摘要
目的 观察利金方联合噻托溴铵治疗慢性阻塞性肺疾病（COPD）稳定期肺气虚证患者的远期疗效.方法 选择2013年1月至2016年9月广西中医药大学附属瑞康医院呼吸内科门诊就诊的120例COPD稳定期肺气虚证患者,按随机数字表法分为噻托溴铵组、利金方组、中西医结合组,每组40例.噻托溴铵组用噻托溴铵粉吸入剂治疗,每粒18μg,每天1粒;利金方组给予利金方（党参10 g、黄芪15 g、川贝母6 g、白术10 g、茯苓10 g、紫菀10 g、防风6 g、麦冬10 g、五味子3 g、蛤蚧5 g、陈皮6 g、甘草6 g）,每日1剂,水煎成200 mL,分早晚两次服用;中西医结合组用利金方联合噻托溴铵粉吸入剂治疗.各组疗程均为6个月.观察各组治疗前、治疗结束时和治疗结束后6个月及12个月运动耐量、COPD评估测试评分（CAT）、肺功能变化及治疗结束后1年内COPD急性发作次数和不良反应发生情况.结果 随着治疗时间延长,噻托溴铵组、利金方组、中西医结合组治疗后6 min步行距离（6MWT）和肺功能指标1秒用力呼气容积（FEV1）、用力肺活量（FVC）均较治疗前增加,CAT评分较治疗前降低,且从治疗结束开始中西医结合组上述指标的改善程度均优于噻托溴铵或利金方组[6MWT（m）：398.69±85.07比358.15±77.84、359.75±79.14,CAT评分（分）：0.99±0.42比1.42±0.64、1.41±0.59,FEV1（L）：1.42±0.17比1.32±0.11、1.33±0.18,FVC （L）：2.49±0.11比2.21±0.15、2.20±0.19,均P＜0.05],持续到治疗后12个月.治疗结束后1年内,中西医结合组急性发作次数较噻托溴铵组和利金方组降低更明显（次：0.95±0.24比1.62±0.64、1.64±0.72,均P＜0.05）.观察期间3组均有病例发生口干,但程度较轻.结论 利金方联合噻托溴铵治疗COPD稳定期肺气虚证患者有较好的远期疗效,能提高患者的运动耐量和生活质量,对肺功能有一定的改善作用,并减少急性发作次数.
Objective To investigate the remote efficacy of Lijin formula combined with Tiotropium bromide for the treatment of chronic obstructive pulmonary disease （COPD） of lung qi deficiency syndrome in stable phase. Methods One hundred and twenty-two patients with lung qi deficiency syndrome of COPD in stable phase admitted to the Department of Respiratory Medicine in Ruikang Hospital Affiliated to Guangxi Traditional Chinese Medical （TCM） University from January 2013 to September 2016 were, enrolled, and they were. divided into tiotropium bromide, Lijin formula and integrated TCM and western medicine groups, each group 40 cases. The patients in tiotropium bromide group were given tiotropium bromide, inhaling 18μg each time, once daily; the patients in Lijin formula group were given Lijin formula （codonopsis pilosula 10 g, astragalus mongholicus 15 g, fritillaria roylei hooker 6 g, bighead atractylodes rhizome 10 g, poria cocos 10 g, radix asteris 10 g, saposhnikovia divaricata 6 g, radix ophiopogonis 10 g, schisandra chinensis 3 g, gekko 5 g, pericarpium citri reticulatae 6 g, liquorice 6 g）, one dose each day, deeoeted to 200 mL divided into two parts and one part taken twice daily, once in the morning and once in the evening; the patients in integrated TCM and western medicine group were treated with the Lijin formula and tiotropium bromide. Each group was treated for 6 weeks. Before treatment, the end of the treatment and after the end for 6 months and 12 months, the exercise tolerance, COPD evaluation test score （CAT）, change of pulmonary function, the times of acute attack and adverse reac, tions occurring in one year after the end of treatment were observed. Results With prolongation of therapeutic time, after treatment 6-minute walking distance （6MWT）, forced expiratory volume in 1 second （FEV1）, forced vital capacity （FVC） were significantly increased compared to those before treatment, while CAT score was less than that before treatment. Moreover, beginning from the end of the therapy, the degree of improvement in integrated TCM and western medicine group was superior to that of tiotropium bromide group and of Lijin formula group [6MWT （m）： 398.69±85.07 vs. 358.15±77.84, 359.75±79.14; CAT score： 0.99±0.42 vs. 1.42±0.64; FEV1 （L）： 1.42±0.17 vs. 1.32 ±0.11, 1.33±0.18; FVC （L）： 2.49 ±0.11 vs. 2.21±0.15, 2.20±0.19, 1.41±0.59, all P 〈 0.05], persisting to 12 months after treatment. In the one year after the end of therapy, the frequency of acute exacerbation of COPD in the integrated TCM and western medicine group was more significantly lower than that of tiotropium bromide group and of Lijin formula group （times： 0.95±0.24 vs. 1.62±0.64, 1.64±0.72, both P 〈 0.05）. During the period of observation, dry. mouth occurred in the three groups, but the phenomenon was relatively mild. Conclusions Lijin TCM formula combined with tiotropium bromide for treatment of patients with COPD of lung qi deficiency syndrome in stable stage has relatively good remote therapeutic effect： it can improve their lung function, decrease the frequency of acute exacerbation, elevate the exercise tolerance and quality of life.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2016年第6期577-580,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
广西壮族自治区科技计划项目（桂科攻1355005-5-2）
关键词
利金方
噻托溴铵
肺疾病
阻塞性
慢性
稳定期
肺气虚证
远期疗效
中西医结合疗法
Lijin formula
Tiotropium bromide
Chronic obstructive pulmonary disease
Stable phase： Lung qi deficiency
Remote efficacy
Combination of traditional Chinese and western Medicine
