中药灌肠联合无创通气治疗COPD急性加重期呼吸衰竭

观察中药灌肠联合无创通气治疗慢性阻塞性肺疾病（COPD）急性加重期呼吸衰竭患者的临床疗效.将符合诊断标准的COPD急性加重期呼吸衰竭患者随机分为2组,治疗组28例,对照组26例.2组均采用无创通气及西医常规方法治疗,治疗组则增加中药“加味大承气汤”保留灌肠.结果：2组在肺部感染控制窗出现时心率及呼吸、血气分析等呼吸指标皆较治疗前显著改善（P＜0.05）,但组间差异无显著性（P＞0.05）.治疗组无创通气过程中的最高PS及PEEP较对照组低（P＜0.01,P＜0.05）;肺部感染控制窗出现时间较对照组早（P＜0.01）,机械通气时间较对照组缩短（P＜0.05）;治疗组无创通气后腹胀及误吸发生率明显低于对照组（P＜0.01,P＜0.05）.治疗组呼吸机相关性肺炎的发生率较对照组低、撤机成功率增高（P＜0.05）,气管插管率、死亡率的差异无显著性（P＞0.05）.结论：中医通下法治疗可提高无创通气的通气效率,较快控制肺部感染,减少机械通气时间,显著减少无创通气的副作用,并可能有效减低并发症的发生,提高撤机率.

TCM Clyster Combined with Non-invasive Ventilation in Treating for Respiratory Failure in Acute Exacerbations of COPD

To observe the effects of TCM clyster combined with non-invasive ventilation(NIV) on gas exchange and patients' transformation in the duration of ventilation,the reintubation rate,the rate of ventilation-associated pneumonia,and evaluate their clinical value.54 patients who received routine treatment were randomly divided into study group(28 cases,treated by TCM clyster combined with NIV) and control group(26 cases,treated by NIV).Result: Arterial blood pH,PaCO_(2),and heart rate were markedly ameliorated at the time pulmonary infection had been significantly controlled in both groups after treatment(P<0.05),but there was no difference bewteen two groups.Compared with the control group,the highest PS and PEEP in study group were markedly reduced(P<0.01,P<0.05),the time of pulmonary infection control arised markedly earlier(P<0.01),the duration of ventilation was significantly shorter(P<0.05),and the incidence of side effect of NIV reduced markedly(P<0.05),the incidence of VAP was lower,the wean rate from ventilation raised(P<0.05).There was no significant difference in reintubation rate and death rate between two groups(P>0.05).Conclusion: This therapy could get the pulmonary infection controlled more quickly,it can reduce the duration of ventilation,the rate of side effect of NIV,the incidence of VAP,and raise the wean rate from ventilation.TCM clyster combined with NIV is a consummate ventilation project,it is definitely valuable for respiratory failure in acute exacerbations of COPD.