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    中藥外敷涌泉穴治療嬰幼兒外感高熱的臨床研究
    關鍵字:臨床,研究,治療,中藥,嬰幼兒,療效,比較,癥狀,體溫,使用 發布時間:2011-08-20

    嬰幼兒急性上呼吸道感染常以高熱為首發癥 狀袁其致病原90%以上是病毒遙目前尚無有效堯安全 的抗病毒藥遙循證醫學證據顯示袁退熱劑只是減輕 小兒因高熱引起的不適及家長對高熱的緊張和恐 懼情緒袁并不能縮短發熱病程 咱1暫遙 我院兒科于2006 年開展小兒中醫外治方法袁其中中藥外敷涌泉穴治 療嬰幼兒外感高熱取得較好療效袁報告如下遙 1臨床資料 1.1納入標準淤符合嬰幼兒急性上呼吸道感 染的中西醫診斷標準曰于體溫>39益袁病程<48 h曰盂年齡院3月~3歲曰榆末梢血WBC<15× 10 9 袁CRP<10mg窯L -1 遙 1.2排除標準淤確診為喉炎堯支氣管炎堯支氣 管肺炎的患兒曰于合并有心血管堯肝堯腎堯腦和其 它嚴重原發病的患兒曰盂就診時已接受抗生素治 療者曰榆未按規定治療堯無法判定療程或療程中 自行增加用藥者遙 1.3一般資料收集2009年4月1日要2009年 8月31日本院兒科門診患兒67781例袁其中2165 例嬰幼兒外感高熱符合納入病例標準入選袁脫落 33例袁2132例進行療效分析遙以就診先后順序袁采 用半隨機對照實驗方法分為治療A組堯治療B組 和對照組遙治療A組810例袁治療B組612例袁對 照組710例遙3組患兒基本資料經統計學檢驗袁在 年齡堯性別堯體溫堯病程方面無顯著性差異淵P> 0.05冤袁具有可比性袁見表1遙 表13組患兒基線資料比較 組別 A組 月組 悅組 n 愿員園 遠員圓 苑員園 男 源猿緣 猿圓員 猿遠怨 女 猿苑緣 圓怨員 猿源員 平均病程轅h 23.5 25.2 24.8 13~24 猿員圓 圓源猿 圓遠圓 25~36 圓遠猿 員愿苑 圓猿遠 3~12 圓猿緣 員愿圓 圓員圓 ~24 源園圓 圓怨猿 猿圓遠 ~48 源園愿 猿員怨 猿愿源 性別年齡轅月病程轅h 中藥外敷涌泉穴治療嬰幼兒外感高熱的臨床研究 陳賽斌袁高樹彬袁田志偉 淵廈門中醫院袁福建廈門361009冤 關鍵詞院嬰幼兒曰高熱曰上呼吸道感染曰中藥外敷曰涌泉穴 中圖分類號院R246.4文獻標志碼院B文章編號院1004-5627淵20員園冤04-0040-02 收稿日期院2010-01-25 作者簡介院陳賽斌淵1958要冤袁女袁主任醫師袁主要從事兒科疾病中醫藥臨床研究遙 2方法 2.1治療方法A組采用中藥敷貼涌泉穴及內 服中藥銀翹散加減袁B組中藥敷貼涌泉穴及口服 利巴韋林袁對照組單用利巴韋林口服遙淤中藥敷 貼院吳茱萸等藥物研末以食醋調成藥膏袁敷貼于患 兒雙側涌泉穴袁每天1次持續敷貼8~12h遙于內 服中藥院基礎方銀翹散加減袁按比例打散成粉袁用 袋泡茶包裝紙包裝袁每袋3g袁由本院制劑室提供袁 每日1~2袋袁加水適量煮沸1~2min袁取汁頻服遙 盂抗病毒院利巴韋林顆粒15mg轅kg窯d袁分3次口 服遙榆退熱院體溫高于38.5益袁每次口服布洛芬混 懸液5~10mg轅kg遙療程3d遙療程結束后再觀察 3d遙觀察3組退熱時間堯使用退熱劑次數及體征堯 癥狀消失的情況和總療效遙 2.2療效評定標準 咱2暫淤 痊愈院用藥72h之內袁 體溫恢復正常袁觀察3d不再回升曰咽部不充血袁 咳嗽堯流涕等癥狀消失曰于有效院用藥72h之內體 溫恢復正常袁觀察3d不再回升曰咽部充血減輕袁 咳嗽堯流涕等癥狀緩解曰盂無效院72h之內體溫未 恢復正常袁或停藥3d體溫再回升曰咽部充血袁咳 嗽堯流涕等癥狀無改善或加劇遙 2.3統計學處理數據處理采用SPSS12.0統計 軟件包完成袁計量資料采用t檢驗袁計數資料采用 卡方字 2 檢驗遙 3結果 3.13組治療后體溫恢復正常時間見表2遙 窯臨床報道窯 JournalofFujianUniversityofTCMAugust2010袁20淵4冤 福建中醫學院學報2010年8月第20卷第4期 40 PDF 文件使用 "pdfFactory Pro" 試用版本創建 www.fineprint.cn 換頁 3.23組退熱藥使用次數比較表猿結果顯示3 組患兒治療期間使用退熱劑次數有顯著性差異袁 治療A堯B組均少于C組袁尤其是治療B組與C組 差異更顯著袁說明中藥敷貼涌泉穴退熱療效優于 利巴韋林遙 