%～9.1%,得2分者无效率为12.8%～20.0%,得3～6分者无效率为31.0%～40.5%.ROC曲线分析显示,CCERW对推导组、内部组和外部组临床无效结局的预测能力分别为0.709[95%可信区间(95%CI)0.638～0.780]、0.725(95%CI 0.613～0.838)、0.686(95%CI 0.590～0.782).CCERW对全部698例患者的临床结局判断能力为0.710(95%CI 0.659～0.761),而PSI、CURB65、CRB65的判断能力分别为0.667(95%CI 0.614～0.719)、0.648(95%CI 0.592～0.705)和0.584(95%CI 0.530～0.638).结论 CCERW可帮助临床医师快速区分出中国中老年CAP患者的临床无效结局,且其对临床结局的判断能力优于PSI、CURB65、CRB65等预测工具,谨慎推荐将其在中国大陆地区汉族中老年CAP患者中使用.

Abstract：

Objective To develop and validate a clinical rule to predict treatment failure in middleaged and elderly patients suffering from community-acquired pneumonia (CAP) in China, and to compare it with other prognostic rules. Methods Data of 58 variables affiliated to 6 aspects, including demographics,underlaying diseases, previous status, complications, symptoms, signs and laboratory examination results from the CAP patients aged ≥ 45 years admitted to the respiratory departments in three university affiliated hospitals between December 17, 2006 and December 22, 2008 were enrolled prospectively and then validated in two groups to create a derivation cohort with 75% of the patients for rule development and an internal validation cohort with the other 25% for internal test. An external validation cohort was formed at the same time with patients admitted to the other university affiliated hospital for external test. The single outcome was treatment failure at the time of 14 days after admitted or at discharge from hospital. Univariate analysis, multivariate analysis and receiver operating characteristics (ROC) curve were used for the rule establishment, assessment and comparison among the pneumonia severity index (PSI), CURB65 [confusion,blood urea nitrogen＞6.8 mmol/L, respiratory rate (RR)≥30 breaths per minute, systolic blood pressure (SBP)＜90 mm Hg (1 mm Hg=0. 133 kPa) or diastolic blood pressure (DBP)≤60 mm Hg, age≥65 years]and CRB65 (confusion, RR ≥ 30 breaths per minute, SBP ＜ 90 mm Hg or DBP ≤ 60 mm Hg,age≥65 years). Results The data of a total of 539 patients in three hospitals were enrolled for analysis. Ofthose, 400 and 139 patients were randomly allocated into the derivation cohort or internal validation cohort respectively. Meanwhile, 159 patients were enrolled in the external validation cohort. Analyzing the data from 400 patients in the derivation cohort, 33 variables of 6 aspects had significant difference between cure and treatment failure outcome in the univariate analysis. Then, in the multivariate analyses, five independent predictive factors showed significant difference, including confusion (C), creatinine ＜60 μmol/L, electrolyte disturbances (E), respiratory failure (R), white blood cell (WBC)＞7.5× 109/L. A clinical prediction rule CCERW based on these variables showed that the treatment failure outcome increased directly with increasing scores : 5.5%- 9. 1 %, 12.8 %- 20. 0% and 31.0 %- 40. 5% for scores of 0 - 1, 2 and 3 - 6, respectively. ROC curve analysis yielded an area under the curve (AUC) for CCERW of 0. 709 [95% confidence intervals (95%CI) 0.638 - 0.780], 0.725 (95%CI 0.613 - 0.838) and 0.686 (95%CI 0.590 - 0.782) in the derivation, internal and external validation cohorts respectively; and in the same manner, of 0.710(95%CI 0. 659 - 0. 761) for total 698 patients, which was better than PSI, CURB65 and CRB65, at 0. 667(95%CI 0. 614 - 0. 719), 0. 648 (95%CI0. 592 - 0. 705), and 0. 584 (95%CI 0.530 - 0.638), respectively.Conclusion CCERW can help physicians to distinguish high and low risk leading to treatment failure in middle-aged and elder patients with CAP, and has better predictable capability than PSI, CURB65 and CRB65. We prudent recommend the simple rule can be used in the middle-aged and elder patients with CAP of Han race people in China.     

