摘要
目的观察支扩方结合支气管灌洗治疗支气管扩张合并感染的远期疗效。方法将73例支气管扩张急性加重期患者随机分为:中药+灌洗组(n=23)、灌洗组(n=24)、中药组(n=25)。中药+灌洗组急性期给予中药支扩感染方加减,结合支气管灌洗及抗生素等西医常规治疗,稳定期予支扩稳定方加减;灌洗组不服用中药,其余治疗同中药+灌洗组;中药组不做灌洗,其余治疗同中药+灌洗组。观察1年或2年内急性发作次数以及圣乔治呼吸问卷评分、肺功能FVC%或FEV1%等指标,评价各组的远期临床疗效,并用logistic回归分析评价1年及2年临床疗效的影响因素。结果中药+灌洗组1年期临床好转率为82.6%,灌洗组为45.5%,中药组为45.8%,中药+灌洗组高于灌洗组、中药组(P<0.05)。多因素分析结果表明,中药治疗有助于提高1年、2年期临床疗效(P<0.05),支气管镜局部灌洗有助提高1年期临床疗效(P<0.05),但对2年期疗效无明显影响(P>0.05)。多肺叶受累可降低1年、2年期临床疗效(P<0.05),合并肺心病降低2年期临床疗效(P<0.05)。结论中药治疗与支气管镜局部灌洗都是提高支气管扩张症的远期疗效的独立因素,支扩方结合支气管灌洗治疗支气管扩张合并感染,能明显提高远期疗效,减少急性发作次数,改善患者生活质量,且安全性良好。
Objective To evaluate the long-term effects of the recipes for bronchieetasis combined with segmental bronchial lavage in the treatment of bronchiectasis. Methods 72 in-patients diagnosed with acute exacerbation of bronchiectasis were randomly divided into three groups： traditional Chinese medicine （TCM） combined with bronchial lavage group（ n =23 ） , bronchial lavage group （n =24） and TCM group（ n =25 ）. In the stage of acute exacerbation, TCM combined with bronchial lavage group was treated with TCM recipe for acute exacerbation of bronchiectasis modified by syndrome differentiation, combined with bronchial lavage, antibiotics and other routine procedures. In the stable stage, TCM recipe for stable bronchiectasis modified by syndrome differentiation was administered for three months. The bronchial lavage group was given the same treatment as the combined group except for traditional Chinese medicine, and the TCM group received the same treatment as the combined group except for bronchial lavage. Long term clinical effects were evaluated, based on the change in the frequency of acute exacerbations, scores of St George＇ s respiratory questionnaire （ SGRQ ）. The influential factors to the long term effects were analysed with logistic regression models. Results The one year rates of clinical improvement of the TCM combined with bronchial lavage group, the bronchial lavage group and the TCM group were 82.6%, 45.5% , 45.8% respectively. The rate of TCM combined with bronchial lavage group was significantly higher than that of the bronchial lavage group and TCM group（ P 〈0.05 ）. Logistic regression models revealed that administration of the recipes for bronchiectasis increased one year and two year clinical improvement rates（P 〈0.05 ）. Segmental bronchial lavage increased one year clinical improvement rates（ P 〈0.05 ） except for two year rates （P 〉0.05 ）. More affected lobes decreased one year and two year clinical improvement rates （P 〈 0.05）. Chronic cor pulmonal
出处
《上海中医药杂志》
2010年第1期43-47,共5页
Shanghai Journal of Traditional Chinese Medicine
基金
上海中医药大学岳阳中西医结合医院院级课题资助项目(04Y-3)
关键词
支气管扩张
中医药疗法
支气管灌洗
多因素分析
Bronchieetasis
Chinese medicine
bronchoalveolar lavage
multivariate analysis
