人参四逆汤加减联合呼吸支持对危重慢性阻塞性肺疾病呼衰患者下丘脑-垂体-肾上腺轴的影响

Study on the Effects of Modified Renshen Sini Decoction Combined with Respiratory Support on Hypothalamus-pituitary-adrenal Axis in AECOPD Patients with Respiratory Failure

目的观察人参四逆汤加减联合呼吸支持对危重慢性阻塞性肺疾病呼衰患者下丘脑-垂体-肾上腺轴的影响并探讨其作用机制。方法60例患者随机分为治疗组与对照组,每组各30例。治疗组给予常规呼吸支持及常规治疗的基础上使用人参四逆汤加减,对照组给予西医常规治疗组,治疗14 d后评定疗效。治疗前后采集标本进行常规及血清皮质醇(COR)和促肾上腺皮质激素(ACTH)水平检测。结果治疗组总有效率93.33%优于对照组的86.67%(P<0.05)。两组治疗前动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、pH指标比较,差别均无统计学意义(均P>0.05)。治疗后血气分析PaCO2水平较治疗前下降、PaO2水平则上升(P<0.05),p H水平也上升(P<0.05),且治疗组治疗后PaCO2水平低于对照组,PaO2、pH均高于对照组(均P<0.05)。两组治疗前COR比较差异不明显(均P>0.05)。两组经治疗COR水平呈现先升高后回落的波动,治疗3 d皮质醇水平均高于治疗前(均P<0.01),且治疗组皮质醇水平高于对照组(P<0.05);治疗14 d时两组基本与治疗前接近(P>0.05),但两组治疗14 d后比较差别不大(P>0.05)。两组治疗前ACTH比较,差别不大(P>0.05)。两组治疗3 d及第14日的ACTH均低于治疗前(均P<0.01),且治疗3 d治疗组ACTH较对照组的下降更为明显(P<0.05),而治疗14 d两组ACTH水平比较差别不大(P>0.05)。结论危重慢性阻塞性肺疾病呼吸衰竭患者应用扶助阳气的人参四逆汤加减联合呼吸机治疗具有显著疗效,可提高早期COR水平降低ACTH,调整下丘脑-垂体-肾上腺轴,改善危重慢性阻塞性肺疾病急发呼衰应激的影响。

Objective:To explore the effect of modified Renshen Sini Decoction combined with respiratory support on hypothalamus-pituitary-adrenal axis in patients with critical chronic obstructive pulmonary disease with respiratory failure.Methods:60 patients were randomly divided into two groups.The treatment group was treated with Renshen Sini Decoction on the basis of routine breathing support and routine treatment,while the control group was treated with routine Western medicine.The curative effect was evaluated after 14 days of treatment.Samples were collected before and after treatment for routine detection and serum cortisol(COR)and adrenocorticotropic hormone(ACTH)levels.Results:After treatment,the curative effect of the treatment group was better than that of the control group(P<0.05).After treatment,the levels of PaO2 and pH increased,PaCO2 was lower than before treatment,and the improvement of the treatment group was better than that of the control group,with statistical significance(P<0.05).After treatment,the cortisol index of the two groups increased first and then decreased.The level was significantly higher than that before treatment(P<0.01),while that in the treatment group was higher than that in the control group(P<0.05).There was no significant difference after 14 days of treatment(P>0.05),and there was no significant difference between the two groups(P>0.05).The indices of ACTH decreased in the two groups after treatment.The levels on 3 rd day and 14 th day were significantly lower than those before treatment(P<0.01).The decrease of ACTH levels in the treatment group was more obvious than that in the control group on 3 rd day(P<0.05).There was no significant difference between groups on 14 th day(P>0.05).Conclusions:Modified Renshen Sini Decoction with ventilator has significant effect on severe AECOPD patients with respiratory failure.It can improve the early cortisol level and reduce ACTH,and adjust the hypothalamic-pituitary-adrenal axis to improve the effect of acute respiratory failure stress in critical chronic obstructive pulmonary disease.