慢性阻塞性肺疾病急性加重期有创、无创机械通气模式的APACHE Ⅱ评分及中医证候对比研究

Comparative study of TCM syndromes and APACHE Ⅱ scores of non-invasive ventilation and invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease

目的对比研究慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)有创、无创两种机械通气模式的急性生理与慢性健康状况评分(APACHE II评分)以及中医证候特点,为进一步优化治疗方案,判断病情严重程度及预后提供依据。方法将中国中医科学院望京医院ICU 2014年6月—2016年6月收治的59例AECOPD机械通气患者,分为无创通气组32例和有创通气组27例,比较2组中医证型和APACHE II评分。结果无创通气组中实证10例(31.3%),虚证14例(43.8%),虚实夹杂证8例(25.0%);有创通气组中实证5例(18.5%),虚证6例(22.2%),虚实夹杂证16例(59.3%)。有创通气组APACHE II评分大于无创通气组,差异有统计学意义(P<0.05)。结论无创通气组实证和虚证为主,以肺气虚居多;有创通气组虚实夹杂证为主,以肺脾气虚、痰蒙神窍居多。评分在22分以上考虑有创通气,评分在15分以下选择无创通气。

Objective To observe and compare the characteristics of TCM syndromes and APACHE II scores with two mechanical ventilation modes,that is,non-invasive ventilation and invasive ventilation,in acute exacerbation of chronic obstructive pulmonary disease（ COPD） in order to optimize the therapeutic regime and provide evidences for determining the severity and prognosis of the disease. Methods 59 cases of AECOPD in ICU of Wangjing Hospital,China Academy of Chinese Medical Sciences who received mechanical ventilation from June 2014 to June 2016 were divided into non-invasive ventilation group of 32 cases and invasive ventilation group of 27 cases,and TCM syndrome types and APACHE II scores were compared. Results There were 10 cases（ 31. 3%） belonging to excess syndrome,14 cases（ 43. 8%） belonging to deficiency syndrome,8 cases（ 25. 0%） belonging to syndrome of intermingled deficiency and excess in the non-invasive ventilation group; and there were 5 cases（ 18. 5%） of excess syndrome,6 cases（ 22. 2%） of deficiency syndrome,16 cases（ 59. 3%） of syndrome of intermingled deficiency and excess in the invasive ventilation group. APACHE II scores of invasive ventilation group were larger than that of the non-invasive ventilation group,and the difference was statistically significant（ P〈0. 05）. Conclusion Excess syndrome and deficiency syndrome are the majority in the non-invasive ventilation group,and especially lung qi deficiency is the most; while,intermingled deficiency and excess syndrome is the majority in the invasive ventilation group,and lung and spleen qi deficiency and phlegm covering the orifices are the most. Those with the scores above 22 may consider using invasive ventilation,while those with the scores under 15 choosing non-invasive ventilation.