中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
4期
249-253
,共5页
鄢素琪%周俪姗%汤建桥%张红宇%郑文彬%王芳%毕颖怀%李君
鄢素琪%週儷姍%湯建橋%張紅宇%鄭文彬%王芳%畢穎懷%李君
언소기%주려산%탕건교%장홍우%정문빈%왕방%필영부%리군
手法按摩%婴儿淤胆性肝病%巨细胞病毒%胃扭转%婴儿肺炎%中西医结合疗法
手法按摩%嬰兒淤膽性肝病%巨細胞病毒%胃扭轉%嬰兒肺炎%中西醫結閤療法
수법안마%영인어담성간병%거세포병독%위뉴전%영인폐염%중서의결합요법
Massage%Infantile cholestatic hepatopathy%Cytomegalovirus%Gastric volvulus%Infant pneumonia%Integrated traditional Chinese and western medicine
目的：探讨早期采用中、西药及手法按摩对巨细胞病毒（CMV）感染淤胆性肝病（ICH）婴儿合并胃扭转病程中发生肺炎及肺炎严重程度和预后的影响。方法采用前瞻性随机对照研究方法，选择武汉市儿童医院中西医结合科住院的1～6个月小婴儿120例，按随机数字表法分为治疗组与对照组，每组60例。两组均给予中药利胆合剂（组成：茵陈蒿30 g，连翘30 g，黄连5 g，熟大黄5 g，赤芍30 g，桂枝5 g，枳壳10 g，白术10 g，五味子10 g，穿山甲3 g，甘草5 g）口服或灌肠，更昔洛韦静脉滴注等综合治疗；对照组在综合治疗基础上胃扭转采用体位疗法、饮食疗法、给予促动力药吗丁啉（多潘立酮）；治疗组在综合治疗基础上对胃扭转采用手法按摩复位治疗。两组肺炎按照小儿肺炎、毛细支气管炎、重症肺炎诊疗常规、儿童社区获得性肺炎管理指南治疗。观察两组治疗前后病程中发生肺炎总例数和肺炎严重程度，以及ICH、胃扭转、婴儿肺炎的临床疗效、临床体征、生化指标及住院时间的差异。结果治疗组治疗后ICH、胃扭转、婴儿肺炎的治愈率和总有效率均较对照组升高〔ICH治愈率：83.05%（49/59）比71.93%（41/57），总有效率：96.61%（57/59）比91.23%（52/57）；胃扭转治愈率：72.88%（43/59）比51.79%（29/56），总有效率：96.61%（57/59）比78.57%（44/56）；婴儿肺炎治愈率：81.08%（30/37）比67.44%（29/43），总有效率：100%（37/37）比100%（43/43），P＜0.05或P＜0.01〕。治疗组治疗过程中肺炎发生总例数和重症肺炎发生率均较对照组明显减少〔肺炎总例数：12例比21例，重症肺炎发生率：16.67%（2/12）比42.86%（9/21），P＜0.05或P＜0.01〕。两组治疗后肝脾肿大程度、总胆红素（TBil）、直接胆红素（DBil）、总胆汁酸（TBA）、丙氨酸转氨酶（ALT）均较治疗前明显降低，且以治疗组降低更显著（P＜0.05或P＜0.01），治疗组住院时间（d）较对照组缩短（21.32±3.26比27.38±6.09，P＜0.05）。结论对CMV感染ICH婴儿合并胃扭转采用中西医疗法早期干预能明显降低病程中发生肺炎的概率和严重程度，有利于CMV感染ICH患儿的治疗和预后。
目的：探討早期採用中、西藥及手法按摩對巨細胞病毒（CMV）感染淤膽性肝病（ICH）嬰兒閤併胃扭轉病程中髮生肺炎及肺炎嚴重程度和預後的影響。方法採用前瞻性隨機對照研究方法，選擇武漢市兒童醫院中西醫結閤科住院的1～6箇月小嬰兒120例，按隨機數字錶法分為治療組與對照組，每組60例。兩組均給予中藥利膽閤劑（組成：茵陳蒿30 g，連翹30 g，黃連5 g，熟大黃5 g，赤芍30 g，桂枝5 g，枳殼10 g，白術10 g，五味子10 g，穿山甲3 g，甘草5 g）口服或灌腸，更昔洛韋靜脈滴註等綜閤治療；對照組在綜閤治療基礎上胃扭轉採用體位療法、飲食療法、給予促動力藥嗎丁啉（多潘立酮）；治療組在綜閤治療基礎上對胃扭轉採用手法按摩複位治療。兩組肺炎按照小兒肺炎、毛細支氣管炎、重癥肺炎診療常規、兒童社區穫得性肺炎管理指南治療。觀察兩組治療前後病程中髮生肺炎總例數和肺炎嚴重程度，以及ICH、胃扭轉、嬰兒肺炎的臨床療效、臨床體徵、生化指標及住院時間的差異。結果治療組治療後ICH、胃扭轉、嬰兒肺炎的治愈率和總有效率均較對照組升高〔ICH治愈率：83.05%（49/59）比71.93%（41/57），總有效率：96.61%（57/59）比91.23%（52/57）；胃扭轉治愈率：72.88%（43/59）比51.79%（29/56），總有效率：96.61%（57/59）比78.57%（44/56）；嬰兒肺炎治愈率：81.08%（30/37）比67.44%（29/43），總有效率：100%（37/37）比100%（43/43），P＜0.05或P＜0.01〕。治療組治療過程中肺炎髮生總例數和重癥肺炎髮生率均較對照組明顯減少〔肺炎總例數：12例比21例，重癥肺炎髮生率：16.67%（2/12）比42.86%（9/21），P＜0.05或P＜0.01〕。兩組治療後肝脾腫大程度、總膽紅素（TBil）、直接膽紅素（DBil）、總膽汁痠（TBA）、丙氨痠轉氨酶（ALT）均較治療前明顯降低，且以治療組降低更顯著（P＜0.05或P＜0.01），治療組住院時間（d）較對照組縮短（21.32±3.26比27.38±6.09，P＜0.05）。結論對CMV感染ICH嬰兒閤併胃扭轉採用中西醫療法早期榦預能明顯降低病程中髮生肺炎的概率和嚴重程度，有利于CMV感染ICH患兒的治療和預後。
