摘要
目的:探讨潜阳丹加半夏汤对无创机械通气治疗的慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴呼吸衰竭患者神经内分泌网络调节作用及机制。方法:将60例AECOPD合并Ⅱ型呼吸衰竭需使用无创呼吸机的患者随机分为治疗组和对照组。对照组给予无创机械通气及西医常规治疗,治疗组在对照组治疗基础上给予潜阳丹加半夏汤。治疗14 d后,比较两组患者临床疗效,比较两组患者治疗前、治疗第3天及治疗后神经-内分泌-免疫(neural-endocrine-immune system,NEI)网络因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、IL-8、三碘甲状腺原氨酸(total triiodothyronine,TT3)、促甲状腺激素(thyroid stimulating hormone,TSH)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、皮质醇(cortisol,COR)水平,并比较中医证候积分。结果:治疗组有效率为93.33%,对照组有效率为86.67%,两组有效率比较,差异有统计学意义(P<0.05)。治疗后两组患者PaO2及pH值高于本组治疗前,PaCO2均低于本组治疗前,且观察组改善程度优于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者中医证候积分均显著降低,且治疗组治疗后低于对照组治疗后,差异均有统计学意义(P<0.05)。治疗第3天,两组患者COR水平均高于治疗前,且治疗组高于对照组,差异均有统计学意义(P<0.05)。治疗第3天,两组患者ACTH水平均高于治疗前,且治疗组高于对照组,差异均有统计学意义(P<0.05);治疗第14天,两组患者ACTH水平均高于治疗前,差异均有统计学意义(P<0.05)。治疗后两组患者T3水平均高于治疗前,且治疗组高于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者TNF-α、IL-6、IL-8水平均显著降低,且治疗组治疗后以上指标均低于对照组治疗后,差异均有统计学意义(P<0.05)。结论:潜阳丹加半夏汤可有效改善无创机械通气AECOPD伴Ⅱ型呼吸衰竭患者的病情及中医阳气虚证候,改善缺氧及二氧化碳潴留,多方位有效调整AECOPD患者应激时的NEI网络,且安全有效。
Objective:To explore the regulatory effect and mechanism of Qianyang Dan Plus Banxia Decoction on neuroendocrine network in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and respiratory failure treated by non-invasive mechanical ventilation.Methods:60 AECOPD patients with type II respiratory failure requiring non-invasive ventilator were randomly divided into treatment group and control group.The control group was treated with non-invasive mechanical ventilation and conventional western medicine,while the treatment group was treated with Qianyang Dan Plus Banxia Decoction on the basis of the control group.After 14 days of treatment,the clinical effects of the two groups were compared.The neural-endocrine-immune system(NEI)tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-8,total triiodothyronine(TT3),thyroid stimulating hormone(TSH),adrenocorticotropic hormone(ACTH),cortisol(COR)were compared,and the scores of TCM syndromes were compared.Results:The effective rate was 93.33%in the treatment group and 86.67%in the control group.There was a significant difference between the two groups(P<0.05).After treatment,the levels of PaO2 and pH of the two groups increased before treatment,and PaCO2 was lower than before treatment,and the improvement degree of the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of TCM syndromes in the two groups were significantly reduced,and the scores in the treatment group were lower than those in the control group(P<0.05).On the third day of treatment,the COR levels of the two groups were higher than before treatment,and the treatment group was higher than the control group,and the difference was statistically significant(P<0.05).On the third day of treatment,ACTH levels of the two groups were higher than those before treatment,and the treatment group was higher than that of the control group,with statistical significance(P<0.05);on the fourteenth day of treatment,ACTH levels of the two groups were higher than those before treatment,with statistical significance(P<0.05).After treatment,the T3 levels of the two groups were higher than those before treatment,and the treatment group was higher than the control group,and the difference was statistically significant(P<0.05).After treatment,the levels of TNF-α,IL-6 and IL-8 in the two groups were significantly decreased,and the above indexes in the treatment group were lower than those in the control group after treatment,and the difference was statistically significant(P<0.05).Conclusion:Qianyang Dan Plus Banxia Decoction can effectively improve the condition of AECOPD patients with type II respiratory failure by non-invasive mechanical ventilation and yang-qi deficiency syndrome of Chinese medicine,improve hypoxia and carbon dioxide retention,effectively adjust the NEI network of AECOPD patients under stress in many ways,and it is safe and effective.
作者
朱立成
吴传中
黄敏
ZHU Licheng;WU Chuanzhong;HUANG Min(Nantong Third Hospital Affiliated to Nantong University,Nantong Jiangsu China 226000;Affiliated Hospital to Nantong University,Nantong Jiangsu China 226000)
出处
《中医学报》
CAS
2019年第9期1958-1963,共6页
Acta Chinese Medicine
基金
江苏省南通市科技局科技计划项目(YYZ17039)
关键词
潜阳丹
半夏汤
无创机械通气
慢性阻塞性肺疾病急性加重期
呼吸衰竭
神经-内分泌-免疫网络
Qianyang Dan
Banxia Decoction
non-invasive mechanical ventilation
acute exacerbation of chronic obstructive pulmonary disease
respiratory failure
neuro-endocrine-immune system
