保元平喘汤联合平喘调中针刺法对无创通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的改善作用

目的观察保元平喘汤联合平喘调中针刺法对无创通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的改善作用。方法将60例AECOPD合并Ⅱ型呼吸衰竭患者随机分为2组,对照组30例予无创正压通气治疗,治疗组30例在对照组治疗基础上应用保元平喘汤联合平喘调中针刺法治疗。2组均2周为1个疗程,治疗1个疗程。观察患者临床症状、体征及不良反应;比较2组治疗前后血气分析,包括p H、氧分压p(O_2)]、二氧化碳分压p(CO_2)]、血氧饱和度(Sa O_2)、心率(HR)、呼吸频率(RR),肺功能相关指标,包括第1 s用力呼气容积(FEV_1)、FEV_1/用力肺活量(FVC)、FEV_1占预计值百分比(FEV_1%)、最大呼气中段流量(MMEF);观察2组平均通气时间、人机同步率、气管插管率及呼吸机相关并发症情况。结果治疗组临床控制率76.7%、总有效率93.3%,对照组临床控制率63.3%、总有效率86.7%,治疗组临床控制率及总有效率均高于对照组(P0.01),治疗组临床疗效优于对照组。2组治疗24、72 h p H、p(O_2)、p(CO_2)、Sa O_2、HR及RR均较本组治疗前改善(P0.05,P0.01);且治疗组治疗24、72 h上述指标较对照组治疗同期改善明显(P0.05,P0.01)。2组治疗后FEV_1、FEV_1/FVC、FEV_1%及MMEF均较本组治疗前升高(P0.05),且治疗组治疗后升高更明显(P0.05,P0.01)。治疗组平均通气时间、气管插管率均低于对照组(P0.05),人机同步率高于对照组(P0.05)。治疗组呼吸机相关并发症发生率(10.0%)低于对照组(33.3%)(P0.01)。结论保元平喘汤联合平喘调中针刺法,能改善无创通气治疗AECOPD合并Ⅱ型呼吸衰竭的疗效,减少呼吸机相关并发症,提高人机同步率,从而提高无创通气效率,降低气管插管率及无创通气时间,从而减轻患者痛苦及经济负担。

Improving effects of Origin - preserving and preventing - asthma decoction combined with preventing - asth-ma and regulating - middle energizer acupuncture on AECOPD complicated with type 2 respiratory failure during non-invasive ventilation treatment

Objective To observe the improving effects of Origin - preserving and preventing - asthma de-coction combined with preventing - asthma and regulating - middle energizer acupuncture on chronic obstructive pul-monary disease(AECOPD)complicated with type 2 respiratory failure during non - invasive ventilation treatment. Methods 60 AECOPD patients complicated with type 2 respiratory failure were randomly divided into two groups. 30 cases in control group were treated by non - invasive positive pressure ventilation treatment,and 30 cases in treat-ment group were treated by Origin - preserving and preventing - asthma decoction combined with preventing - asthma and regulating - middle energizer acupuncture on the basis of control group treatment,continuously treatment for 2 weeks. The clinical symptoms,signs and adverse reaction were observed. The blood gas analysis including p(O2 ),p (CO2 ),SaO2 ,heart rate(HR)and respiratory rate(RR),the pulmonary function related indicators including forced expiratory volume in one second(FEV1 ),FEV1 / forced vital capacity(FVC),FEV1% and maximal mid -expiratory flow(MMEF)before and after treatment were compared in two groups. The average duration of ventilation, man - machine synchronous rate,trachea cannula rate and ventilator associated complication were observed in two groups. Results The clinical control rate in treatment and control group was 76. 7% and 63. 3% respectively,and the total effective rate was 93. 3% and 86. 7% respectively. The clinical control rate and total effective rate in treatment group were superior to those in control group(P < 0. 01). The pH,p(O2 ),p(CO2 ),SaO2 ,HR and RR after 24 h and 72 h treatment were improved in two groups as com-pared with before treatment(P < 0. 05,P < 0. 01),and the improvements in treatment group were more obvious than control group at the same period(P < 0. 05,P < 0. 01). The FEV1 ,FEV1 / FVC,FEV1% and MMEF after treatment were increased in two groups(P < 0. 05),and the increase in treatment was more obvious than control group(P < 0. 05,P < 0. 01). The average duration of ventilation and trachea cannula rate after treatment in treatment group were lower than those in control group(P < 0. 05),and man - machine synchronous rate was higher(P < 0. 05). The oc-currence rate of ventilator associated complication in treatment group(10. 0% )was lower than control group(33. 3% ,P < 0. 01). Conclusion Origin - preserving and preventing - asthma decoction combined with preventing -asthma and regulating - middle energizer acupuncture can improve curative effects on the treatment of AECOPD com-plicated with type 2 respiratory failure during non - invasive ventilation treatment,reduce ventilator associated compli-cation,enhance man - machine synchronous rate,thus enhance the non - invasive ventilation efficiency and decrease trachea cannula rate and average duration of ventilation,relieve the sufferings and economical burden.