潜阳丹加半夏汤干预需无创通气危重慢阻肺甲状腺素水平低下患者临床研究

Study of the Efect of Qianyang Pellet Plus Pinelia Decoction in Patients With Low Thyroxine Levels in Critical Severe Chronic Obstructive Pulmonary Disease Requiring Non-invasive Ventilation

目的:探讨潜阳丹加半夏汤干预需无创机械通气治疗的危重慢性阻塞性肺疾病甲状腺素水平低下患者的疗效安全性及作用机制。方法:将60例慢性阻塞性肺疾病急性发作合并Ⅱ型呼吸衰竭且甲状腺素水平低下的患者随机分为两组,治疗组给予无创机械通气及常规治疗的基础上使用潜阳丹加半夏汤加减,对照组给予无创机械通气及西医常规治疗,14 d后评定疗效。治疗前后采集标本进行常规及甲状腺功能检测,给与APACHE Ⅱ评分及中医证候评分。结果:两组治疗后治疗组疗效优于对照组(P<0.05),治疗后两组患者的PaO2及pH水平上升高于本组治疗前,PaCO2均低于本组治疗前,且观察组改善程度优于对照组,差异均具有统计学意义(P<0.05)。两组经治疗APACHE Ⅱ评分及中医总证候评分均减低,中药治疗组优于西医对照组,差异具有统计学意义(P<0.01)。两组经治疗对照组治疗前后FT3、TT3、TT4水平上升差异具有统计学意义(P<0.05),治疗组治疗前后FT3、FT4、TT3、TT4水平比较差异具有统计学意义且治疗组优于对照组(P<0.05)。结论:潜阳丹加半夏汤加减可有效改善需无创机械通气的危重慢阻肺急性发作并Ⅱ型呼吸衰竭且甲状腺素水平低下的患者病情及中医证候,改善缺氧及二氧化碳潴留,通过调整下丘脑-垂体-甲状腺轴的状态提高了甲状腺激素水平,临床使用安全有效。

Objective:To explore clinical efficacy,safety and mechanism of Qianyang pellet plus Pinelia decoction in patients with low thyroxine levels in critical chronic obstructive pulmonary disease requiring non-invasive mechanical ventilation.Methods:A total of 60 severe AECOPD patients with typeⅡrespiratory failure and low thyroxine levels were randomly divided into two groups.The treatment group was given non-invasive mechanical ventilation and conventional treatment based on the use of modified Qianyang pellet plus Pinelia decoction.The control group was given non-invasive mechanical ventilation and conventional Western medicine treatment.The clinical efficacy was observed after 14 day treatment.The specimen was collected before and after treatment to detect routine indicators and thyroid function,APACHEⅡscore and TCM syndrome score.Results:The treatment group had better therapeutic efficacy than the control group after treatment(P<0.05).After treatment,both groups had higher PaO2 and pH values,whereas lower PaCO2 than treatment before,and the treatment group improved more significantly than the control group,which showed significant between-group differences(P<0.05).The two groups had lower APACHEⅡscore and the total TCM score.The treatment group was better than the control group,and the difference was statistically significant(P<0.01).The elevated levels of FT3,TT3 and TT4 in the two groups were statistically significant(P<0.05).The comparison of FT3,FT 4,TT3 and TT4 before and after treatment in the treatment group was statistically significant and the treatment group was superior to the control group(P<0.05).Conclusion:The addition and subtraction of modified Qianyang pellet plus Pinelia decoction can effectively improve the condition and Chinese medicine syndrome of severe AECOPD patients with respiratory failure and low thyroxine levels requiring non-invasive mechanical ventilation.It can improve hypoxia and carbon dioxide retention,increase thyroid hormone levels by adjusting the state of the hypothalamus-pituitary-thyroid axis.This research is safe and effective.