中藥外敷聯合抗結核藥物治療淋巴結結核51例療效觀察

方斐　郎雅珍　金姍姍

[摘要] 目的 探討中藥外敷聯合抗結核藥物治療淋巴結結核的療效。 方法 選自我院于2015年1月～2017年1月期間收治的淋巴結結核患者102例，依據隨機數字表法分為觀察組51例與對照組51例，兩組均予 HRZE方案（異煙肼、利福平、吡嗪酰胺、乙胺丁醇）進行抗結核治療，異煙肼片（INH）0.3 g/次，每天1次；利福平膠囊（RFP）0.45 g/次，每天1次，空腹服； 吡嗪酰胺片（PZA）0.5 g/次，每天1次；乙胺丁醇片（EMB）0.75 g/次，每天1次；觀察組同時予以自擬五蟲散結膏局部外敷，涂抹厚度約2 mm，每48小時更換敷料 1 次，連用2個月。比較兩組治療后的臨床療效及住院時間、復發率、不良反應情況。 結果 觀察組患者治療后的總有效率達94.1%，顯著高于對照組的72.5%，組間比較差異有統計學意義（P<0.05）。觀察組患者的住院時間明顯短于對照組（P<0.05）。隨訪1年后，觀察組的復發率低于對照組（P<0.05）。兩組肝功能異常、白細胞降低及胃腸道反應的發生率比較， 無統計學差異（P>0.05）。 結論 中藥外敷聯合抗結核藥物治療淋巴結結核療效明顯，可以縮短住院時間、且安全性好，可以降低復發率，具有重要的臨床推廣價值。

[關鍵詞] 淋巴結結核；中藥外敷；抗結核藥物；淋巴結結核

[中圖分類號] R256.1 [文獻標識碼] B [文章編號] 1673-9701（2018）23-0061-03

The curative effect of external application of Chinese Medicine combined with anti-tuberculous drugs in the treatment of patients with lymph node tuberculosis

FANG Fei LANG Yazhen JIN Shanshan HE Ting

Department of Tuberculous Medicine， Red Cross Hospital of Hangzhou City， Hangzhou 310003， China

[Abstract] Objective To explore the curative effect of external application of Chinese Medicine combined with anti-tuberculous drugs in the treatment of patients with lymph node tuberculosis. Methods 102 patients with lymph node tuberculosis who were treated in our hospital from January 2015 to January 2017 were selected and randomly divided into observation group and control group by random number table. Each group had 51 cases and received HRZE regimen（isoniazid， rifampicin， pyrazinamide and ethambutol） to treat tuberculosis. The patients in each group took 0.3 g of INH， 0.45 g of RFP， 0.5 g of PZA and 0.75 g of EMB per time and one time a day. The observation group was treated with external application of self-made Wuchongsan ointment at the same time. The coating thickness was about 2 mm and the dressing was replaced every 48 hours， which would be used for 2 months. We compared the curative effect after treatment，the length of hospital stay， the recurrence rate and the incidence of side effects of each group. Results The total curative effect of observation group was 94.1%， which was significantly higher than that of control group at 72.5%. There was significant difference between two groups（P<0.05）.The length of hospital stay of observation group was significantly shorter than that of control group（P<0.05）. After following up for one year， we found that the recurrence rate of observation group was lower than that of control group（P<0.05）. There were no significant differences in liver function， the decrease of white blood cells， the incidence of gastrointestinal symptoms of two groups（P>0.05）. Conclusion External application of Chinese Medicine combined with anti-tuberculous drugs in the treatment of patients with lymph node tuberculosis has obvious curative effect and good safety， which shortens the length of hospital stay and reduces the recurrence rate， deserving clinical application and popularization.

[Key words] Lymph node tuberculosis； External application of Chinese medicine； Anti tuberculosis drugs； Lymph node tuberculosis

淋巴結結核是發生于外周淋巴系統的慢性結核分枝桿菌感染性疾病，若治療不當，可發生膿腫，甚至液化、壞死、破潰形成瘺管和潰瘍，導致病情反復遷延不愈或耐藥性的發生[1-2]。淋巴結結核病程長，易反復，根治難，治療方法較多，但6個月內治愈者較少[3]。淋巴結結核單純西藥治療需1～1.5年，且治療后易復發。淋巴結結核中醫稱瘰癘，俗稱“老鼠瘡”，系由外邪侵襲，肝郁化火或肝腎陰虧虛火內生，灼津為痰，痰火凝結而成[4]。研究發現，多數抗結核藥物具有殺菌或抑菌作用，目前臨床多采取中藥外敷聯合西藥同時治療，有利于提高臨床療效[5]。……