목적：탐토조기채용중、서약급수법안마대거세포병독（CMV）감염어담성간병（ICH）영인합병위뉴전병정중발생폐염급폐염엄중정도화예후적영향。방법채용전첨성수궤대조연구방법，선택무한시인동의원중서의결합과주원적1～6개월소영인120례，안수궤수자표법분위치료조여대조조，매조60례。량조균급여중약리담합제（조성：인진호30 g，련교30 g，황련5 g，숙대황5 g，적작30 g，계지5 g，지각10 g，백술10 g，오미자10 g，천산갑3 g，감초5 g）구복혹관장，경석락위정맥적주등종합치료；대조조재종합치료기출상위뉴전채용체위요법、음식요법、급여촉동력약마정람（다반립동）；치료조재종합치료기출상대위뉴전채용수법안마복위치료。량조폐염안조소인폐염、모세지기관염、중증폐염진료상규、인동사구획득성폐염관리지남치료。관찰량조치료전후병정중발생폐염총례수화폐염엄중정도，이급ICH、위뉴전、영인폐염적림상료효、림상체정、생화지표급주원시간적차이。결과치료조치료후ICH、위뉴전、영인폐염적치유솔화총유효솔균교대조조승고〔ICH치유솔：83.05%（49/59）비71.93%（41/57），총유효솔：96.61%（57/59）비91.23%（52/57）；위뉴전치유솔：72.88%（43/59）비51.79%（29/56），총유효솔：96.61%（57/59）비78.57%（44/56）；영인폐염치유솔：81.08%（30/37）비67.44%（29/43），총유효솔：100%（37/37）비100%（43/43），P＜0.05혹P＜0.01〕。치료조치료과정중폐염발생총례수화중증폐염발생솔균교대조조명현감소〔폐염총례수：12례비21례，중증폐염발생솔：16.67%（2/12）비42.86%（9/21），P＜0.05혹P＜0.01〕。량조치료후간비종대정도、총담홍소（TBil）、직접담홍소（DBil）、총담즙산（TBA）、병안산전안매（ALT）균교치료전명현강저，차이치료조강저경현저（P＜0.05혹P＜0.01），치료조주원시간（d）교대조조축단（21.32±3.26비27.38±6.09，P＜0.05）。결론대CMV감염ICH영인합병위뉴전채용중서의요법조기간예능명현강저병정중발생폐염적개솔화엄중정도，유리우CMV감염ICH환인적치료화예후。
Objective To study the effects of early application of integrated traditional Chinese medicine (TCM)and western medicine and massage on the incidence and severity of pneumonia and prognosis in the therapeutic course of infants with cytomegalovirus(CMV)infection infantile cholestatic hepatopathy(ICH)accompanied by gastric volvulus(GV). Methods A prospective randomized controlled trial was conducted. 120 infants 1-6 months old with CMV infection ICH and complicated with GV inpatients were divided into treatment group and control group (each,60 cases). The TCM Lidanheji(consisting of artemisiae capillaris 30 g,weeping forsythia 30 g,Chinese goldthread 5 g,prepared rhubarb 5 g,unpeeled root of herbaceous peony 30 g,cassia 5 g,fruit of citron or trifoliate orange 10 g,large-headed atractylodes 10 g,fruit of Chinese magnoliavine 10 g,pangolin scale 3 g and licorice root 5 g)for oral administration or enema and ganciclovir intravenous injection were given to both groups. In the control group,based on the above treatment,postural and diet therapy,prokinetics(domperidone)were given in cases with GV. The