世界中医药

目的：探索大青龙汤治疗外寒内热证型小儿哮喘的临床疗效及机制。方法：选取2017年1月至2017年12月山东肥城矿业中心医院儿科收治的外寒内热型哮喘患儿118例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组59例。所有患儿均按照小儿哮喘西医常规治疗规范，予以抗感染、抗炎、及对症治疗。观察组在常规治疗基础上，以大青龙汤为基础方，根据患儿中医兼证化裁治疗。2组患儿均连续治疗2周为1个疗程，连续治疗2个疗程。2组患儿均于治疗前、治疗过程中每3 d、完成治疗后由经验丰富的中医师对其中医临床症状严重程度进行量化分级，根据治疗前后症状积分的变化判断症状疗效，统计临床症状改善时间并进行比较；抽取2组患儿治疗前、后的静脉血检测血清IgE、IL-4、TNF-α及动脉血气指标（pH值、二氧化碳分压、氧分压、氧饱和度）并行组内治疗前后、治疗后组间比较。完成治疗后评价2组患儿临床疗效并进行比较。观察治疗期间2组患者药物不良反应发生率并进行比较。结果：1）2组患儿完成4周治疗后，哮喘、咳嗽、胸闷、气促症状积分均较治疗前明显降低，且观察组低于对照组（P<0.05），观察组患儿哮喘、咳嗽、胸闷、气促症状改善时间明显较对照组短（P<0.05），各症状有效率均高于对照组（P<0.05）；2）2组患儿治疗后血清IgE、IL-4、TNF-α均较治疗前降低，且观察组均低于对照组（P<0.05）；3）2组患儿治疗后动脉血气指标PCO2均低于治疗前，且观察组低于对照组，PO2、SatO2均高于治疗前，且观察组高于对照组(P<0.05）；4）完成治疗后，观察组患儿临床总有效率明显高于对照组患儿（P<0.05）；5）2组患儿治疗过程中未收集到严重药物不良反应，2组间的不良反应率比较，差异无统计学意义（P>0.05）。结论：大青龙汤治疗外寒内热型小儿哮喘可更好地降低患儿炎性反应状态，提升患儿动脉血氧交换能力，从而快速改善患儿临床症状，提升临床治疗疗效，且安全，具有较高的临床价值。

English Summary:

To analyze the clinical effect of Daqinglong Decoction on infantile asthma with syndrome of external cold and internal heat.Methods:A total of 118 children with asthma of external cold and internal heat syndrome admitted to Feicheng Mining Central Hospital from January 2017 to December 2017 were selected as the subjects.According to the order number，they were randomly divided into a control group and an observation group，with 59 cases in each group.All the children were given anti-infection，anti-inflammation and symptomatic treatment according to the standard of western medicine treatment for infantile asthma.On the basis of conventional treatment，the observation group was treated with modification based on Daqinglong Decoction according to TCM syndromes in children.Two groups of children were treated for 2 consecutive weeks as a course of treatment，continuous treatment for 2 courses.The severity of TCM clinical symptoms was quantitatively graded by experienced Chinese physicians every 3 days before and after treatment，and the curative effect was judged according to the changes of symptom scores before and after treatment，and the improvement time of clinical symptoms was counted and compared.Serum IgE，IL-4，TNF-a and arterial blood gas indexes(pH value，partial pressure of carbon dioxide，partial pressure of oxygen，oxygen saturation)were measured and compared before and after treatment.After completion of treatment，the clinical efficacy of the 2 groups was evaluated and compared.The adverse drug reactions/side effects of the 2 groups were compared during the treatment period.Results:1)After 4 weeks of treatment，the scores of asthma，cough，chest tightness and shortness of breath of the 2 groups were significantly decreased than before treatment，and the observation group was significantly lower than those in the control group(P<0.05).The improvement time of asthma，cough，chest tightness and shortness of breath in the observation group was significantly shorter than that in the control group(P<0.05).The effective rate of all symptoms were higher than the control group(P<0.05). 2)The serum IgE，IL-4，TNF-α of the 2 groups were decreased than before treatment，and the study group was lower than the control group(P<0.05). 3)After treatment，the arterial blood gas index PO2 in both groups was lower than before treatment，and the study group was lower than that in the control group.PO2 and SatO2 were higher than before treatment，and the study group was higher than the control group(P<0.05). 4)After treatment，the total clinical efficacy rate of the treatment group was significantly higher than that of the control group(P<0.05).5)There were no serious adverse drug/toxic side effects collected in the treatment process of the 2 groups of children，and there was no statistical significance in the adverse drug reaction rate between the 2 groups(P > 0.05).Conclusion:Daqinglong Decoction can reduce inflammation and enhance arterial oxygen exchange ability in children with asthma of external cold and internal heat syndrome，so as to rapidly improve clinical symptoms and enhance clinical efficacy，and it is safe and has high clinical value.

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