中药结合早期肠内营养支持对重型颅脑外伤患者呼吸机相关性肺炎的疗效观察

The effect of TCM medicine with early enteral nutrition support on ventilatorassociated pneumonia in patients with severe head injury

目的:探讨中药通腑平喘汤结合大黄及早期肠内营养支持对重型颅脑外伤患者呼吸机相关性肺炎(Ventilator-associated Pneumonia,VAP)的临床疗效。方法:将46例重型颅脑外伤患者随机分为治疗组和对照组,各23例,均采用同样的西医综合治疗,同时治疗组加用通腑平喘汤、大黄胃管注入和能全力早期肠内营养支持,对照组单纯加用能全力早期肠内营养支持。比较两组VAP患者的临床疗效;治疗前及治疗7 d后炎症指标的变化;治疗前、治疗第7 d及治疗第14 d各项营养指标的变化。结果:治疗组总有效率高于对照组总有效率,差异有统计学意义(P<0.05);两组患者治疗后白细胞计数(White Blood Cell count,WBC)、超敏C-反应蛋白(High-sensitivity C-reactive Protein,hs-CRP)、血清降钙素原(Procalcitonin,PCT)较治疗前下降明显,差异有统计学意义(P<0.05);两组间比较,血清总蛋白(Total Protein,TP)、血清白蛋白(ALB)、血清前白蛋白(Prealbumin,PALB)在治疗组的改善情况均优于对照组,差异有统计学意义(P<0.05)。结论:合理应用中药通腑平喘汤结合大黄及早期肠内营养支持对呼吸机相关性肺炎疗效确切,可以降低肺部感染率,促进蛋白质合成、免疫功能恢复,有利于重型颅脑外伤患者的预后。

Objective:To investigate the clinical efficacy of the Tongfu Pingchuan decoction(通腑平喘汤)with rhubarb and early enteral nutrition on VAP in patients with severe head injury.Methods:46 patients were randomly divided into the treatment group and the control group,23 cases in each group.All underwent the same comprehensive western medicine.At the same time,the treatment group was treated with the Tongfu Pingchuan decoction,rhubarb gastric tube injection and early enteral nutrition support with Nengquanli(能全力).The control group can early enteral nutrition support with Nengquanli.Results:The total effective rate in the treatment group was higher than that in the control group(P<0.05),after treatment,the WBC and hs-CRP and PCT were significantly lower than before treatment(P<0.05).The improvement of TP,ALB and PALB in the treatment group were better than that in the control group(P<0.05).Conclusion:TCM medicine with rhubarb and early enteral nutrition support has a definite effect on VAP.It can reduce the rate of lung infection,promote protein synthesis and immune function recovery in patients,and is beneficial to patients with severe head injury the prognosis.