massage treatment was only applied for treatment of GV in treatment group. The pneumonia in both groups was treated in accord to the conventional diagnosis and treatment for infantile pneumonia,bronchiolitis,severe pneumonia and the guide and management of infantile community acquired pneumonia. The total number of cases with pneumonia and its severity occurring before and after treatment in the course of the disease,the clinical therapeutic effects of ICH, GV and infantile pneumonia,the clinical physical signs,biochemical indexes and the time of hospitalization were observed and compared between the two groups. Results Compared with control group,after treatment the curative rate and total effective rate of ICH,GV,infant pneumonia in treatment group were significantly higher〔the curative rate of ICH:83.05%(49/59)vs. 71.93%(41/57),total effective rate:96.61%(57/59)vs. 91.23%(52/57);the curative rate of GV:72.88%(43/59)vs. 51.79%(29/56),total effective rate:96.61%(57/59)vs. 78.57%(44/56);the curative rate of infant pneumonia:81.08%(30/37)vs. 67.44%(29/43),total effective rate:100%(37/37)vs. 100%(43/43),P<0.05 or P<0.01〕. In the treatment group,the total number of cases with pneumonia occurring in the therapeutic course and the incidence of severe pneumonia were significantly less than those in the control group〔the occurrence of pneumonia:12 cases vs. 21 cases,the incidence of severe pneumonia:16.67%(2/12) vs. 42.86%(9/21),P<0.05 or P<0.01〕. The enlargement of liver and spleen,the level of total bilirubin(TBil), direct bilirubin(DBil),total bile acids(TBA)and alanine aminotransferase(ALT)in two groups after treatment were significantly lower than those before treatment,the changes being more marked in treatment group(P<0.05 or P<0.01). The time of stay in hospital in treatment group was remarkably shortened(days:21.32±3.26 vs. 27.38±6.09, P<0.05). Conclusion Early interference with combined TCM and western medicine and massage for treatment of infants with CMV infection ICH accompanied by GV can significantly decrease the incidence of pneumonia and its severity occurring in the disease course,therefore this therapeutic method is beneficial to the treatment and prognosis of infants with CMV infection ICH.
