中医调肠法配合无创通气治疗AECOPD呼吸衰竭的临床研究

目的观察中医调肠法配合无创通气治疗对慢性阻塞性肺病急性加重期(acute exacerbations ofchronic obstructive pulmonary disease,AECOPD)呼吸衰竭(简称呼衰)患者的免疫功能影响及调肠法对无创通气并发症的作用。方法将AECOPD合并呼衰患者随机分为两组,每组各30例。两组均使用双水平无创正压通气(Bi-level positive airway pressure ventilation,BiPAP)及常规药物治疗,治疗组则在以上治疗基础上予中医调肠法(电针双侧足三里、上巨虚、丰隆、曲池穴,中药"宣白大承气汤"灌肠)。动态观察两组患者的营养指标(TP、ALB、HGB)、免疫指标(IgG、IgA、IgM、C3、C4、CH50、CD3、CD4、CD8、CD4/CD8)、通气指标(最高PS和PEEP、无创通气时间)及无创通气并发症的发生率。结果两组治疗后血清总蛋白(TP)、血红蛋白(HGB)均较治疗前下降(P0.05,P0.01),对照组治疗后血清白蛋白(ALB)较治疗前下降(P0.05);与对照组比较,治疗组TP、ALB水平有统计学意义(P0.05,P0.01),HGB水平则无统计学意义。两组治疗后IgG、IgA、CD3、CD4、CD4/CD8均较治疗前升高(P0.05,P0.01);与对照组比较,治疗组治疗后的IgG、IgA、CD3、CD4、CD4/CD8水平高于对照组(P0.05,P0.01)。对照组治疗后腹胀发生率较治疗前明显增加(P0.01),而治疗组腹胀、嗳气及误吸发生率明显低于对照组(P0.05,P0.01);治疗组可有效降低无创通气过程中的最高PS和PEEP,减少机械通气时间(P0.05)。结论中医调肠法有助于改善AECOPD呼衰无创通气患者的营养状况,增强机体免疫功能,并可提高无创通气效率,减少机械通气时间,显著减少无创通气腹胀、嗳气、误吸等并发症的发生。

Effect of Chinese Medicine Intestine Adjusting Therapy on Patients with Respiratory Failure Caused by Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Undergoing Noninvasive Ventilation

Objective To observe the effect of Chinese medicine intestine adjusting therapy（IAT） on pa-tients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and undergoing noninvasive ventilation,their immune function,ventilation indices and incidence of complication.Methods Patients matched with the inclusive criteria were randomized into two groups,30 in each group.All re-ceived bi-level positive airway pressure ventilation and conventional drug therapy,but to patients in the treatment group,IAT was applied additionally by electro-acupuncturing（EA） acupoints Zusanli（ST36 ）,Shangjuxu（ST37）,Fenglong（ST40）,and Quchi（LI11）,also the retention enema with Xuanbai Dachengqi Decoction.The nutritional indicators,including serum total protein（TP）,serum albumin（ALB） and hemoglobin（HGB）;immune indices,including immuno-globulins（IgG,IgA,IgM）,complements,and T-lymphocyte subsets;and the incidence of ventilation complications in the two groups were dynamically observed and compared.Result-s After treatment,the nutritional indicators went down in both groups（P 0.05,P 0.01）,but the lowering in the treatment group were lesser.Moreover,the treatment group showed a higher TP level（P 0.05） and lower depressive amplitude of ALB（P 0.01） than those in the control group.Immune indices,excepting IgM,in-creased significantly in both groups（P 0.05 or P 0.01）,but the increments in the treatment group were high-er,so significant difference was shown between groups（P 0.05 or P 0.01） .As for comparison in ventilationcomplication,the incidence of abdominal distension（which was extensively occurred in the control group）,belc-hing and error aspiration in the treatment were significantly fewer（P 0.05,P 0.01） .Besides,the maximum PS and PEEP,and the mechanical ventilation time were significantly reduced in the treatment group（P 0.05） .Conclusion IAT of Chinese medicine is facilitated to improve the nutritional status of AECOPD patients with re-spiratory failure undergoing noninvasive ventilation,enhance their immune function,improve the ventilatory effi-ciency,reduce the duration of mechanical ventilation and the occurrence of complications.