曹世宏辨治支气管扩张症之经验

曹世宏教授根据多年诊治支气管扩张症的临床经验,总结出本病以气阴亏虚为本,痰热瘀阻为标,提出“养阴以润肺体,益气以复肺用”思想,治疗以益气养阴为主,同时注重补益肺脾、清热化痰、活血化瘀,临床常取得较好的疗效。附验案1则以佐证。     

吴门名家曹鸣高论治肺系疾病的经验

曹鸣高教授是吴门医派的临床大家,擅治肺系疾病。曹老认为慢支久发,虚寒为多,多属支饮,治从温补,肺病涉脾,肺脾同治,经久伤肾,则扶正培元;哮喘之治,重在培本,治本之法,重在治肾;论治肺炎,当达邪扶正,标本兼顾;支扩咯血,宜养阴清肺,凉血止血,清化痰热以治标,养阴益气以治本;对于肺系疑难杂症,多参以活血化痰法。     

吴门名家曹鸣高论治脾胃病的经验

曹鸣高教授是吴门医派的临床大家,擅长治疗脾胃病。曹老调理脾胃重在顾护中气,升清降浊为主;认为腹泻之本在脾胃,健运脾气,恢复脾胃升降转运之机,是治疗腹泻的关键;寒温并用,仿乌梅丸法治疗溃疡性结肠炎;清营凉血,顺气降火,和络止血治疗上消化道出血,并以止血为当务之急;温润兼顾,甘温益气为主,佐以酸甘化阴,阳旺则运健,刚柔并济治疗慢性萎缩性胃炎。附验案4则以佐证。     

慢性阻塞性肺气肿患者常练呼吸保健操

呼吸保健操能有效改善慢性阻塞性肺气肿患者呼吸浅促的症状,增加肺活量,改善换气、通气功能. 摩鼻 用双手食指上下按摩鼻翼两旁的迎香穴及鼻梁两侧10-20次;以右手掌心按摩鼻尖素髎穴,方向由右向左,10～20次,再从相反方向按摩10～20次.     

补肾调周法治疗月经性哮喘探析

月经性哮喘的发病与月经周期相关,基于调周法的理论指导,探讨月经性哮喘的独特病机与辨治要点。该病发时处于经前后半期或行经期,常见热象,证候类型主要有肝火犯肺、痰热壅肺;平时以肾阴亏虚、肺脾气弱为主。结合经后期、经前期的阴阳消长特点,经后期强调养血滋阴补肾、益气健脾化痰,经前期治从养血益气助阳、清热降逆化痰。     

固肾补脾膏联合舒利迭治疗中老年慢性阻塞性肺疾病稳定期疗效观察

目的 :观察固肾补脾膏在中老年慢性阻塞性肺疾病稳定期治疗中的效果。方法 :纳入60例处于稳定期辨证属肺脾肾虚的慢性阻塞性肺疾病(COPD)患者,按随机分组法分为观察组与对照组各30例,对照组予规律吸入沙美特罗替卡松(舒利迭),观察组予固肾补脾膏口服联合舒利迭吸入,治疗3个月后观察两组CAT评分、肺功能、免疫指标变化,之后随访9个月,记录两组1年内感冒次数与急性加重情况。结果 :两组患者经治疗后CAT积分、FEV1%显著改善(P0.05),观察组CAT评分较对照组下降更明显(P0.05)。治疗后观察组免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、C3、C4均有升高(P0.05);1年内急性发作与感冒次数显著低于对照组(P0.05)。结论 :固肾补脾膏能有效提高生活质量、增强免疫功能、改善短期预后,综合疗效方面优于舒利迭单药治疗。