麻杏饮治疗慢性阻塞性肺疾病急性加重期呼吸肌疲劳的疗效及对肺功能、血气分析指标、炎症因子的影响

Effect of Maxing Drinking on acute exacerbation of chronic obstructive pulmonary disease with respiratory muscle fatigue and its influence on pulmonary function and blood gas analysis index and inflammatory factors

目的观察麻杏饮治疗慢性阻塞性肺疾病急性加重期(AECOPD)呼吸肌疲劳的疗效及对肺功能、血气分析指标、炎症因子的影响。方法将60例AECOPD呼吸肌疲劳患者按照随机数字表法分为2组,对照组30例予西医常规治疗,治疗组30例在对照组治疗基础上加麻杏饮治疗,2组均治疗2周。比较2组疗效;观察2组治疗前后肺功能指标、血气分析指标、炎症因子及中医证候评分变化;观察2组不良反应发生情况。结果治疗组总有效率86.7%(26/30),对照组总有效率63.3%(19/30),治疗组疗效优于对照组(P<0.05)。2组治疗后用力肺活量(FVC)、第1 s用力呼气容积占预计值百分比(FEV1%pred)、FEV1/FVC、每分钟最大通气量(MVV)及呼吸肌功能指标最大吸气压(MIP)与本组治疗前比较均升高(P<0.05),且治疗组较对照组升高更明显(P<0.05)。2组治疗后pH值、氧分压[p(O_(2))]、血氧饱和度(SaO_(2))均较本组治疗前升高(P<0.05),二氧化碳分压[p(CO_(2))]较本组治疗前降低(P<0.05),且治疗组治疗后pH值、p(O_(2))、SaO_(2)均高于对照组(P<0.05),p(CO_(2))低于对照组(P<0.05)。2组治疗后肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血清C反应蛋白(CRP)、降钙素原(PCT)水平均较本组治疗前降低(P<0.05),且治疗组较对照组降低更明显(P<0.05)。2组治疗后中医证候咳嗽咯痰、喘息、动则喘甚、气短气急、神疲乏力、食少纳呆评分均较本组治疗前降低(P<0.05),且治疗组较对照组降低更明显(P<0.05)。2组患者均未出现严重不良反应。结论麻杏饮治疗AECOPD呼吸肌疲劳,能有效改善患者肺功能和血气分析指标,改善临床症状,且安全性高,其机制可能与改善呼吸道炎症因子水平有关。

Objective The curative effect of Maxing Drinking on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory muscle fatigue and its influence on pulmonary function and blood gas analysis index and inflammatory factors.Method Totally 60 patients with AECOPD with respiratory muscle fatigue were randomly grouped,30 in each.Efficacy analysis on weeks 2 were performed on control group(conventional therapy),and treatment group(Maxing drinks plus conventional therapy).Meanwhile the key observation was pulmonary function,blood gas analysis index and inflammatory factors;as well as adverse incidents before and after treatment.Result The total effective rate was better in treatment group than that in control group[86.7%(26/30)vs 63.3%(19/30);(P<0.05),respectively].Forced vital capacity(FVC),the forced expiratory volume in the first second in percent predicted values(FEV1%pred),the first second ratio(FEV1.0/FVC),maximum voluntary ventilation(MVV)per minute,as well as maximal inspiratory pressure(MIP)in groups were higher than those before treatment,which in treatment group was better in comparison with control group(P<0.05).The level of tumor necrosis factor-α(TNF-α),interleukin 6(IL-6),serum C-reactive protein(CRP)and procalcitonin(PCT)in groups were lower(P<0.05),and the decrease in treatment group was more conmmonly(P<0.05).TCM syndromes scores(cough,expectoration,wheezing,wheezing during exercise,shortness of breath,fatigue,and poor appetite and appetite)were decreased(P<0.05),and the reduction in treatment group was more significant(P<0.05).No serious adverse reactions occurred in groups.Conclusion For AECOPD patients with respiratory muscle fatigue,Maxing Drinking can effectively improve pulmonary function and blood gas analysis index,improve clinical symptoms,and has high safety.Its mechanism may be related to the improvement of inflammatory factors level of respiratory tract.