摘要
目的探讨桑翘清肺方联合西医常规疗法辅以机械通气对慢性阻塞性肺疾病急性加重(AECOPD)呼吸衰竭患者肺功能及气道炎症的影响,评价临床疗效。方法随机对照试验研究。选择2020年1月-2022年12月本院90例AECOPD合并呼吸衰竭患者作为观察对象,采用随机数字表法分为2组,每组45例。对照组予以西医常规疗法辅以机械通气治疗,观察组在对照组基础上服用桑翘清肺方。2组均治疗2周。分别于治疗前后进行中医证候评分,记录成功撤机时间;采用血气分析仪检测PaO_(2)、PaCO_(2)、血氧饱和度(SaO_(2))和pH值;记录呼吸机中平台压(Pplat)、气道峰压(Ppeak)、气道阻力(Raw)、动态肺顺应性(Cdyn);采用肺功能仪检测呼吸频率(RR)、最大呼气流量(PEF)、FVC、FEV1及FEV1占预计值百分比(FEV1%预计值);采用ELISA法检测血清CRP、TNF-α、降钙素原(PCT),评价临床疗效。结果2组治疗期间均无脱落病例。观察组机械通气时间为(7.16±0.69)d、对照组为(9.88±1.04)d,2组比较差异有统计学意义(t=14.62,P<0.001);观察组治疗后主症、次症积分及总分均低于对照组(t值分别为13.43、18.53、31.21,P<0.001);观察组治疗后PaO[(279.16±7.42)mmHg比(67.49±6.88)mmHg,t=8.24]、SaO[(295.15±9.93)%比(84.59±9.48)%,t=5.16]及pH值[(7.35±0.23)比(7.26±0.16),t=2.16]高于对照组(P<0.01或P<0.05),PaCO_(2)[(49.89±3.65)mmHg比(62.39±4.27)mmHg,t=14.93]低于对照组(P<0.01);观察组治疗后Pplat[(15.31±2.51)cmH_(2)O比(17.53±2.02)cmH_(2)O,t=4.62]、Ppeak[(22.43±3.16)cmH_(2)O比(25.78±3.17)cmH_(2)O,t=5.02]、Raw[(18.96±3.86)cmH_(2)O/(S•L)比(24.29±4.29)cmH_(2)O/(S•L),t=6.20]低于对照组(P<0.01),Cdyn[(34.53±3.35)cmH_(2)0(/S•L)比(30.27±3.87)cmH_(2)0(/S•L),t=5.58]高于对照组(P<0.01);观察组治疗后RR[(19.25±2.43)次/min比(23.49±3.07)次/min,t=7.26]低于对照组(P<0.01),PEF[(4.99±0.40)L/s比(4.03±0.34)L/s,t=12.27]、FVC[(3.04±0.20)L比(2.14±0.22)L,t=20.31]、FEV1[(2.83±0.20)L比(2.16±0.13)L,t=18.84]、FEV1%预计值[(42.23±4.66)%比(36.43±5.09)%,t=5.64]高于对照组(P<0.01);观察组治疗后血清CRP、IL-6、TNF-α、PCT水平低于对照组(t值分别为18.13、13.36、15.97、30.67,P<0.01)。观察组总有效率为93.33%(42/45)、对照组为77.78%(35/45),2组比较差异有统计学意义(χ^(2)=4.41,P=0.036)。结论桑翘清肺方联合西医常规疗法辅以机械通气可有效改善AECOPD合并呼吸衰竭患者的肺通/换气功能,降低炎症因子水平,提高临床疗效。
Objective To explore the effects of Sangqiao Qingfei Prescription combined with Western medicine conventional therapy with mechanical ventilation on lung function and airway inflammation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)respiratory failure;To evaluate clinical efficacy.Methods A randomized controlled trial study was conducted.Totally 90 AECOPD patients with respiratory failure in our hospital from January 2020 to December 2022 were selected as the observation subjects.They were divided into two groups using a random number table method,with 45 cases in each group.The control group received mechanical ventilation treatment,while the observation group received Sangqiao Qingfei Prescription on the basis of the control group.Both groups were treated for 2 weeks.TCM syndrome scoring was performed before and after treatment,and the time of successful withdrawal from the machine was recorded;a blood gas analyzer was used to detect PaO_(2),PaCO_(2),blood oxygen saturation(SaO_(2))and pH values;the plateau pressure(Pplat),peak airway pressure(Ppeak),airway resistance(Raw)and dynamic lung compliance(Cdyn)were recorded during the ventilator;a pulmonary function meter was used to measure respiratory rate(RR),maximum expiratory flow(PEF),FVC,FEV1,and the percentage of FEV1 to