清热通腑灌肠法联合无创通气治疗老年重症肺炎阳明腑实证临床研究

Clinical study on treatment of senile severe pneumonia by Qingre-Tongfu enema combined with non-invasive ventilation with syndrome of excess of Yangming fushi

目的评价清热通腑灌肠法联合无创正压通气治疗老年重症肺炎阳明腑实证患者的疗效。方法将符合入选标准的北京市东城区第一人民医院呼吸科2017年9月-2019年8月老年重症肺炎阳明腑实证患者60名,采用随机数字表法分为2组,每组30例。对照组予西药控制感染及无创正压通气等常规治疗,治疗组在对照组基础上加用清热通腑灌肠法保留灌肠。2组均治疗10 d。分别于治疗前后进行中医证候评分量表(Traditional Chinese Medicine Syndrome Score Scale,TCMSSS)评分;采用急性生理和慢性健康状况评分Ⅱ(Acute Physiology And Chronic Health EvaluationⅡ,APACHEⅡ)、临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS)和肺炎严重程度指数评分(Pneumonia Severity Index,PSI)评估患者病情严重程度;采用双抗体夹心免疫层析法检测血清降钙素原(PCT)水平、采用双抗体夹心ELISA法检测CRP水平、采用全自动血细胞分析仪检测WBC;采用血气分析仪检测PaCO_(2)、动脉血氧饱和度(SaO_(2))、PaO_(2),计算氧合指数、呼吸频率数值;记录治疗期间并发症发生频次,评价临床疗效。结果治疗组总有效率为96.7%(29/30)、对照组为73.3%(22/30),2组比较差异有统计学意义(χ^(2)=4.706,P=0.030)。治疗组治疗后血清PCT、CRP、WBC水平均低于对照组(t值分别为15.359、25.784、13.460,P<0.01);治疗后,治疗组SaO_(2)[(93.18±3.79)%比(88.78±5.56)%,t=3.584]、PaO_(2)[(86.81±4.01)mmHg比(80.01±4.76)mmHg,t=5.975]、氧合指数[(285.53±15.05)mmHg比(227.65±12.37)mmHg,t=16.272]高于对照组(P<0.01);PaCO_(2)[(43.28±6.84)mmHg比(48.83±7.66)mmHg,t=-2.956]、呼吸频率[(22.00±3.79)次/min比(26.30±3.73)次/min,t=-4.434]水平低于对照组(P<0.05)。治疗组治疗后TCMSSS、APACHE-Ⅱ、CPIS、PSI评分均低于对照组(t值分别为41.310、11.035、8.399、5.752,P<0.01)。治疗组机械通气时间、住院时间均短于对照组(P<0.01)。结论清热通腑灌肠法联合无创正压通气可改善老年重症肺炎阳明腑实证患者的症状,降低炎性细胞因子水平,缩短机械通气时间,提高疗效。

Objective To investigate the effect of Qingre-Tongfu enema combined with noninvasive positive pressure ventilation on the ventilation function of elderly patients with severe pneumonia.Methods A total of 60 elderly patients with severe pneumonia with syndrome of excess of Yangming fushi from September 2017 to August 2019 in the respiratory department of the First People’s Hospital of Dongcheng District,Beijing were randomly divided into two groups,30 cases in each group.The control group was treated with western medicine to control infection and noninvasive positive pressure ventilation.The treatment group was treated with Qingre-Tongfu enema on the basis of the control group.The Traditional Chinese Medicine Syndrome score(TCMSSS),Acute Physiology and Chronic Health EvaluationⅡ(APACHE-Ⅱ)and Clinical Pulmonary Infection Score(CPIS)were compared before and after treatment,The Pneumonia Severity Index(PSI)was compared.Serum procalcitonin(PCT)was detected by upconversion luminescence immunoassay,CRP was detected by double antibody sandwich ELISA,WBC was detected by automatic hematology analyzer;partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation(SaO2),partial pressure of oxygen(PaO2)were detected by blood gas analyzer,oxygenation index(OI)and respiratory rate(RR)were calculated.The complications were investigated and the clinical efficacy was evaluated.Results The total effective rate was 96.7%(29/30)in the treatment group and 73.3%(22/30)in the control group,with significant difference between the two groups(χ^(2)=4.706,P=0.030).After treatment,the levels of serum PCT,CRP and WBC in the treatment group were significantly lower than those in the control group(t=15.359,25.784 and 13.460,respectively,P<0.01);after treatment,the levels of SaO_(2)[(93.18±3.79)%vs.(88.78±5.56)%,t=3.584],PaO2[(86.81±4.01)mmHg vs.(80.01±4.76)mmHg,t=5.975],OI[(285.53±15.05)mmHg vs.(227.65±12.37)mmHg,t=16.272]in the treatment group significantly were higher than those in the control group(P<0.01);PaCO_(2)[(43.28±6.84)mmHg vs.(48.83±7.66)mmHg,t=-2.956],RR[(22.00±3.79)times/min vs.(26.30±3.73)times/min,t=-4.434]in the treatment group were significantly lower than those in the control group(P<0.05).After treatment,the scores of TCMSSS,APACHE-Ⅱ,CPIS and PSI in the treatment group were significantly lower than those in the control group(t=41.310,11.035,8.399,5.752,P<0.01).The treatment group in the course of antibiotics,mechanical ventilation time,hospital stay were significantly shorter than the control group(P<0.01).Conclusion Qingre-Tongfu enema combined with noninvasive positive pressure ventilation can improve the clinical symptoms of elderly patients with severe pneumonia,reduce inflammatory reaction,shorten the time of mechanical ventilation and antibiotic treatment,and improve the clinical efficacy.