基于肺饮理论探讨运用小青龙汤加减治疗对ARDS患者呼吸力学指标的影响

Influence of Modified XiaoqinglongDecoction on Respiratory Mechanics Indicators in ARDS Patients Based on Pulmonary Fluid Retention Theory

目的探讨在肺饮理论下运用小青龙汤加减治疗急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)对患者呼吸力学指标的影响。方法选取收治的ARDS患者60例纳入研究,按随机对照原则分为西医组和中药组各30例。两组均给予内科基础治疗(抗感染、机械通气、镇静、镇痛、营养支持等),西医组在此基础上给予支气管肺泡灌洗治疗,中药组在西医组基础上加用小青龙汤加减,比较两组临床疗效及治疗前后中医症候积分、氧合指数和呼吸力学指标[气道峰压(Ppeak)、气道平台压(Pplat)、吸气阻力(RI)、呼气阻力(RE)]水平。结果中药组临床总有效率高于西医组(P<0.05);两组中医症候积分,Ppeak、Pplat、RI、RE水平明显低于治疗前(P<0.05),且中药组显著低于对照组(P<0.05);两组氧合指数明显高于治疗前(P<0.05),且中药组显著高于对照组(P<0.05)。结论小青龙汤加减治疗ARDS,可有效改善患者症状,提高临床治疗效果和氧合指数,并有助于改善患者呼吸力学指标水平。

Objectives To explore the influence of modified Xiaoqinglong decoction on respiratory mechanics indicators in patients with acute respiratory distress syndrome(ARDS)under pulmonary fluid retention theory.Methods A total of 60 patients with ARDS admitted to and treated in department of pulmonary diseases of our hospital were selected and randomly divided into western medicine group and traditional Chinese medicine group,with 30 cases in each group.Both groups were given basic medical treatment(anti-infection,mechanical ventilation,sedation,analgesia,nutritional support,etc.).The western medicine group was treated with bronchoalveolar lavage,while the traditional Chinese medicine group was treated with modified Xiaoqinglong decoction on this basis.The clinical efficacy and TCM symptom scores,oxygenation index and respiratory mechanics indicators[peak airway pressure(Ppeak),airway platform pressure(Pplat),inspiratory resistance(RI),expiratory resistance(RE)]before and after treatment were recorded and compared between the two groups.Results The total clinical effective rate in traditional Chinese medicine group was significantly higher than that in western medicine group(P<0.05).After treatment,the TCM symptom score,Ppeak,Pplat,RI and RE in the two groups were significantly decreased(P<0.05),and the decreases were greater in traditional Chinese medicine group(P<0.05).The oxygenation index was increased significantly in both groups(P<0.05),and the increase in traditional Chinese medicine group was significantly greater(P<0.05).Conclusions ModifiedXiaoqinglong decoction can effectively improve the symptoms of patients,enhance the clinical treatment effect and oxygenation index,and help to improve the respiratory mechanics indicators in the treatment of ARDS patients.