中药补中益气辅助重症慢性阻塞性肺疾病患者撤离有创正压通气的前瞻性随机对照研究  

Tonifying middle-Jiao and Qi to facilitate weaning from invasive ventilation in patients with severe chronic obstructive pulmonary disease: a prospective, randomized controlled trial

作　　者：罗祖金[1] 曹志新[1] 李倩[1] 刘思杰[1] 刘霁尘 刘翼琪 朱剑[1] 赵娜[1] 郑颖颖[1] 庞宝森[1] 马迎民[1] LUO Zu-jin CAO Zhi-xin LI Qian LIU Si-jie LIU Ji-chen LIU Yi-qi ZHU Jian ZHAO Na ZHENG Ying-ying PANG Bao-sen MA Ying-min(Department of Respiratory and Critical Care Medicine, Beo＇ing Chaoyang Hospital, Capital Medical University, Beo＇ing 100043, China)

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100043

出　　处：《中国医刊》2016年第10期30-35,共6页Chinese Journal of Medicine

基　　金：北京市中医药科技项目(JJ2011-08)

摘　　要：目的探讨在现有内科治疗基础之上,给予中医药"补中益气"辅助治疗,对改善重症慢性阻塞性肺疾病患者的有创通气(invasive positive pressure ventilation,IPPV)撤离效果及改善患者预后的作用。方法采用前瞻性随机对照研究的设计方案,将患者随机分为中药组和对照组。中药组患者鼻饲中药补中益气合剂(10ml/次,3次/日),对照组患者鼻饲温开水(10ml/次,3次/日);补中益气合剂与温开水均给予鼻饲至拔除气管插管为止。记录并比较两组患者基本情况、每天主要呼吸力学指标、进入撤机阶段前IPPV时间、IPPV撤离时间、IPPV总时间、自主呼吸试验次数、未达到撤机标准患者比例、拔管后无创通气(noninvasive positive pressure ventilation,NPPV)使用率、48小时后重新气管插管率、呼吸机相关肺炎(ventilator associated pneumonia,VAP)发生率、院内病死率、住重症监护病房(intensive care unit,ICU)时间及住院时间。结果研究期间共有60例符合研究条件的患者入选,其中中药组30例,对照组30例。在接受气管插管时,两组患者的基础情况差异无显著性。在IPPV前3天及进入撤机阶段时,两组患者最大吸气压均逐渐增加,呼吸频率均逐渐降低,潮气量均逐渐增加,浅快呼吸指数均逐渐降低,两组各项指标改善程度相似。与对照组相比,中药组有创通气撤离时间显著缩短[1.0(1.0)vs 2.0(1.8),P<0.05],自主呼吸试验需求次数显著降低[2.0(1.8)vs 3.0(1.8),P<0.05];中药组在进入撤机阶段前IPPV时间及IPPV总时间有降低趋势,但差异无显著性(P>0.05)。两组患者未达到撤机标准率、NPPV使用率、48小时后再次插管率、VAP发生率、院内病死率、住ICU时间、住院时间等医疗指标比较差异无显著性(P>0.05)。结论补中益气合剂可安全应用于辅助重症慢性阻塞性肺疾病患者的有创通气撤离,可有效改善撤机效果,并有望改善患者整体预后。Objective To assess whether tonifying middle-Jiao and Qi over conventional medical therapy is able to promote the weaning from invasive positive pressure ventilation （IPPV）, and to improve the clinical outcome in patients with severe chronic obstructive pulmonary disease （COPD）.Method A prospective, randomized controlled trial was performed, and eligible patients were randomized to tonifying middle-Jiao and Qi group or conventional medical therapy group. Patients in tonifying middle-Jiao and Qi group received tonifying middle-Jiao and Qi （10ml each time and 3 times each day）, while patients in conventional medical therapy received normal saline （10ml each time and 3 times each day）, and all patients stopped to receive when to implement extubation. Baseline characteristics, respiratory mechanic index, duration of IPPV before weaning, duration of weaning, duration of IPPV, spontaneous breathing trial （SBT） times, percentage of patients without presence of weaning criteria, percentage of noninvasive ventilation use after extubation, reintubation rate within 48 hours, incidence of ventilator associated pneumonia, in-hospital mortality, intensive care unit （ICU） mortality, ICU stay and hospital stay were recorded and compared between the two groups.Result A total of 60 patients were assigned to tonifying middle-Jiao and Qi group （30 patients） or conventional medical therapy group （30 patients）. Baseline characteristics were similar between the two groups. Maximal inspiratory pressure, respiratory rate, tidal volume and rapid shallow breathing index in the first 3 days and at weaning entry improved in both groups and did not differ between the two groups. Duration of weaning was significantly shorter [1.0（1.0） vs 2.0（1.8）,P〈0.05], and SBT times was significantly decreased [2.0（1.8） vs 3.0（1.8）,P〈0.05] in tonifying middle-Jiao and Qi group than in conventional medical therapy. Despite no significance, duration of IPPV before weaning and duration of IPPV tended to be sh

关 键 词：重症慢性阻塞性肺疾病 有创正压通气 呼吸衰竭 补中益气 中药 撤机 

分 类 号：R563.3[医药卫生—呼吸系统]