二术清解方联合纤维支气管镜肺泡灌洗治疗急性呼吸窘迫综合征机械通气的临床观察

Clinical Efficacy of Erzhu Qingjie Decoction Combined with Fiber Bronchoalveolar Lavage in the Treatment of Acute Respiratory Distress Syndrome Patients with Mechanical Ventilation

目的 观察二术清解方联合纤维支气管镜肺泡灌洗治疗急性呼吸窘迫综合征机械通气患者临床疗效并探讨其作用机制。方法 90例患者采用随机数字表法分为二术清解方组与对照组各45例。对照组采用内科常规治疗及纤维支气管镜肺泡灌洗,二术清解方组在对照组基础上采用二术清解方治疗,两组均治疗14 d。比较两组治疗前后临床症状评分、炎症指标水平、急性生理与慢性健康量表(APACHEⅡ)评分、全身炎症反应综合征(SIRS)评分、支气管肺泡灌洗液中中性粒细胞、巨噬细胞数及预后相关指标。结果 两组治疗后降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平较治疗前均降低(P <0.05),且二术清解方组PCT、IL-6、CRP水平均低于对照组(均P <0.05)。两组治疗后APACHEⅡ、SIRS评分较治疗前均降低(P <0.05),且二术清解方组APACHEⅡ、SIRS评分均低于对照组(均P <0.05)。两组治疗后喘息、气促、胸闷、咳嗽咯痰评分较治疗前均降低(P <0.05),且二术清解方组喘息、气促、胸闷、咳嗽咯痰评分均低于对照组(均P <0.05)。两组治疗后细胞总数、中性粒细胞数及巨噬细胞数较治疗前均改善(均P <0.05),且二术清解方组细胞总数、中性粒细胞数及巨噬细胞数改善均优于对照组(P <0.05)。二术清解方组机械通气时间、ICU住院天数、总住院时间均低于对照组(均P <0.05),气管切开及死亡率明显降低,但差异无统计学意义(P> 0.05)。两组治疗期间均未发生不良反应。结论 二术清解方联合纤维支气管镜肺泡灌洗能改善ARDS患者临床症状,降低炎症指标水平,降低肺泡灌洗液中中性粒细胞数目,增加巨噬细胞数,改善患者的预后。

Objective:To observe the clinical efficacy of Erzhu Qingjie Decoction combined with fiber bronchoal-veolar lavage in the treatment of acute respiratory distress syndrome(ARDS)patients with mechanical ventilation.Methods:A total of 90 patients with ARDS were randomly divided into the treatment group and control group,45 cases in each group.The control group was treated with conventional medical treatment and fiber bronchoscopic al-veolar lavage,and the treatment group was treated with Erzhu Qingjie Decoction on the basis of the control group.Both groups were treated for 14 days.The clinical symptom score,inflammation index level,APACHE II score,SIRS score,the number of neutrophils and macrophages in bronchoalveolar lavage fluid and prognostic indexes were compared between the two groups before and after treatment.Results:The levels of PCT,IL-6 and CRP in both groups were lower than those before treatment(P<0.05),and the levels of PCT,IL-6 and CRP in the treat-ment group were lower than those in the control group(all P<0.05).The scores of APACHE II and SIRS were low-er than those before treatment(P<0.05)in both groups,and the scores of APACHE II and SIRS in the treatment group were lower than those in the control group(both P<0.05).The scores of wheezing,shortness of breath,chest tightness,cough and sputum production after treatment were lower in both groups than before treatment(P<0.05),and the scores of wheezing,shortness of breath,chest tightness,cough and sputum production in the treatment group were lower than those in the control group(all P<0.05).The total number of cells,neutrophils and macro-phages in both groups decreased compared with those before treatment(all P<0.05),and the total number of cells,neutrophils and macrophages in the treatment group were lower than those in the control group(P<0.05).The du-ration of mechanical ventilation,the number of days of ICU hospitalization and the total length of stay in the treat-ment group were lower than those in the control group(all P<0.05),and the tracheostomy and mortality were sig-nificantly reduced,but the difference was not statistically significant(P>0.05).There were no adverse effects dur-ing either group of treatments.Conclusion:Erzhu Qingjie Decoction combined with fiber bronchoscopic alveolar lavage can improve the clinical symptoms of ARDS patients,reduce the level of inflammatory indicators,reduce the number of neutrophils in alveolar lavage fluid,increase the number of macrophages,and improve the prognosis of patients.