续命汤加附子辅助治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭并发肺性脑病的临床疗效观察

Clinical Observation of Xuming Decoction Plus Monkshood on Aucte Exacerbation of Chronic Obstructive Pulmonary Disease with Respiratory Failure and Palmonary Ercephalopathy

目的观察《古今录验》续命汤加附子辅助治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭并发肺性脑病(PE)的临床疗效。方法将60例AECOPD合并呼吸衰竭及PE患者均分为两组,对照组常规治疗+双水平无创呼吸机辅助呼吸,观察组此基础上加服续命汤加附子。治疗2周后比较两组的疗效、中医症候积分、咳嗽咳痰情况、通气功能和GCS评分及相关生理和血清指标。结果治疗后,观察组总有效率、PaO_(2)、FEV1/FVC、FEV1、PCF、GCS、MMSE评分高于对照组(P<0.05),中医证候积分、HR、MAP、PH、PaCO_(2)、咳痰量、APACHEⅡ评分、S-100β、NSE、TNF-α、1L-8、1L-6、气管插管率、住院病死率低于对照组(P<0.05),肝肾功能指标比较差异无统计学意义(P>0.05)。结论续命汤加附子辅助治疗AECOPD合并呼吸衰竭并发PE患者疗效显著,可有效改善患者的血气分析指标,安全性较高。

Objective To observe the clinical effect of Xuming decoction with Fuzi in the adjuvant treatment of Aucte Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD) complicated with respiratory failure and Pulmonary Encephalopathy(PE).Methods 60 patients with AECOPD complicated by respiratory failure and pulmonary encephalopathy were divided into 2 groups.The control group received conventional treatment plus bilevel positive airway pressure ventilation,while the treatment group received Xuming decoction with Fuzi in addition to the treatment in the control group.After two weeks of treatment,the therapeutic effects,TCM symptom score,cough and sputum status,ventilatory function,Glasgow Coma Scale(GCS),and related physiological and serum indicators were compared between the two groups.Results After treatment,the total effective rate,PaO_2,FEV1/FVC,FEV1,PCF,GCS and MMSE scores were higher in the treatment group than in the control group(P <0.05),while the TCM symptom score,HR,MAP,PH,PaCO_2,sputum volume,APACHE II score,s-100β,NSE,TNF-α,IL-8,IL-6,tracheal intubation rate,and hospital mortality rate were lower in the treatment group than in the control group(P<0.05).There was no statistically significant difference in hepatic and renal function indicators(P >0.05).Conclusion Xuming decoction with Fuzi as an adjuvant treatment for AECOPD patients with respiratory failure and pulmonary encephalopathy has a significant therapeutic effect,which can effectively improve the patient's blood gas analysis indicators and is relatively safe.