补肺汤加减对慢性阻塞性肺疾病急性加重期机械通气患者的肺顺应性及血气指标的影响

Effects of Modified Bufei Decoction on Pulmonary Compliance and Blood Gas Index in Patients with Mechanical Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:评价中药补肺汤加减治疗慢性阻塞性肺疾病(COPD)急性加重期机械通气患者对肺顺应性及血气分析指标的影响。方法:选取江西中医药大学附属医院及南昌市洪都中医院共80例COPD急性加重期患者,中医辨证均属肺肾气虚为主,均需行有创机械通气治疗,将所有患者随机分为对照组及治疗组。对照组实施常规药物及有创机械通气治疗,治疗组在对照组治疗基础上联合中药补肺汤加减治疗,比较两组患者治疗前后平台压、肺顺应性及血气分析指标。结果:气管插管初期,两组平台压与肺静态顺应性比较,差异均无统计学意义(P>0.05);治疗72 h后,治疗组的平台压低于对照组,肺静态顺应性高于对照组,差异均有统计学意义(P<0.05);治疗组平台压与肺静态顺应性的改善值均高于对照组,差异均有统计学意义(P<0.05)。气管插管前,两组二氧化碳分压及氧合指数比较,差异均无统计学意义(P>0.05);拔管后24 h,治疗组二氧化碳分压低于对照组,氧合指数高于对照组(P<0.05);治疗组氧合指数改善值高于对照组(P<0.05),而二氧化碳分压改善值与对照组比较,差异无统计学意义(P>0.05)。结论:对于慢性阻塞性肺疾病急性加重期机械通气患者中医辨证肺肾气虚显著者,联合中药补肺汤加减治疗有其特殊优势,可改善患者呼吸力学参数指标、动脉血气指标,提高疗效,值得应用及推广。

Objective:To evaluate the effects of Chinese herbal modified Bufei Decoction on pulmonary compliance and blood gas analysis indexes in patients with mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease(COPD).Method:A total of 80 COPD patients in acute exacerbation from Affiliated Hospital of Jiangxi University of Chinese Medicine and Nanchang Hongdu Hospital of Traditional Chinese Medicine were selected,and all of them were mainly lung and kidney qi deficiency according to TCM syndrome differentiation,and all of them needed invasive mechanical ventilation treatment.All the patients were randomly divided into the control group and the treatment group.The control group was treated with conventional drugs and invasive mechanical ventilation,and the treatment group was treated with Chinese medicine modified Bufei Decoction on the basis of the treatment of the control group.The platform pressure,pulmonary compliance and blood gas analysis indexes of the two groups were compared before and after treatment.Result:At the beginning of endotracheal intubation,there were no significant differences in platform pressure and pulmonary static compliance between the two groups(P>0.05);after 72 h of treatment,the platform pressure in the treatment group was lower than that in the control group,and the pulmonary static compliance in the treatment group was higher than that in the control group(P<0.05);the improvement values of platform pressure and pulmonary static compliance in the treatment group were higher than those in the control group(P<0.05).Before endotracheal intubation,there were no significant differences in carbon dioxide partial pressure and oxygenation index between the two groups(P>0.05);24 h after extubation,the partial pressure of carbon dioxide in the treatment group was lower than that in the control group,and the oxygenation index was higher than that in the control group(P<0.05);the improvement of oxygenation index in the treatment group was higher than that in the control group(P<0.05),but there was no significant difference in the improvement of carbon dioxide partial pressure between the treatment group and the control group (P>0.05). Conclusion: For COPD patients with acute exacerbation of mechanical ventilation with significant lung and kidney qi deficiency in TCM syndrome differentiation, the combined treatment with TCM modified Bufei Decoction has its special advantages, which can improve the respiratory mechanical parameters and arterial blood gas indexes of patients, and improve the curative effect. Therefore, it is worthy of application and promotion.