世界中医药

目的：探讨健脾养肺汤加减在老年肺部感染治疗中对炎性反应的控制效果。方法：选取2016年1月至2018年11月安徽中医药大学第一附属医院收治的老年肺部感染患者60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30例。对照组采用抗生素治疗，观察组在此基础上增加健脾养肺汤并辨证加减治疗，2组均连续治疗5 d。比较2组治疗后临床疗效、相关临床指标、临床症状、中医症状改善情况及治疗前后血清炎性因子水平。结果：治疗后，观察组总有效率明显高于对照组（P<0.05）。与对照组比较，治疗后观察组咳嗽/咳痰症状缓解时间、体温及X线胸片恢复正常时间均明显提前（P<0.05或P<0.01）。与治疗前比较，治疗后2组患者咳嗽、咳痰等临床症状评分及痰稠色黄、喉间痰鸣、壮热烦躁、气促憋闷等中医症状评分均明显降低，且观察组明显低于对照组（P<0.01）。与治疗前比较，治疗后2组患者血清CRP、PCT及D-D水平均明显降低，且观察组明显低于对照组（P<0.05或P<0.01）；2组SaO2、OI均明显升高，且观察组明显高于对照组（P<0.01）。结论：健脾养肺汤辨证加减可明显改善老年肺部感染患者临床症状，纠正低氧血症及血液高凝状态，提高整体临床疗效，其对炎性反应的控制效果明显优于单独西药治疗，值得临床推广使用。

English Summary:

To explore the control effect of Jianpi Yangfei Decoction on the inflammation in elderly patients with pulmonary infection.Methods:A total of 60 cases of elderly patients with pulmonary infection admitted to First Affiliated Hospital of Anhui University of Chinese Medicine from January 2016 to November 2018 were selected and divided into an observation group and a control group by random number table method,with 30 cases in each group.The control group was treated with antibiotic,and the observation group added modified Jianpi Yangfei Decoction with syndrome differentiation.The 2 groups were treated continuously for 5 days.The clinical efficacy,related clinical indicators,clinical symptoms,improvement of TCM symptoms and the serum levels of inflammatory factors before and after treatment were compared between the 2 groups.Results:After treatment,the total effective rate of the observation group was significantly higher than that of the control group(P<0.05).Compared with the control group,the symptoms remission time such as cough/expectoration,the normal time of body temperature and X-ray chest radiograph significantly advanced in the observation group(P<0.05 or P<0.01).Compared with before treatment,the scores of clinical symptoms such as cough and expectoration and the scores of TCM symptoms,and greasy and yellowish phlegm,throat snoring,strong fever and irritability significantly decreased in the 2 groups after treatment,and the observation group was significantly lower than the control group(P<0.01).Compared with before treatment,the serum levels of CRP,PCT and D-D significantly decreased in the 2 groups after treatment,and the observation group was significantly lower than the control group(P<0.05 or P<0.01); the SaO2,OI significantly increased in the 2 groups,and the observation group was significantly higher than the control group(P<0.01).Conclusion:Jianpi Yangfei Decoction can significantly improve the clinical symptoms of elderly patients with pulmonary infection,correct hypoxemia and hypercoagulability,and enhance the overall clinical efficacy.The control effect on inflammation is significantly better than western medicine alone,and it is worthy of clinical promotion.

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