3.33組治療后癥狀體征比較見表源遙 表53組總療效比較 組別 A組 B組 C組 n 810 612 710 痊愈 635 421 375 注院與C組比較袁1冤P<0.01遙 有效 141 132 167 總有效率轅豫 95.80 1冤 90.35 1冤 76.23 表23組治療后體溫恢復正常時間比較淵x依s冤 組別 A組 B組 C組 n 810 612 710 體溫恢復正常時間 30.21±18.25 1冤 29.56±17.28 1冤 42.30±18.53 h 注院與C組比較袁1冤P<0.01遙 表33組退熱藥使用次數比較淵x依s冤 組別 A組 B組 C組 n 810 612 710 使用退熱藥次數 3.50±1.61 1冤 3.80±1.75 1冤 4.80±3.65 注院與C組比較袁1冤P<0.01遙 表43組治療后癥狀堯體征比較淵n袁豫冤 組別 A組 1冤 B組 1冤 C組 n 810 612 710 發熱 34淵4.20冤 59淵9.64冤 168淵23.66冤 注院與C組比較袁1冤P<0.01遙 咽部充血 148淵18.27冤 162淵26.47冤 283淵39.86冤 流涕 152淵18.77冤 171淵27.94冤 262淵36.90冤 咳嗽 167淵20.62冤 195淵31.97冤 315淵44.37冤 3.43組總療效比較見表緣遙 4討論 急性上呼吸道感染是兒科常見病袁5歲以下兒 童平均每人每年發病4~6次袁其病原體以病毒為 主袁占原發上呼吸道感染的90%以上 咱3暫遙 嬰幼兒急 性上呼吸道感染常以高熱為首發癥狀袁是兒科急 癥之一遙葉中國0-5歲兒童病因不明急性發熱診斷 處理指南曳推薦退熱藥物布洛芬和對乙酰氨基酚可 用于腋溫高于38.5益袁年齡大于3個月的嬰幼兒遙 退熱藥過量使用可導致虛脫袁甚至肝堯腎功能損害 咱1暫遙 利巴韋林作為經典的抗病毒藥物袁對多種病毒 有抑制作用遙中藥對多種病毒感染性疾病療效肯 定遙中醫認為小兒臟腑嬌嫩袁肺脾不足袁腠理疏松袁 衛外不固袁四時六淫邪氣易乘虛而入袁同時因其陽 常有余袁感邪后化熱最速袁在衛分短暫停留后直入 氣分袁常常因衛分癥狀未出袁而氣分高熱已見遙若 治療不及時袁則變證從生袁危害患兒健康遙治宜辛 涼解表袁清熱解毒遙 本文研究觀察袁中藥內服外治療效顯著袁由于 辛涼解毒堯標本兼顧袁退熱作用平穩袁且伴隨癥狀 改善迅速遙中藥打散成粉袁用袋泡茶包裝紙包裝后 水煎袁既能保持中藥傳統飲片的療效袁又方便煎 煮堯節省藥材袁但其口感不好袁在嬰幼兒使用有一 定局限性袁并且嬰幼兒臟腑嬌嫩袁形氣未充袁藥物 不能多受遙中醫外治法治療小兒外感發熱歷史悠 久袁歷來倍受醫家重視遙涌泉穴袁在人體足底袁位于 足前部凹陷處第2堯3趾跖縫紋頭端與足跟連線的 前三分之一處袁位于全身俞穴的最下部袁乃是腎經 的首穴遙葉黃帝內經曳云院野腎出于涌泉袁涌泉者足心 也冶曰野病在上者下取之噎噎并在頭者取之足 噎噎冶遙足少陰腎經野走足心噎噎挾舌本冶袁涌泉為 足少陰井穴袁取之能從陰引陽遙葉本草備要曳記載院 野吳茱萸雖熱能引熱下行噎噎冶遙以吳茱萸等藥物 引火歸元袁實乃上病下治袁引熱下行之意袁雖藥性 辛熱然可治熱病遙涌泉穴的敷貼袁一方面足底皮薄 易于藥物的吸收和穴位刺激效應袁而且療效可靠堯 方法簡便堯患兒易接受遙 本文研究顯示袁中藥敷貼涌泉穴治療外感高 熱退熱療效優于利巴韋林袁結合中藥內服對緩解 咽部充血堯咳嗽堯流涕等癥狀袁療效明顯提高袁但嬰 幼兒內服中藥仍存在一定局限性遙中藥外治敷貼 涌泉穴袁簡便堯易行袁治療嬰幼兒外感高熱前景廣 闊袁值得我們進一步結合實驗研究深入探討其作 用機理遙繼承和挖掘這些傳統療法袁對嬰幼兒上呼 吸道感染的防治有著重要的意義遙 參考文獻院 咱1暫萬朝敏.中國0-5歲兒童病因不明的急性發熱診斷處理指 南院發熱的處理咱J暫.中國循證兒科雜志袁2009袁4淵3冤院306- 307. 咱2暫陳永紅.兒科疾病診斷與療效標準咱M暫.上海院上海中醫藥 大學出版社袁2006院51. 咱3暫胡亞美袁江載芳.諸福棠實用兒科學咱M暫.7版.北京院人民 衛生出版社袁2002院1167. 第4期陳賽斌等院中藥外敷涌泉穴治療嬰幼兒外感高熱的臨床研究 41 PDF 文件使用 "pdfFactory Pro" 試用版本創建 www.fineprint.cn 換頁

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