清肺蠲饮汤联合经络推拿治疗...医证候评分和炎性指标的影响_胡丽丽.pdf

世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1临床研究DOI:10 13935/j cnki sjzx 230128基金项目:河南省卫生健康委项目(20 21ZY2024)作者单位:河南中医药大学第一附属医院儿科五区，河南 郑州 450000通信作者:赵倩义，Email:15188305966163 com清肺蠲饮汤联合经络推拿治疗热饮阻肺证小儿肺炎的临床疗效及对中医证候评分和炎性指标的影响胡丽丽刘卫萍李亚丽曹梦李利阳任雪华杨爽赵倩义【摘要】目的探究清肺蠲饮汤联合经络推拿治疗热饮阻肺证小儿肺炎对中医证候评分和炎性指标的影响。方法选取 2019 年 1 月2021 年 12 月期间河南中医药大学第一附属医院儿科五区收治的 120 例热饮阻肺证型肺炎患儿作为研究对象，按随机数字表法分为观察组和对照组，每组各 60 例。对照组行常规西医治疗，观察组在对照组基础上给予清肺蠲饮汤联合经络推拿治疗。治疗 1 周后，观察比较两组疾病综合疗效、中医证候疗效，治疗前后主、次证候积分及血清炎性介质 白细胞介素 6(Interleukin 6，IL 6)、C 反应蛋白(Creactive pro-tein，CP)、肿瘤坏死因子(Tumor necrosis factor ，TNF )水平。结果治疗后观察组疾病综合疗效总有效率 98 33%(59/60)明显高于对照组 88 33%(53/60)，差异有统计学意义(2=4 821，P 0 05)。治疗后观察组中医证候疗效总有效率 96 67%(58/60)明显高于对照组 86 67%(52/60)，差异有统计学意义(2=3 927，P 0 05)。治疗后两组患儿主、次证候积分均较治疗前明显降低，差异有统计学意义(P 0 05);且观察组主证总积分、稀涎、肺部湿啰音，次证总积分均较对照组明显降低，差异有统计学意义(P 0 05)。治疗后两组患儿 IL 6、CP、TNF 水平均较治疗前明显降低，差异有统计学意义(P 0 05);且观察组 IL 6、CP、TNF 水平均较对照组明显降低，差异有统计学意义(P 0 05)。结论清肺蠲饮汤联合经络推拿辅助治疗热饮阻肺证肺炎患儿效果显著，可以缓解机体炎性反应，改善中医证候。【关键词】热饮阻肺证;清肺蠲饮汤;经络推拿;肺炎;中医证候;炎性指标【中图分类号】722 13+5【文献标识码】AEffects of Qingfei Juanyin Decoction Combined with Meridian and Collateral Mas-sage on TCM Syndrome Score and Inflammatory Indexes in Children with Pneumo-nia of Heat and Fluid etention Obstructing Lung SyndromeHU Li li，LIU Wei ping，LI Ya li，CAO Meng，LI Li yang，EN Xue hua，YANG Shuang，ZHAO Qian yi(The Fifth Division of Pediatrics Department，the First Affiliated Hospital of Henan University of Chinese Medicine，Zheng-zhou Henan 450000)【Abstract】ObjectiveTo explore the effects of Qingfei Juanyin Decoction combined with meridian and collateralmassage on traditional Chinese medicine(TCM)syndrome score and inflammatory indexes in children with pneumonia ofheat and fluid retention obstructing lung syndrome MethodsA total of 120 children with pneumonia of heat and fluid re-tention obstructing lung syndrome admitted to the fifth division of the Pediatrics Department，the First Affiliated Hospital ofHenan University of Chinese Medicine from January 2019 to December 2021 were enrolled and divided into an observationgroup(n=60)and a control group(n=60)according to the random number table method All patients were treated withconventional western medicine，while those in the observation group received additional Qingfei Juanyin Decoction com-bined with meridian and collateral massage After one week of treatment，comprehensive curative effect，curative effect onTCM syndrome，changes in scores of main and