通腑平喘汤联合机械通气治疗慢性阻塞性肺疾病并发呼吸衰竭的临床疗效观察

Observation on clinical effects of Tongfu Pingchuan decoction(通腑平喘汤) combined with mechanical ventilation on patients with respiratory failure induced by chronic obstructive pulmonary disease

目的:观察通腑平喘汤联合机械通气治疗慢性阻塞性肺疾病(COPD)并发呼吸衰竭的临床疗效。方法:将符合诊断标准的COPD并呼吸衰竭患者随机分为治疗组(20例)和对照组(20例)。两组均采用西医常规治疗(包括机械通气),治疗组加用通腑平喘汤,每日1剂,煎汁200 m l,分2次鼻饲。比较两组治疗前、治疗后3 d和5 d及脱机后的动脉血气指标,痰液中中性粒细胞占白细胞百分比(N%)、氧合指数(PaO2/F iO2)、肺动态顺应性(Cdyn),病死率、呼吸机相关性肺炎(VAP)的发生率及机械通气时间。结果:治疗组治疗后5 d血气分析、N%、PaO2/F iO2、Cdyn均较对照组显著改善(P均<0.05),而其余观察时间点两组上述指标差异均无显著性(P均>0.05)。治疗组机械通气时间〔(8.6±3.7)d〕较对照组〔(12.1±5.2)d〕显著缩短(P<0.05),VAP发生率亦较对照组显著减少〔20%(4/20例)比40%(8/20例),P<0.05〕,两组病死率差异无显著性。结论:在机械通气等治疗基础上加用通腑平喘汤,有助于尽快控制COPD并发呼吸衰竭患者的肺部炎症反应,改善呼吸功能,减少机械通气时间及VAP发生率。

Objective： To evaluate the clinical effects of Tongfu Pingchuan decoction （通腑平喘汤） combined with mechanical ventilation （MV） on patients with respiratory failure induced by chronic obstructive pulmonary disease （COPD）. Methods： These patients were randomly divided into treatment group （n=20） and control group （n = 20）. Routine western medicine （including MV） was used in two groups, and one dosage of the decoction 200 ml infused via nasal tube twice a day was added in the treatment group. Parameters of arterial blood gas analysis, the ratio of neutrophil-leukocyte in sputa （N%）, oxygenation index （PaO2/FiO2）, dynamic compliance （Cdyn） of lung, the mortality rate in hospital, the incidence rate of ventilation associated pneumonia （VAP） and the total time of MV were compared before therapy, on the 3 rd and 5 th day after therapy and weaning of MV. Results： Compared with the control group, the indexes of treatment group including arterial blood gas analysis, N%, PaO2/FiO2 and Cdyn were more distinctly improved on the 5 th day （all P〈0.05） than those of the control group, but on the other time points the above items had no significant differences between the two groups （all P 〉 0.05）. The total time of MV （（8.6±3.7） days] in treatment group was markedly shorter than that of control group （（12.1 ±5.2） days, P〈0. 05], the incidence rate of VAP in treatment group was also reduced more markedly than that of the control group [20%（4/20 cases） vs. 40% （8/20 cases）,P〈0.05]. The mortality rate showed no significant difference between the two groups （P〉0. 05）. Conclusion： Based on the treatment of MV in patients with respiratory failure induced by COPD, Tongfu Pingchuan decoction can help control inflammatory reaction in lung tissues, improve respiratory function as soon as possible, shorten the time of MV and reduce the incidence rate of VAP.