the estimated value(FEV1%estimated value);serum CRP,TNF-α,and Procalcitonin(PCT)were detected using ELISA method.Clinical efficacy was evaluated.Results During the treatment period,there were no cases of detachment in both groups.The mechanical ventilation time in the observation group was(7.16±0.69)d,while in the control group it was(9.88±1.04)d,with statistical significance(t=14.62,P<0.001);after treatment,the main symptom,secondary symptom scores,and total scores of the observation group were lower than those in the control group(t values of 13.43,18.53,31.21,P<0.001);the PaO_(2)[(79.16±7.42)mmHg vs.(67.49±6.88)mmHg,t=8.24],SaO_(2)[(95.15±9.93)%vs.(84.59±9.48)%,t=5.16],and pH value(7.35±0.23 vs.7.26±0.16,t=2.16)in the observation group were higher than those in the control group(P<0.01 or P<0.05),while PaCO_(2)[(49.89±3.65)mmHg vs.(62.39±4.27)mmHg,t=14.93]was lower than that of the control group(P<0.01);after treatment in the observation group,Pplat[(15.31±2.51)cmH_(2)O vs.(17.53±2.02)cmH_(2)O,t=4.62],Ppeak[(22.43±3.16)cmH_(2)O vs.(25.78±3.17)cmH_(2)O,t=5.02],Raw[(18.96±3.86)cmH_(2)O/(S•L)vs.(24.29±4.29)cmH_(2)O/(S•L),t=6.20]were lower than those in the control group(P<0.01),Cdyn[(34.53±3.35)cmH_(2)O/(S•L)vs.(30.27±3.87)cmH_(2)O/(S•L),t=5.58]was higher than the control group(P<0.01);the RR[(19.25±2.43)times/min vs.(23.49±3.07)times/min,t=7.26]in the observation group was lower than that of the control group(P<0.01),PEF[(4.99±0.40)L/s vs.(4.03±0.34)L/s,t=12.27],FVC[(3.04±0.20)L vs.(2.14±0.22)L,t=20.31],FEV1[(2.83±0.20)L vs.(2.16±0.13)L,t=18.84],FEV1%estimated value[(42.23±4.66)%vs.(36.43±5.09)%,t=5.64]were higher than those in the control group(P<0.01);serum CRP,IL-6,TNF-αand PCT in the observation group were lower than those in the control group(t values were 18.13,13.36,15.97,30.67,P<0.01).The total effective rate of the observation group was 93.33%(42/45),while that of the control group was 77.78%(35/45),with statistical significance(χ^(2)=4.41,P=0.036).Conclusion The combination of Sangqiao Qingfei Prescription and conventional Western medicine treatment with mechanical ventilation can effectively improve lung ventilation function,reduce inflammatory cytokine levels,alleviate inflammatory reactions,and improve clinical efficacy in AECOPD patients with respiratory failure.
作者
俞新
张宇锋
王聪
花海兵
江卫龙
Yu Xin;Zhang Yufeng;Wang Cong;Hua Haibing;Jiang Weilong(Department of Pulmonary Diseases,Jiangyin Hospital of Traditional Chinese Medicine,Jiangyin 214400,China)
出处
《国际中医中药杂志》
2024年第9期1121-1127,共7页
International Journal of Traditional Chinese Medicine
基金
江苏省中医药科技发展计划项目(ZT202113)
无锡市卫生健康委科技计划项目(T202130)。
关键词
肺疾病
慢性阻塞性
呼吸衰竭
机械通气
桑翘清肺方
肺功能
Pulmonary disease,chronic obstructive
Respiratory failure
Mechanical ventilation
Sangqiao Qingfei Formula
Pulmonary function
