血竭散合桂枝茯苓汤联合纤维支气管镜肺泡灌洗在严重肺挫伤并ARDS患者的临床疗效研究

Clinical efficacy study of Xuejie Powder and Guizhi Fuling Decoction combined with fiberoptic bronchoscopy and alveolar lavage in treating patients with severe lung contusion and ARDS

目的:探讨血竭散合桂枝茯苓汤联合纤维支气管镜肺泡灌洗在严重肺挫伤并ARDS患者的临床疗效研究。方法:将2017年7月—2018年7月在我院ICU治疗的40例严重肺挫伤并ARDS患者随机分为两组,对照组采用基础治疗和支气管镜肺泡灌洗,观察组在基础治疗、纤维支气管镜肺泡灌洗同时口服血竭散合桂枝茯苓汤7天,比较两组患者的中医证候评分变化、临床指标情况。结果:观察组治疗有效率为100%,明显高于对照组的85%(P<0.05);观察组治疗后中医证候评分明显低于对照组(P<0.05);观察组治疗后肺复张率、肺部感染率、呼吸机待机时间、氧合指数、CRP等指标与对照组相比均有明显差异(P<0.05)。结论:血竭散合桂枝茯苓汤联合纤维支气管镜肺泡灌洗在严重肺挫伤并ARDS患者的临床疗效显著,能有效改善炎症,促进肺复张和肺通气功能的恢复,降低肺部感染概率,提升临床救治效果,具有积极的临床意义。

Objective： To explore the clinical efficacy study of Xuejie Powder （血竭散） and Guizhi Fuling Decoction （桂枝茯苓汤） combined with fiberoptic bronchoscopy and alveolar lavage in treating patients with severe lung contusion and ARDS. Methods： From July 2017 to July 2018, 40 patients with severe lung contusion and ARDS were randomly divided into two groups： the control group was treated with basic therapy and bronchoalveolar lavage, and the observation group was treated Xuejie Powder （血竭散） and Guizhi Fuling Decoction （桂枝茯苓汤） combined with fiberoptic bronchoscopy and alveolar lavage on the basis of the basic treatment for 7 day. The changes of TCM syndromes and clinical indicators were compared between the two groups. Results： The treatment efficiency of the observation group was 90%, which was significantly higher than 75% of the control group （P〈0.05）. The TCM syndrome score of the observation group after treatment was significantly lower than that of the control group （P〈0.05）. After treatment, there were significant differences between the observation group and the control group in terms of pulmonary re-tension rate, pulmonary infection rate, ventilator standby time, oxygenation index and CRP （P〈0.05）. Conclusion： Xuejie Powder （血竭散） and Guizhi Fuling Decoction （桂枝茯苓汤） combined with fiberoptic bronchoscopy and alveolar lavage had significant effect in treating patients with severe lung contusion and ARDS, it could effectively relieve inflammation, promote the recovery of pulmonary rehabilitation and ventilation function, reduce the probability of pulmonary infection, and improve the clinical treatment effect, which was of positive clinical significance.