清热化痰通腑法防治高血压脑出血术后继发性肺部感染的临床观察

目的探讨清热化痰通腑法防治高血压脑出血术后继发性肺部感染的临床疗效。方法将高血压脑出血（出血量〉30 mL）急诊行开颅血肿清除手术或钻孔置管血肿引流术后出现肺部感染患者162例,随机分为观察组82例和对照组80例,观察组予以鼻饲清热化痰通腑中药（千金苇茎汤合大承气汤加减）治疗,对照组予以鼻饲安慰剂处理。根据病情轻重,分别采用气管切开术,重型肺炎者使用支纤镜下肺泡灌洗,并结合痰培养结果使用敏感抗生素防治感染。治疗4周后观察两组患者气管切开例数、重型肺炎肺泡灌洗例数、咳痰消失时间和发热缓解时间及治疗总有效率。结果治疗后观察组气管切开例数和肺泡灌洗例数均显著低于对照组（P〈0.05）,咳痰消失时间、发热缓解时间均显著短于对照组（P〈0.05）,临床治疗总有效率显著高于对照组（P〈0.01）。结论采用清热化痰通腑法能有效防治高血压脑出血术后继发性肺部感染,减轻临床症状,改善患者临床预后。

Clinical Observation on the Treatment of Clearing Heat and Resolving Phlegm and Tongfu with Secondary Pulmonary Infection after Operation of Hypertensive Cerebral Hemorrhage

Objective To observe the clinical effect of the treatment of resolving phlegm and Tongfu on secondary pulmonary infection clearing heat and after operation of hypertensive cerebral hemorrhage. Method Selecting hospitalized patients after operation of hypertensive cerebral hemorrhage from January 2007 to June 2013, cerebral hemorrhage were at least 30 mL, emergency craniotomy hematoma removal operation or drilling drainage of hematoma, postoperative patients with pulmonary infection. According to infection severity, respectively tracheotomy, severe pneumonia using branch a fiberoptic bronchoscope lavage, combined with theresults of sputum culture with antibiotics to prevent infection. There were 162 cases after operation of cerebral hemorrhage patients with pulmonary infection. They were randomly divided into treatment group and control group. Treatment group was given nasal feeding of traditional Chinese medicine of clearing heat and resolving phlegm and Tongfu （Qianjin Weijing Decoction and Dachengqi Decoction）, control group was given nasal placebo treatment. After 4 weeks treatment, something were observed in patients with tracheotomy cases of severe pneumonia cases, bronchoalveolar lavage, control time of clinical symptom, fever relief average time and the total efficiency of treatment. Results The pulmonary infection of patients with hypertensive cerebral hemorrhage by the treatment of clearing heat and resolving phlegm and Tongfu, the number of cases of tracheotomy and bronchoalveolar lavage were significantly lower than in control group （P〈0.01）; Clinical symptoms such as cough disappeared time, average heat release time was significantly lower than the patients in the control group（P〈0.05）. The clinical total effective rate of treatment was significantly higher than control group（P〈0.01）. Conclusion The treatment of clearing heat and resolving phlegm and Tongfu was significantly effective on secondary pulmonary infection after operation of hypertensive cerebral hemorrhage, and can r