百合固金汤合生脉散辨治呼吸机相关性肺炎肺肾阴虚证疗效观察

目的:观察百合固金汤合生脉散化裁联合亚胺培南西司他丁钠治疗呼吸机相关性肺炎(ventilator associated pneumo-nia,VAP)的临床疗效.方法:选择泰安市中医医院重症医学科呼吸机相关性肺炎患者120例,随机分为对照组和观察组各60例.对照组患者给予亚胺培南西司他丁钠静脉滴注,观察组在对照组治疗的...

Observation of the Efficacy Curative Effect of Lily Bulb Metal-Securing Decoction Combined with Pulse-Engendering Powder on Ventilator Associated Pneumonia with Lung-Kidney Yin Deficiency Syndrome

Objective:To observe the clinical curative effect of Lily Bulb Metal-Securing Decoction combined with Modified Pulse-Engendering Powder and imipenem cilastatin sodium on ventilator associated pneumonia(VAP).Methods:A total of 120 patients with VAP in Department of Critical Medicine of critical medicine of Tai′an Hospital of Traditional Chinese Medicine were randomly divided into the control group and the observation group,with 60 cases in each group.The control group was given imipenem cilastatin sodium intravenously,while the observation group was given Lily Bulb Metal-Securing Decoction combined with Modified Pulse-Engendering Powder for nasal feeding on the basis of the treatment of the control group.The changes of the effective rate,hospitalization time,mechanical ventilation time,APACHE score,clinical pulmonary infection score(CPIS),respiratory mechanical parameters and arterial blood gas indexes,serum related factors of the two groups were compared.Results:The effective rate was 73.33%in the control group and 88.33%in the observation group.There was significant difference between the two groups(P<0.05).The hospitalization time and mechanical ventilation time of the observation group were significantly shorter than that of the control group,and the difference was statistically significant.APACHE score and CPIS score in the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=15.444,8.581,P<0.05).After treatment,the respiratory mechanics indexes of the two groups were improved.Compared with those before treatment,the differences were statistically significant(P<0.05);there were also statistically significant differences between the two groups(P<0.05).After treatment,the partial pressure of oxygen(PaO₂)increased,the partial pressure of carbon dioxide(PaCO₂)decreased,and the partial pressure of oxygen/oxygen assistance(PaO₂/FiO₂)increased in the two groups(P<0.05).Compared with those before treatment,the differences were statistically significant(P<0.05);there were also statistically significant differences between the two groups(P<0.05).After treatment,the concentration of procalcitonin(PCT),the levels of procalcitonin(pro-ADM),soluble myeloid cell trigger receptor-1(sTREM-1)and C-reactive protein(CRP)all decreased significantly.Compared with those before treatment,the differences were statistically significant(P<0.05);there were also statistically significant differences between the two groups(P<0.05).Conclusion:Lily Bulb Metal-Securing Decoction combined with Modified Pulse-Engendering Powder and imipenem cilastatin sodium in the treatment of VAP can shorten the course of disease and reduce the time of mechanical ventilation.The mechanism may be related to improving respiratory mechanical parameters,and arterial blood gas indexes and inhibiting the expressions of PCT,pro-ADM,sTREM-1 and CRP in serum.