通腑消积汤治疗呼吸衰竭患者腑气不通证的临床研究

吕鹭萍

【摘要】 目的：研究自擬通腑消积汤治疗肺部感染并发呼吸衰竭应用机械通气患者腑气不通证的临床效果。方法：选取2015年6月-2018年5月厦门市海沧医院重症医学科收治的74例应用有创机械通气的肺部感染并发呼吸衰竭患者，按照随机数字法将患者分为观察组和对照组，各37例。两组均给予抗感染、化痰、平喘、抑酸、维持水电解质及酸碱平衡、营养支持治疗，在此基础上，观察组加服通腑消积汤3 d，对照组则加服乳果糖口服溶液3 d。除外4例自动出院患者，比较两组患者进入ICU和转出ICU时的血气分析、机械通气时间与ICU住院时间、中医证候积分等指标。结果：两组转出ICU时的PO2均较进入ICU时显著改善，差异均有统计学意义（P<0.01）;观察组转出ICU时的PO2较对照组有显著提高，差异有统计学意义（P<0.01）。转出ICU时，两组的中医证候积分均明显低于进入ICU时，且观察组的中医证候积分明显低于对照组，差异均有统计学意义（P<0.01）。观察组的中医证候疗效明显优于对照组，差异有统计学意义（P<0.01）。结论：通腑消积汤治疗肺部感染并发呼吸衰竭的机械通气患者腑气不通证的效果优于乳果糖口服溶液，不仅能改善动脉血氧分压，还能缩短机械通气时间及ICU住院时间。

【关键词】 通腑消积汤; 呼吸衰竭; 机械通气; 腑气不通证

【Abstract】 Objective：To study Tongfuxiaoji Decoction in treating pulmonary infection with respiratory failure patients use mechanical ventilation with Fuqibutong Syndrome about the clinical efficacy.Method：From June 2015 to May 2018，74 cases of pulmonary infection complicated with respiratory failure treated by invasive mechanical ventilation in the ICU department of Xiamen Haicang Hospital were selected，according to the random number method，the patients were divided into observation group and control group，37 cases in each group.Both groups were treated with anti-infection，phlegm resolving，asthma relieving，acid suppressing，water electrolyte maintaining and acid-base balance，and nutritional support，on this basis，the observation group was given Tongfuxiaoji Decoction for 3 days，while the control group was given Lactulose Oral Solution for 3 days.In addition to 4 patients were discharged automatically，and blood gas analysis，mechanical ventilation time，ICU hospitalization time，TCM syndrome score and other indicators were compared between the two groups when they entered and transferred out of ICU.Result：PO2 was significantly improved after ICU transfer in both groups compared with that after ICU entry，the differences were statistically significant（P<0.01）.PO2 was significantly increased in the observation group after ICU transfer compared with the control group，the difference was statistically significant（P<0.01）.When transferred out of the ICU，the TCM syndrome score of both groups were significantly lower than those when entering the ICU，and the TCM syndrome score of the observation group was significantly lower than that of the control group，with statistically significant differences（P<0.01）.The effect of TCM syndromes in the observation group was significantly better than that in the control group，the difference was statistically significant（P<0.01）.Conclusion：The efficacy of Tongfuxiaoji Decoction in the treatment of pulmonary infection with respiratory failure patients with mechanical ventilation is better than use Lactulose，it can not only improve arterial oxygen pressure，but also shorten the time of mechanical ventilation and the time of ICU residence.

【Key words】 Tongfuxiaoji Decoction; Respiratory Failure; Mechanical Ventilation; Fuqibutong Syndrome

First-authors address：Xiamen Haicang Hospital，Xiamen 361026，China

doi：10.3969/j.issn.1674-4985.2019.08.019

呼吸衰竭是重症医学科临床工作中极为常见的一组临床综合征，诊断依赖于动脉血气分析。呼吸衰竭患者由肺内外各种原因导致严重的肺通气功能和/或肺换气功能障碍，在海平面大气压、静息状态下呼吸空气时发生低氧血症，或伴有高碳酸血症。我国目前尚缺乏病例统计数据，据美国报道称每年呼吸衰竭患者约有36万例，仅住院期间死亡率就高达36%[1]。呼吸衰竭患者病情危重，并发症多，诊疗费用高，治疗难度大，导致社会及家庭的经济负担沉重。肺部感染包括终末支气管、肺泡及肺间质在内的肺实质炎症[2]，是引发呼吸衰竭的常见病因之一，包括了Ⅰ型呼吸衰竭和Ⅱ型呼吸衰竭，治疗难度大，严重者须使用有创机械通气，其中高龄患者容易出现呼吸机依赖。……