刘洁静　冯京帅　李霞　李炬明

摘要 目的：觀察桑白皮汤加减治疗慢阻肺急性加重期痰热壅肺型患者的疗效及对肺功能、血气指标的影响。方法：选取2016年1月至2018年12月北京中医医院顺义医院收治的慢阻肺急性加重期痰热壅肺型患者80例作为研究对象，按照随机数字表法分为对照组和观察组，每组40例。对照组患者给予西药常规治疗，观察组患者在对照组基础上给予由桑白皮汤加减而成的汤剂内服治疗，疗程为2周。通过中医证候积分变化比较2组患者的临床疗效，观察并比较2组患者肺通气功能、动脉血气指标，监测血清炎症指标，记录用药过程中的不良反应。结果：治疗后，观察组有效率为92.50%，高于对照组的75.00%，差异有统计学意义（P<0.05）;观察组患者的中医证候积分显著低于对照组（P<0.05），相关肺功能指标均高于对照组，呼吸指数（RI）水平则明显降低（P<0.05）;动脉血氧饱和度（SaO2）、血氧分压（PaO2）水平明显高于对照组，血二氧化碳分压（PaCO2）水平则明显低于对照组（P<0.05）;观察组的气道炎症减轻更明显，血清中PCT、TWEAK、IL-1β、IL-17A等水平显著降低（P<0.05），观察组不良反应发生率为17.50%，对照组为12.50%，差异无统计学意义（P>0.05）。结论：桑白皮汤加减治疗慢阻肺急性加重期患者的疗效确切，有利于缓解急性加重期症状，改善肺通气功能、动脉血气状态，减轻气道炎症，用药安全性高，值得临床推广应用。

关键词 桑白皮汤;慢性阻塞性肺疾病;急性加重期;痰热壅肺型;肺功能;血气分析

Effects of Treating Acute Exacerbation of Chronic Obstructive Pulmonary Disease（Syndrome of Phlegm-Heat Obstructing Lung Type） Patients with Modified Sangbaipi Decoction

LIU Jiejing，FENG Jingshuai，LI Xia，LI Juming

（Department of Respiratory Medicine，Shunyi Hospital，Beijing Hospital of Traditional Chinese Medicine，Beijing 101300，China）

Abstract Objective：To explore the effects of treating acute exacerbation of chronic obstructive pulmonary disease（syndrome of phlegm-heat obstructing lung）patients with Sangbaipi Decoction，and to explore the influence on lung function and blood qi analysis.Methods：A total of 80 patients with phlegm-heat obstructed lung type in the acute exacerbation stage of COPD from January 2016 to December 2018 were selected as the research objects and were randomly divided into a control and an observation groups according to the random number table method，with 40 cases in each group.Patients in the control group were given conventional Western medicine treatment，and patients in the observation group were given modified Sangbaipi Decoction on the basis of the control group.The course of the treatment was 2 weeks.The clinical efficacy of the 2 groups of patients was analyzed by TCM syndrome scores，the pulmonary ventilation function and arterial blood gas indicators were measured，the serum inflammatory indicator were monitored，and the adverse reactions during medication were collected.Results：The control group had a clinical control rate of 25.00% and an effective rate of 75.00%.The clinical control rate was 47.50% and the effective rate was 92.50%（P<0.05）.After treatment，the symptom relief，pulmonary ventilation function and arterial blood qi improvement were more obvious in the observation group，and the TCM syndrome score of wheezing，cough，cough and other main symptoms was significantly lower than that of the control group（P<0.05）.The levels of pulmonary function indicators were significantly higher than those of the control group，while RI levels were significantly lower（P<0.05）.The SaO2 and PaO2 levels were significantly higher than the control group，the level of PaCO2 was significantly lower than the control group（P<0.05），the airway inflammation of the observation group was significantly reduced，and the serum levels of PCT，TWEAK，IL-1β and IL-17A were significantly decreased（P<0.05）.The incidence of adverse reactions in the observation group was 17.50%，in the control group of 12.50%，but the difference was not statistically significant（P<0.05）.Conclusion：Modified Sangbaipi Decoction has definite curative effect on patients with acute exacerbation of chronic obstructive pulmonary disease，which is conducive to relieving the symptoms，improving the pulmonary ventilation function and arterial blood qi status，and reducing airway inflammation，which has high drug safety and worthy of clinical promotion.

Keywords Sangbaipi Decoction; Chronic obstructive pulmonary disease; Acute exacerbation; Phlegm heat obstructing lung type; Lung function; Blood qi analysis

中图分类号：R289.5;R563文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.12.020

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）是以反复呼吸道症状和持续气流受限为特征的疾病，好发于老年人群，其病情有稳定期和急性加重期。COPD急性加重期（Acute Exacerbation of Chronic Obstructive Pulmonary Disease，AECOPD）患者以日常的症状突然恶化、病情急性加重为特点，当COPD急性加重发作时，患者可见呼吸困难加重，肺功能下降，甚至诱发死亡，严重威胁患者的生命安全[1-2]。现代医学认为，气道慢性非特异性炎症肺部浸润增加了气道张力，损伤了气道上皮细胞，导致气道纤维化，气流受限严重，肺功能下降，是诱发AECOPD发作的关键[3]。……