中西医长程方案辨证治疗耐多药肺结核39例

目的观察中西医联合长程方案治疗耐多药肺结核的临床效果。方法选择78例耐多药肺结核患者,随机分为观察组和对照组,各39例,两组均给予西药长程方案治疗,观察组按中医理论辨证分型施治6～12个月,肺阴亏虚型按照滋阴润肺、清热杀虫方治疗;阴虚火旺型按照补益肺肾、滋阴降火方治疗;气阴耗伤型按照养阴润肺、益气健脾方治疗;阴阳两虚型按照温补脾肾、滋补精血方治疗;虚实夹杂证在上述基础上辨证施治,按照补虚培元、抗痨杀虫方治疗。观察治疗前后两组患者的临床症状、体征、X线片病灶变化及痰涂片转阴情况。结果经过治疗,观察组患者的痰菌涂片转阴性率和治愈率均为64.10%,优于对照组（53.85%、53.85%）,差异有统计学意义（P〈0.05）。巩固治疗期间观察组的不良反应发生率为12.82%,低于对照组的43.59%,差异有统计学意义（P〈0.05）。强化治疗期间观察组患者轻度肝损害8例（20.52%）,重度肝损害2例（5.13%）,均低于同期对照组的肝损害情况,差异有统计学意义（P〈0.05）。结论中西医长程方案辨证治疗耐多药肺结核的临床疗效优于单纯西药治疗,不良反应低,安全可靠,值得推广。

Western and traditional Chinese medicine syndrome differentiation and treatment of long-range plan of 39 cases of multi drug resistant pul- monary tuberculosis

Objective To observe the clinical curative effect of combination of Chinese traditional and western medicine on long-range regimen in the treatment of multi drug resistant pulmonary tuberculosis. Methods 78 cases of multi drug resistant pulmonary tuberculosis patients were randomly divided into the observation group and the control group, with 39 cases in each group, all were given medicine long-range plan with western medicine. The observation group was taken the treatment of 6-12 months in accordance with the theory of traditional Chinese medicine syndrome differentiation, Lung-Yin deficiency in accordance with nourishing Yin and moistening lung, clearing heat and insecti- cidal treatment; Fire due to Yin deficiency type by tonifying the lung and kidney, treated by nourishing Yin to reduce pathogenic fire; lungs hurt consumption in accordance with Qi and Yin and nourishing Yin, replenishing Qi to invigo- rate the spleen decoction in treating; deficiency of both Yin and Yang by warming and invigorating spleen and kidney~ and nourishing essence and blood treatment; syndrome o1 intermingled deficiency and excess in the above differential treatment on the basis, in accordance with tonic, anti-tuberculosis, insecticide treatment. The clinical symptoms and signs, X-ray focal changes, sputum smear negative effect of patients in two groups before and after treatment were ob- served. Results After treatment, the sputum smear-negative change rate and cure rate of observation group were all 64.10%, which were superior to those in the control group （53.85%,53.85%）, the differences were statistically signifi- cant （P 〈 0.05）. During consolidation therapy, the incidence of adverse reactions of observation group was 12.82%, which was lower to that in the control group （43.59%）, the difference was statistically significant （P 〈 0.05）. During the intensive therapy, the mild and severe liver damage cases of observation group were 8 eases （20.52%） and 2 cases （5.13%）, which were lower to those in the control group during the same time, the differences were statistically signifi- cant （P 〈 0.05）. Conclusion The clinical curative effect of long-range plan of integrated traditional Chinese and west- ern medicine syndrome differentiation and treatment of multi drug resistant pulmonary tuberculosis is better than that of simple western medicine, which has low side effects, and it is safe, reliable and worth of promotion.