扶正化痰清热法治疗支气管扩张症46例远期疗效观察

目的观察扶正化痰清热法对支气管扩张稳定期(支扩)的远期疗效。方法将来自3个中心的100例支扩患者随机分为对照组和中药组各50例,对照组予西医常规治疗(主要为胸部体位引流法,若遇急性加重可短期应用抗生素),中药组予西医常规治疗加中药支扩稳定方辨证加减。观察两组患者治疗前及治疗开始1年后急性加重次数、肺功能包括用力肺活量(FVC)、第一秒用力呼气容积(FEV1)],并根据圣乔治问卷(SGRQ)进行生活质量评分。结果治疗后中药组患者急性加重次数较前明显减少(P<0.01),而对照组患者急性加重次数无明显变化(P>0.05),两组急性加重次数变化率差异有统计学意义(P<0.01)。治疗后,中药组SGRQ症状、活动、心理及总分较治疗前均明显减少(P<0.05或P<0.01),而对照组治疗后各项评分改善均不明显(P>0.05);治疗后中药组与对照组比较,除症状评分外,其他3项评分差异均有统计学意义(P<0.01);治疗前后评分差值比较,两组活动评分、症状、心理及总分差异均有统计学意义(P<0.05或P<0.01)。治疗后,对照组FVC、FVC%、FEV1、FEV1%均明显降低(P<0.05),中药组FVC%下降(P<0.05)。中药组治疗后FEV1值趋于稳定,与对照组比较差异有统计学意义(P<0.05),中药组治疗前后FEV1、FEV1%变化率与对照组比较差异有统计学意义(P<0.01)。结论根据扶正化痰清热法辨证施治,能减少支扩患者年急性加重次数,提高生活质量,减缓肺功能FEV1的下降,提高远期疗效,且安全性良好。

Long Term Effect of the Treatment Method of Strengthening Vital Qi,Transforming Phlegm and Clearing Heat for 46 Cases of Bronchiectasis

Objective To observe the long term effect of strength ening vital qi,trans forming phlegm and clearing heat for stable bronchiectasis.Methods One hundred cases of stable bronchiectasis from three clinical centers were randomized into the control group and Chinese medication group,with 50 in each.The control gro up was treated with conventional western medication including sputum drainage and short term use of antibiotics,while Zhikuo Wending Formul a(formula for bronchiectasis) was added in the Chinese medication group.One ye ar after the treatment,the frequency of acute exacerbations,scores from the St George’s Respiratory Questionnaire(SGRQ) and pulmonary function parameters wer e observed and compared.Results After treatment,the annual fre quency of acute exacerbations in the Chinese medication group decreased significantly(P<0.01),with significant difference between that in the control group(P<0.01).The SGRQ in symptom,activity,psychology and total score in the Chinese medication group decreased significantly after treat ment(P<0.05 or P<0.01),with significant difference between those in the contro l group except symptom score(P<0.01).After treatment,forced vital capacity(FVC),F VC%,forced expiratory volume 1(FEV1) and FEV1% decreased significantly in the control group(P<0.05).The decline of FVC,FEV1 and FEV1% in the Chinese medica tion group was not significant(P>0.05) except FVC%(P<0.05).The value of FEV1 in the Chinese medication group was stable with significant difference between t he control group(P<0.05).The decline rates of FEV1 and FEV1% in the Chinese me dication group were significantly lower than those in the control group(P<0.01).Conclusion The therapy of strengthening vital qi,transforming phlegm and clea ring heat is effective and safe for bronchiectasis.It could reduce the annual frequency of acute exacerbations,improve the quality of life,slow down the decline of FEV1,and improve long term efficay.