摘要
目的:观察宣白承气汤加味保留灌肠联合利奈唑胺注射液治疗重症监护室(ICU)呼吸机相关性肺炎(VAP)的临床疗效。方法:选取102例VAP患者,按随机数字表法分为对照组及观察组各51例。对照组给予利奈唑胺注射液静脉滴注,观察组在对照组基础上给予宣白承气汤保留灌肠,观察2组临床疗效,比较2组机械通气时间、ICU住院时间,比较2组治疗前后临床肺部感染评分(CPIS评分)、急性生理和慢性健康状况(APACHE)评分、动脉血气指标[二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))、最低氧分压/吸氧浓度(PaO_(2)/FiO_(2))]、呼吸力学指标[气道阻力(Raw)、呼吸做功(WOB)、气道峰压(PIP)、动态顺应性(Cdyn)],血清相关因子[穿透素-3(PTX-3)、前肾上腺髓质素(pro-ADM)、巨噬细胞炎性蛋白-2(MIP-2)、C-反应蛋白(CRP)]水平变化。结果:观察组总有效率为88.24%,对照组总有效率为72.55%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组CPIS评分、APACHE评分均较治疗前下降,观察组上述2项评分均低于对照组,差异均有统计学意义(P<0.05)。观察组机械通气时间、ICU住院时间均短于对照组,差异均有统计学意义(P<0.05)。治疗后,2组PaCO_(2)含量均较治疗前降低,PaO_(2)含量、最低PaO_(2)/FiO_(2)均较治疗前上升;观察组PaCO_(2)含量低于对照组,PaO_(2)含量、最低PaO_(2)/FiO_(2)均高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组Raw、WOB、PIP指标值均较治疗前下降,Cdyn指标值均较治疗前上升;观察组Raw、WOB、PIP指标值均低于对照组,Cdyn指标值高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组血清PTX-3、pro-ADM、MIP-2、CRP水平均较治疗前下降,观察组上述4项水平均低于对照组,差异均有统计学意义(P<0.05)。结论:宣白承气汤加味保留灌肠联合利奈唑胺注射液治疗VAP的疗效较好,可控制肺部感染,改善呼吸功能。
Objective:To observe the clinical effect of the therapy of retention enema with Xuanbai Chengqi tang combined with linezolid injection on ventilator-associated pneumonia(VAP)in intensive care unit(ICU).Methods:A total of 102 patients with VAP were selected and divided into the control group and the observation group according to the random number table method,with 51 cases in each group.The control group was given intravenous infusion of linezolid injection,and the observation group was additionally given retention enema with Xuanbai Chengqi tang based on the treatment of the control group.The clinical effects in the two groups were observed,and the time of mechanical ventilation and ICU hospitalization was compared.Before and after treatment,the changes of scores of Clinical Pulmonary Infection Score(CPIS)and Acute physiology And Chronic Health Evaluation(APACHE),arterial blood gas indexes,including PaCO_(2),PaO_(2),and PaO_(2)/FiO_(2),indexes of respiratory mechanics,including airway resistance(Raw),work of breathing(WOB),peak inspiratory pressure(PIP),and dynamic compliance(Cdyn),and levels of serum related factors,including pentraxin-3(PTX-3),proadrenomedullin(pro-ADM),macrophage inflammatory protein-2(MIP-2)and C-reactive protein(CRP),in the two groups were compared.Results:The total effective rate was 88.24%in the observation group and was 72.55%in the control group,the difference being significant(P<0.05).After treatment,the scores of CPIS and APACHE in the two groups were decreased when compared with those before treatment,and the above two scores in the observation group were lower than those in the control group,differences being significant(P<0.05).The time of mechanical ventilation and ICU hospitalization in the observation group was shorter than that in the control group,differences being significant(P<0.05).After treatment,the PaCO_(2) content in the two groups was decreased when compared with that before treatment,and the PaO_(2) content and the lowest PaO_(2)/FiO_(2) were increased;the PaCO_(2) content in the observation group was lower than that in the control group,and the PaO_(2) content and the lowest PaO_(2)/FiO_(2) were higher,differences being significant(P<0.05).After treatment,the values of Raw,WOB and PIP in the two groups were decreased when compared with those before treatment,and the Cdyn values were increased;the values of Raw,WOB and PIP in the observation group were lower than those in the control group,and the Cdyn value was higher,differences being significant(P<0.05).After treatment,the serum levels of PTX-3,pro-ADM,MIP-2 and CRP in the two groups were decreased when compared with those before treatment,and the above four levels in the observation group were lower than those in the control group,differences being significant(P<0.05).Conclusion:The therapy of retention enema with modified Xuanbai Chengqi tang combined with linezolid injection for VAP has a good curative effect,which can control the pulmonary infection and improve the respiratory function.
作者
胡俊杰
朱卿
汪伟哲
陈华珍
余敏
胡勇
HU Junjie;ZHU Qing;WANG Weizhe;CHEN Huazhen;YU Min;HU Yong
出处
《新中医》
CAS
2022年第1期51-56,共6页
New Chinese Medicine
关键词
呼吸机相关性肺炎
宣白承气汤
保留灌肠
利奈唑胺注射液
呼吸力学指标
Ventilator-associated pneumonia
Xuanbai Chengqi tang
Retention enema
Linezolid injection
Indexes of respiratory mechanics
