大承气汤灌肠联合机械通气对慢性阻塞性肺病合并呼吸衰竭患者炎性反应介质及血气的影响

Effects of Dachengqi Decoction Enema Combined with Mechanical Ventilation on Inflammatory Indicators and Blood Gas in COPD Patients with Respiratory Failure

目的:探讨大承气汤灌肠联合机械通气治疗慢性阻塞性肺病(COPD)合并呼吸衰竭的临床效果及对患者血气指标及炎性反应介质的影响。方法:选取2015年1月至2017年10月阜阳市第二人民医院收治的COPD合并急性呼吸衰竭患者66例,根据治疗措施的不同分为观察组和对照组,每组33例。2组患者均进行控制感染,纠正电解质失衡等常规治疗,对照组给予机械通气治疗,观察组在对照组基础上联合大承气汤灌肠治疗,连续用药7 d。比较2组患者临床疗效;检测并比较2组临床指标、血气及炎性反应介质水平变化。结果:观察组总有效率为93.94%,显著高于对照组的75.76%(P<0.05)。与对照组比较,治疗2 d时观察组氧合指数(OI),肺动态顺应性(Cdyn)及脱机成功率均显著升高(P<0.05),而观察组腹胀发生率均显著降低(P<0.05);治疗后2组动脉血氧分压(Pa O2)和动脉血氧饱和度(Sa O2)水平提升,且观察组高于对照组(P<0.05);动脉血二氧化碳分压(Pa CO2)水平下降,且观察组低于对照组(P<0.05);与治疗前比较,治疗后2组血清C反应蛋白(CRP)、降钙素原(PCT)水平降低,且观察组低于对照组(P<0.05)。结论:对COPD合并呼吸衰竭患者采取大承气汤灌肠联合机械通气治疗可明显改善其临床症状,减轻其炎性反应,有助于恢复其肺功能,减少机械通气相关并发症,提高脱机成功率。

Objective： To explore the effects of Dachengqi Decoction enema combined with mechanical ventilation on inflammatory indicators and blood gas in chronic obstructive pulmonary disease （COPD） patients with respiratory failure. Methods： A total of 66 COPD patients with respiratory failure treated in No.2 People′s Hospital of Fuyang City from January 2015 to October 2017 were selected and were divided into the study group and the control group according to the different treatment measures,with 33 cases in each group.and.the clinical data were retrospectively analyzed.Both groups received the conventional treatment such as control injection and remedying electrolyte disturbance.Based on the conventional treatment,control group was treated with mechanical ventilation while the study group was treated with Dachengqi Decoction Enema method with the basis of the same treatment for continuous 7 days.The clinical efficacy of both groups of patients was compared,and the changes of clinical indicators,blood gas and inflammatory indicators in both groups were detected and compared. Results： The total clinical effective rate of the study group was 93.94%,which was significantly higher than 75.76% of the control group （ P 〈0.05）.After 2 days treatment,compared with the control group,the OI,Cdyn and success rate of off-line in study group were increased （ P 〈0.01）,and the ventosity occurrence rates decreased （ P 〈0.01）; the levels of PaO2 and SaO2 in the both groups were increased,and the study group increased more than the control group （ P 〈0.01）.The level of PaCO2 in both groups decreased,and the level of study group was significantly decreased more than the control group （ P 〈0.01）.Compared with before treatment,the levels of serum CRP,PCT in the both groups decreased after treatment （ P 〈0.01）,and the study group decreased more than the control group （ P 〈0.05 or P 〈0.01）. Conclusion： Treatment of COPD patients with respiratory failure with Dachengqi Decoction Enema method combined with mechanical ventilation can significantly improve their clinical symptoms,reduce their inflammatory response,help to improve the lung function,reduce mechanical ventilation related complication and increase the success rate of off-line.