通腑法对慢性阻塞性肺疾病呼吸衰竭患者呼吸力学及气道炎症因子的影响

Effect of catharsis method on breathing mechanics and airway inflammatory factors of patients with respiratory failure induced by chronic obstructive pulmonary disease

目的:观察通腑法对慢性阻塞性肺疾病(COPD)呼吸衰竭患者呼吸力学及气道炎症因子的影响。方法:将符合诊断标准的COPD呼吸衰竭患者随机分为试验组50例和对照组30例,试验周期为28d。两组均采用西医常规治疗(包括机械通气),试验组加用通腑平喘汤治疗。比较两组治疗前、治疗后3d、治疗后7d及脱机时的氧合指数(PaO2/FiO2)和呼吸力学指标(包括肺顺应性,气道峰压,气道平台压,气道阻力)的变化;同时,比较两组治疗前、治疗后5d及脱机时痰上清液炎症因子(包括IL-8,TNF-α,Neu/Leu%)的变化;最后,比较两组有效机械通气时间、VAP发生率和病死率。结果:试验组治疗3d后,呼吸力学指标(气道峰压除外)较对照组迅速改善(P<0.05),氧合指数和气道峰压在治疗后7d时较对照组也显著改善(P<0.01);试验组痰上清液中IL-8和TNF-α水平在治疗5d时较对照组迅速改善(P<0.05),脱机时仍明显优于对照组(P<0.05);试验组在治疗后5d时Neu/Leu%显著优于对照组(P<0.01);两组病死率比较无统计学意义,但试验组有效机械通气时间(8.71±1.81)d(P<0.01),和呼吸机相关性肺炎发生率18%(9/50例)(P<0.05),均优于对照组(11.85±1.59)d,43.33%(13/30例)。结论:通腑法能有效地改善COPD呼吸衰竭患者气道炎症因子水平和呼吸力学状况,最终达到降低VAP的发生率并缩短机械通气时间的目的。

Objective：To evaluate the effect of catharsis method on the breathing mechanics and airway Inflammatory factors of patients with respiratory failure induced by chronic obstructive pulmonary disease.Methods：Those patients were randomly divided into experiment group（n=50） and comparison group（n=30）.The experiment period is 28 days.Routine western medicine（including mechanica ventilation method） was used in two groups,and patients in the experiment group were added the Tongfu Pingchuan decoction for each day.Such values as Oxygenation index and breathing mechanics,including pulmonary compliance,peak inspiratory pressure,plateau pressure,airway resistance,were compared before therapy,on the 3rd and 7th day after therapy and after offline.Meanwhile,the Changes of sputum supernatant Inflammatory factors,including IL-8,TNF-α and Neu/Leu%,between the two groups were compared before therapy,on the 5th and after offline.Finally,we compared the time of mechanica ventilation（MV）,incidence rate of ventilation associ-ated pneumonia（VAP） and mortality rate between the two groups.Results：Compared with the comparison group,the breathing mechanics values（peak inspiratory pressure excepted） of the experiment group were improved rapidly 3 days later（P0.05）.Oxygenation index and peak inspiratory pressure were also improved obviously in the experiment group（P0.01）.IL-8 and TNF-α in the Sputum supernatant of experiment group were improved markedly 5 days later（P0.05）,so is the time after offline.The mortality rate showed no signi-ficant difference between the two groups,But the time of MV in treatment group [（8.71±1.81） days] wasmarkedly shorter than that of comparison group [（11.85±1.59） days,P0.01],and the incidence rate of VAP in treatmentgroup was also reduced more markedly than that of the comparison group [18%（9/50cases） vs.43.33%（13/30cases）,P0.05].Conclusion：The catharsis method can effectively improve the airway inflammatory factors and breathing mechanics of patients with respiratory failure induced by chronic obstruct-tive pulmonary disease,Which can reduce the incidence of VAP and shorten the time of mechanical ventila-tion ultimately.