清肺化痰汤对呼吸机性相关肺炎患者呼吸力学及CRP、WBC水平的影响

Effect of Qingfei Huatan Decoction(清肺化痰汤)on Respiratory Mechanics,CRP and WBC in VAP Patients

目的探讨清肺化痰汤对呼吸机性相关肺炎(VAP)患者呼吸力学及C反应蛋白(CRP)、白细胞(WBC)水平的影响。方法选择2019年4月—2020年5月该院接受治疗的VAP患者60例,均符合VAP的诊断标准,随机分为头孢米诺组(T组)和头孢米诺联合清肺化痰汤组(Q组),比较T组和Q组患者治疗有效率、呼吸力学指标、中医症状积分等差异性;ELISA检测WBC、CRP、血小板(PCT)水平;流式细胞仪检测CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(8)水平。结果Q组治疗总有效率为96.67%(29/30),相比T组治疗有效率明显增加(χ^(2)=13.482,P=0.044);治疗前T组、Q组患者WBC、CRP、PCT水平接近(P>0.05);治疗后两组WBC、CRP、PCT表达均下降,且Q组患者低于T组(P<0.05);治疗前,T组、Q组患者CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(8)及CD^(+)_(4)/CD^(+)_(8)水平接近(P>0.05),治疗后,两组患者CD^(+)_(3)水平相差较小(P>0.05),CD^(+)_(4)及CD^(+)_(4)/CD^(+)_(8)水平均显著升高(P<0.05),CD^(+)_(8)T水平显著降低(P<0.05),Q组与T组相比CD^(+)_(4)、CD^(+)_(8)及CD^(+)_(4)/CD^(+)_(8)水平差异有统计学意义(P<0.05);治疗前,T组、Q组患者气道峰压(PIP)、气道阻力(Raw)、呼吸做功(WOB),动脉顺应性(Cdyn)水平较为接近(P>0.05);治疗后两组患者PIP、Raw及WOB均下降(P<0.05),Cdyn水平升高(P<0.05),且Q组较T组相比呼吸力学相关指标均差异有统计学意义(P<0.05);治疗前,T组、Q组患者中医症状积分水平较为接近(P>0.05);治疗后两组患者中医症状积分均有所下降(P<0.05),Q组低于T组(P<0.05)。结论清肺化痰汤通过降低CRP、WBC水平,改善患者呼吸力学指标,提高免疫水平,从而改善VAP患者的病情,提高治疗效果。

Objective To explore the effect of Qingfei Huatan Decoction(清肺化痰汤)on respiratory mechanics,CRP and WBC in VAP patients.Methods From April 2019 to May 2020,60 patients with VAP who were treated in our hospital were selected and all met the diagnostic criteria of VAP.They were randomly divided into cefminol group(T group)and cefminol combined with Qingfei Huatan Decoction group(Q group).The differences in treatment effectiveness,respiratory mechanics indexes and TCM symptom scores between T group and Q group were compared.ELISA was used to detect levels of WBC,CRP and PCT.Flow cytometry was used to detect levels of CD^(+)_(3),CD^(+)_(4)and CD^(+)_(8).Results The total effective rate in Q group was 96.67%(29/30),which was significantly higher than that in T group(χ^(2)=13.482,P=0.044).Before treatment,the levels of WBC,CRP and PCT in T and Q groups were not significant(P>0.05).After treatment,the levels of WBC,CRP and PCT were decreased in both groups,and those in Q group were lower than those in T group(P<0.05).Before treatment,levels of CD^(+)_(3),CD^(+)_(4),CD^(+)_(8)and CD^(+)_(4)/CD^(+)_(8)were not significant(P>0.05).After treatment,the difference in CD^(+)_(3)levels between the two groups was not significant(P>0.05).The levels of CD^(+)_(4)and CD^(+)_(4)/CD^(+)_(8)were significantly increased(P<0.05)and CD^(+)_(8)T levels were significantly reduced(P>0.05).Compared with those of T group,the levels of CD^(+)_(4),CD8+and CD^(+)_(4)/CD^(+)_(8)in group Q were significantly different(P<0.05).Before treatment,the levels of PIP,Raw,WOB and Cdyn in T and Q groups were not significant(P>0.05).After treatment,PIP,Raw and WOB of the two groups were decreased(P<0.05).The Cdyn level was increased(P<0.05)and the respiratory mechanics related indicators of Q group were significantly better than those of group T(P<0.05).Before treatment,the TCM symptom scores of the patients in the T and Q groups were not significant(P>0.05).After treatment,the TCM symptom scores of the two groups were decreased(P<0.05),and the scores of the Q group was lower than that of the T group(P<0.05).Conclusion Qingfei Huatan Decoction can reduce the levels of CRP and WBC,improve the respiratory mechanics of patients and improve the immune level,thereby improving the condition of patients with VAP and the treatment effect.