天枢穴贴敷对呼吸机相关性肺炎患者的呼吸力学与血清炎症因子的影响

Effect of Tianshu acupoint application on respiratory mechanics and serum inflammatory factors in ventilator-associated pneumonia patients with nosocomial infection

目的探讨天枢穴贴敷对呼吸机相关性肺炎的呼吸力学及血清炎症因子的影响。方法选择2017年3月-2018年3月淳安县中医院收治的呼吸机相关性肺炎患者98例为研究对象,随机分为试验组与对照组,各49例。两组均采用常规抗感染治疗,常规细菌培养后依据细菌学检查和药敏试验结果,按照结果采用有效抗菌药物进行抗感染治疗。试验组加用天枢穴贴敷,贴敷膏采用医院自配的通里膏(药物成分为生大黄、芒硝、枳实、冰片)于天枢穴贴敷。比较两组患者治疗前后氧和指数(PaO2/FiO2)、呼吸力学及血清超敏C-反应蛋白(hs-CRP)和降钙素原(PCT)水平。结果两组患者治疗后PaO2/FiO2较治疗前均升高(P<0.001);试验组治疗后PaO2/FiO2为(243.68±20.19)mmHg高于对照组(P<0.001)。两组患者治疗后肺顺应性较治疗前升高,而气道峰压和气道阻力较治疗前降低(P<0.001);试验组治疗后肺顺应性为(34.68±3.10)ml/mmH2O高于对照组,而气道峰压和气道阻力分别为(18.49±1.80)cmH2O、(8.78±1.01)cmH2O/(L/s)低于对照组(P<0.001)。两组患者治疗后血清hs-CRP和PCT较治疗前降低(P<0.001);试验组治疗后血清hs-CRP和PCT分别为(16.89±1.92)mg/L、(2.41±0.67)ng/L低于对照组(P<0.001)。结论天枢穴贴敷可改善呼吸机相关性肺炎患者的呼吸力学指标,及减轻患者炎症反应,具有一定的临床价值。

OBJECTIVE To explore the effects of Tianshu point application on respiratory mechanics and serum inflammatory factors in ventilator-associated pneumonia patients with nosocomial infection.METHODS Totally 98 patients with ventilator-associated pneumonia treated in Chun’an County Hospital of Traditional Chinese Medicinel in Mar.2017 to Mar.2018 were enrolled in the study.According to the random table method,the patients were divided into the experimental group and the control group,with 49 cases in each group.The two groups were treated with conventional anti-infection treatment.After routine bacterial culture,effective antiseptic drugs were used to treat infection according to the results of bacteriological examination and drug sensitivity test.The experimental group was treated additionally with Tianshu acupoint application.The paste was made from the Tongli ointment in our hospital.The ingredients were raw rhubarb,mirabilite,Fructus aurantii Immaturus and borneol.The changes of oxygen and index(PaO2/FiO2),respiratory mechanics and serum high-sensitivity C-reactive protein(CRP)and procalcitonin(PCT)levels were compared between the two groups before and after treatment.RESULTS The PaO2/FiO2 of both groups increased significantly after treatment(P<0.001).The PaO2/FiO2 of the experimental group was(243.68±20.19)mmHg,significantly higher than that of the control group(P<0.001).After treatment,the lung compliance of both groups was significantly higher than that before treatment,whereas the airway peak pressure and airway resistance were significantly lower than those before treatment(P<0.001).The lung compliance in the experimental group was(34.68±3.10)ml/mmH2O,significantly higher than that in the control group,while the airway peak pressure and airway resistance were(18.49±1.80)cmH2O and(8.78±1.01)cmH2O/(L/s),significantly lower than those of the control group(P<0.001).The serum hs-CRP and PCT levels of both groups decreased significantly after treatment(P<0.001),while the serum hs-CRP and PCT levels were(16.89±1.92)mg/L and(2.41±0.67)ng/L in the experimental group,significantly lower than those in the control group(P<0.001).CONCLUSION Tianshu acupoint application can improve the respiratory mechanics of patients with ventilator-associated pneumonia and nosocomial infection and reduce the inflammatory reaction of patients,which is worthy of clinical reference.