纳肾降肺平喘汤联合无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的临床观察

Clinical Observation of Nashen Jiangfei Pingchuan Decoction Combined with Non-invasive Ventilator in the Treatment of COPD Complicated with Respiratory Failure

目的观察纳肾降肺平喘汤联合无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭(痰浊阻肺、肾不纳气证)的临床疗效及治疗期间不良反应发生率。方法64例患者随机分为两组各32例。对照组采用西医常规治疗,治疗组在对照组基础上加用纳肾降肺平喘汤治疗。治疗7 d后,比较两组临床疗效、治疗前后中医主症状积分并观察两组动脉血气氧分压(PO_(2))、二氧化碳分压(PCO_(2))、氧合指数(PO_(2)/FiO_(2))、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、机械通气时间、撤机失败率、入住ICU时间等指标及治疗期间腹胀、纳差、不寐不良反应发生率。结果治疗组总有效率为93.75%,高于对照组的81.25%(P<0.05);两组治疗前后比较,治疗后中医主症状积分、动脉血气PCO_(2)、APACHEⅡ评分均明显下降,血气分析PO_(2)、PO_(2)/FiO_(2)均明显升高,且治疗组优于对照组(P<0.05);治疗组使用呼吸机通气时间、入住ICU时间、撤机失败率均较对照组减少(P<0.05);治疗期间腹胀、纳差、不寐不良反应发生率:治疗组为15.62%,低于对照组的40.62%(P<0.05)。结论纳肾降肺平喘汤联合无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭(痰浊阻肺、肾不纳气证),可有效改善患者临床症状及肺氧合指标、缩短呼吸机使用时间及入住ICU时间,安全性高。

Objective:To explore the clinical efficacy and incidence of adverse reactions of Nashen Jiangfei Pingchuan Decoction combined with non-invasive ventilator in the treatment of chronic obstructive pulmonary disease(COPD)complicated with respiratory failure(syndrome of turbid phlegm obstructing lung and syndrome of deficiency of kidney failing to control respiring qi).Methods:64 patients were randomly divided into two groups of 32 each.The control group received conventional western medical treatment,while the treatment group received additional treatment with Nashen Jiangfei Pingchuan Decoction on top of the conventional treatment.After 7 days of treatment,the clinical efficacy and the scores for main TCM symptoms were compared between the two groups.Observations were made on arterial blood gas oxygen partial pressure(PO_(2)),carbon dioxide partial pressure(PCO_(2)),oxygenation index(PO_(2)/FiO_(2)),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,mechanical ventilation time,extubation failure rate,ICU stay duration,and the incidence of adverse reactions such as abdominal distension,poor appetite,and insomnia during the treatment period.Results:The overall effective rate in the treatment group was 93.75%,which was higher than the 81.25%in the control group(P<0.05).After treatment,the scores for main TCM symptoms,PCO_(2),and APACHEⅡscore decreased significantly,while PO_(2) and PO_(2)/FiO_(2) increased significantly in both groups,with the treatment group showing better improvement(P<0.05).The treatment group had shorter mechanical ventilation time,ICU stay duration,and lower extubation failure rate compared to the control group(P<0.05).During the treatment period,the incidence of adverse reactions such as abdominal distension,poor appetite,and insomnia was 15.62%in the treatment group,which was lower than the 40.62%in the control group(P<0.05).Conclusion:The combination of Nashen Jiangfei Pingchuan Decoction and non-invasive ventilator therapy for COPD complicated with respiratory failure(syndrome of turbid phlegm obstructing lung and syndrome of deficiency of kidney failing to control respiring qi)can effectively improve clinical symptoms and lung oxygenation indicators,shorten the duration of ventilator use and ICU stay,and has high safety,which is worthy of clinical promotion and application.