清肺涤痰汤联合亚胺培南西司他丁钠治疗急诊呼吸机相关性肺炎临床观察

Clinical Observation on Qingfei Ditian Decoction Combined with Imipenem and Cilastatin Sodium in the Treatment of Emergency Ventilator-associated Pneumonia

目的探讨清肺涤痰汤鼻饲联合亚胺培南西司他丁钠治疗急诊呼吸机相关性肺炎的临床效果,分析其对患者炎症状态、肺功能、血气指标的影响。方法将114例急诊呼吸机相关性肺炎患者按照随机数字表法分为对照组和观察组各57例。对照组患者给予注射用亚胺培南西司他丁钠静脉滴注,观察组在对照组基础上加用清肺涤痰汤鼻饲治疗,比较2组治疗前后的临床效果、临床肺部感染评分(CPIS评分)、APACHE评分、炎症状态指标、血气指标、呼吸力学指标变化。结果与观察组87.72%的总有效率相比,对照组的总有效率71.93%显著降低,差异有统计学意义(χ^(2)=4.412,P <0.05);与对照组相比,观察组治疗后的CPIS评分、APACHE评分均显著降低,血清中炎症状态相关指标CRP、MIP-2、PCT均下降更明显,血气指标PaO_(2)水平显著升高,PaCO_(2)水平显著降低,呼吸力学指标Raw水平显著降低,Cdyn水平显著升高,差异有统计学意义(P <0.05)。结论清肺涤痰汤鼻饲联合亚胺培南西司他丁钠治疗急诊呼吸机相关性肺炎在控制肺部感染、抗菌、改善血气指标、呼吸力学指标等方面有确切疗效,值得推广。

Objective To investigate the clinical effect of Qingfei Ditan decoction combined with imipenem and cilastatin sodium in the treatment of emergency ventilator-associated pneumonia,and to analyze the effects on the inflammatory state,lung function and blood gas index of the patients. Methods 114 emergency ventilator-associated pneumonia patients were divided into control group( n = 57) and observation group( n = 57) according to random number table method. The control group was given imipen-cilsttin sodium for injection,and the observation group was given nasal feeding with Qingfei Ditian decoction on the basis of the control group. The clinical effects,clinical pulmonary infection score( CPIS score),APACHEA score,inflammatory state indexes,blood gas indexes,respiratory dynamics indexes before and after treatment were compared between the two groups. Results The effective rate of the control group was 71. 93% which was significantly lower than 87. 72% of the observation group,and the difference was statistically significant( χ^(2)= 4. 412,P < 0. 05). Compared with the control group,after treatment,the CPIS score and APACH score in the observation group were significantly decreased,the serum inflammatory state related indexes CRP,MIP-2 and PCT were significantly decreased,the blood gas index PaO_(2)level was significantly increased,the PaCO_(2)level was significantly decreased,the respiratory mechanics index RAW level was significantly decreased,and the Cdyn level was significantly increased,the difference was statistically significant( P < 0. 05). Conclusion Nasal feeding with Qingfei Ditian decoction combined with imipenem and cilastatin sodium in the treatment of emergency ventilators-associated pneumonia has definite effect in controlling pulmonary infection,anti-inflammatory,improving blood gas index and respiratory mechanical index,which is worthy of promotion.