secondary syndromes，and levels of serum inflammatory mediators interleu-kin 6(IL 6)，C reactive protein(CP)，and tumor necrosis factor (TNF )before and after treatment werecompared between the two groups esultsAfter treatment，the total effective rate of comprehensive curative effect in theobservation group was 98 33%(59/60)，significantly higher than 88 33%(53/60)in the control group(2=4 821，P 0 05)After treatment，the total effective rate of curative effect on TCM syndrome in the observation group was 96 67%461世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1(58/60)，higher than 86 67%(52/60)in the control group(2=3 927，P 0 05)After treatment，the scores of primaryand secondary syndromes of the two groups were lower than those before treatment(P 0 05)The total score of the prima-ry syndrome，watery salivation，moist rales in the lung，and the total score of the secondary syndrome in the observationgroup were lower than those in the control group(P 0 05)After treatment，the levels of IL 6，CP，and TNF in thetwo groups decreased compared with those before treatment(P 0 05)，and the levels of IL 6，CP，and TNF in theobservation group were lower than those in the control group(P 0 05)ConclusionThe effect of Qingfei Juanyin De-coction combined with meridian and collateral massage is significant in the treatment of children with pneumonia of heatand fluid retention obstructing lung syndrome，which can relieve inflammatory response and improve TCM syndromes【Keywords】Heat and Fluid etention Obstructing Lung Syndrome;Qingfei Juanyin Decoction;Meridian and Col-lateral Massage;Pneumonia;TCM Syndrome;Inflammatory Index小儿肺炎为最常见的支气管肺炎，中医学称之为肺炎喘嗽，早期多为实症，后期见咳嗽、气促等1，2。中医学认为小儿脏腑娇嫩，形气未充，御邪能力较弱，易感外淫，六淫邪气，无论是从口鼻而入，还是从皮毛而侵，均先犯肺。热饮阻肺为咳喘初期关键病机，及早辨证治疗热饮，至关重要。目前，西医治疗主要以抗感染药物抑菌或杀菌为主，效果良好，但长期使用药物会提高患儿对其的抗性或出现菌群交替、重叠感染等，影响患者预后3，4。因此，本研究采用自拟清肺蠲饮汤5 辅以经络推拿从热饮论治小儿肺炎，深入探究其临床治疗效果及对中医证候评分及炎性指标的影响，旨在为临床小儿肺炎早期有效治疗方式的研究提供理论基础，现报道如下。1资料与方法1 1临床资料1 1 1一般资料选取2019 年1 月2021 年12 月期间本院收治的 120 例肺炎热饮阻肺证患儿作为研究对象，按随机数字表法分为观察组和对照组，每组各 60 例。对照组中男 37 例，女23 例;年龄1 10 岁，平均(477 136)岁;观察组中男35 例，女25 例;年龄1 10 岁，平均(4 64 1 23)岁。两组患者基线资料比较，差异无统计学意义(P 0 05)，具可比性。本研究经本院伦理委员会批准通过(NO:2020H1824)。1 1 2诊断标准1 1 2 1西医诊断标准参照 诸福棠实用儿科学6 中小儿肺炎诊断标准进行:呼吸道症状:咳嗽、咯痰、喘息、呼吸急促，甚至有呼吸困难、鼻塞、三凹征等;肺部体征:早期肺部呼吸音增粗，中期后期就听到中湿啰音或者干啰音、哮鸣音;胸片或胸部 CT 检查:胸片早期可可显示有纹理粗，中期后期显示一个肺段、一个肺叶或者是某一个或者是双下肺，或者是间质部位都出现一些肺部的炎症的特征，点片状的影或者斑片状的影;病原学检测:致病菌为细菌，则白细胞数量会相对增多，倘若是病毒或者是肺炎支原体感染导致的小儿肺炎血液中白细胞数量会减少。1 1 2 2中医诊断标准参照 中医病证诊断疗效标准中医儿科病证诊断疗效标准7 中肺炎喘嗽中痰热闭肺型