大承气汤联合机械通气治疗急性呼吸窘迫综合征疗效观察

Observation of therapeutic effects of Dachengqi decoction(大承气汤) combined with mechanical ventilation on patients with acute respiratory distress syndrome

目的：观察大承气汤联合机械通气治疗急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法：选择2000年6月-2005年12月收入我院重症监护室（ICU）的41例ARDS患者。随机分为治疗组21例。采用机械通气及西医常规治疗并加用大承气汤[由大黄12g、厚朴24g、芒硝6g（冲）、枳实12g组成]灌肠，每日2次，疗程5～10d；对照组20例，仅采用机械通气及西医常规治疗。于治疗后24h和48h分别观察两组患者的氧合指数（OI）、吸入氧浓度（FiO2）、动脉血氧分压（PaO2）、呼吸末正压（PEEP）、肺动态顺应性（Cdyn）；治疗结束后观察机械通气并发症发生率及病死率的变化。结果：治疗组在治疗后24h起OI、PaO2、Cdyn均显著高于对照组，而FiO2显著低于对照组；PEEP于治疗后48h显著低于对照组，差异均有显著性（P〈0．05或P〈0．01）。治疗组患者机械通气并发症（腹胀、呼吸机相关性肺炎、气道水样分泌物等）发生率及病死率等方面均优于对照组，差异均有显著性（P〈0．05或P％0．01）。结论：大承气汤灌肠可改善ARDS患者Cdyn、肺氧合功能，减少机械通气并发症。提高机械通气效率，并最终提高抢救成功率。

Objective： To observe the therapeutic effects of Dachengqi decoction （大承气汤） combined with mechanical ventilation （MV） on patients with acute respiratory distress syndrome （ARDS）. Methods： Forty-one patients with ARDS in intensive care unit （ICU） of Chengdu First People＇s Hospital from June 2000 to December 2005 were selected in the study. The patients were randomly divided into treatment group （n = 21） treated with MV and routine western medicine combined with Dachengqi decoction which composed of radix et rhizoma rhei （大黄） 12 g, cortex magnoliae officinalis （厚朴） 24 g, natrii sulfas （芒硝） 6 g （dilution） and fructus aurantii immaturus （枳实） 12 g was clysterized twice a day for 5 - 10 days, and control group （n= 20） treated with MV and routine western medicine. Oxygenation index （OI）, inspired oxygen concentration （FiO2）, artery partial pressure of oxygen （PaO2）, positive end-expiratory pressure （PEEP） level, pulmonary dynamic compliance （Cdyn） and the changes of complications of MV and mortality rate were observed and compared between the two groups 24 and 48 hours after treatment. Results： In the treatment group, OI, PaO2 and Cdyn were higher from 24 hours after treatment, and FiO2 and PEEP levels were significantly lower than those of control group at 48 hours after treatment, the differences being significant （P〈0.05 or P〈0.01）. The incidence rate of complications after MV （including abdominal distention, ventilation associated pneumonia, water-like secretion in air tube, etc. ） and mortality rate were better than those of control group, the differences being significant （P 〈 0.05 or P 〈 0.01 ）. Conclusion ： Dachengqi decoction clyster can markedly improve oxygenation function and Cdyn of lung in patients with ARDS, decrease the complications of MV, improve its efficiency and eventually increase the achievement ratio of resuscitation.