涤痰汤联合常规疗法治疗慢性阻塞性肺疾病合并呼吸衰竭随机平行对照研究  

Treatment of Chronic Obstructive Pulmonary Disease with Respiratory Failure Randomized Parallel Controlled Study

作　　者：高玉祥[1] 

机构地区：[1]江苏省如东县中医院肺病科,江苏如东226400

出　　处：《实用中医内科杂志》2017年第10期61-64,共4页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：[目的]观察涤痰汤联合常规疗法治疗慢性阻塞性肺疾病合并呼吸衰竭疗效。[方法]使用随机平行对照方法,将60例住患者按病志号抽签方法简单随机分为两组。对照组30常规疗法。以胃管留置、深静脉置管留置。一般措施:气管插管,进行机械通气,痰甚者予以派痰机辅助排痰,气道护理、吸痰;根据病情变化调整呼吸机参数,根据患者病情及呼吸机参数决定是否脱机拔管;抗感染治疗:根据痰培养及药敏试验结果选用敏感抗生素;解痉平喘化痰:根据病情酌情选用氨茶碱、β2-受体兴奋剂、激素、氨溴索等;营养支持:保持充足营养及能量供应,但避免糖类过多,适当增加脂肪与蛋白质摄入;并发症处理:脑水肿:予以甘露醇、甘油、速尿等脱水、利尿治疗,应激性溃疡(上消化道出血):予以抑酸、止血处理,酸碱失衡:予以代酸、代碱、呼酸、呼碱等处理,电解质紊乱:积极调整电解质平衡。治疗组30例涤痰汤:半夏制、胆南星各10g,茯苓15g,竹茹、橘红、枳实炒各10g,石菖蒲15g,人参6g,丹参、川芎各10g,甘草6g,生姜3g,1剂/d,水煎200mL,分早晚两次鼻饲,100mL/次;西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、动脉血pH、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、脱机拔管成功率、最终拔管时间、不良反应。治疗1疗程(7d),判定疗效。[结果]治疗组显效17例,有效9例,无效14例,总有效率86.67%;对照组显效10例,有效8例,无效12例,总有效率60.00%;治疗组疗效优于对照组(P<0.05)。动脉血pH、PaCO_2、PaO两组均有改善(P<0.05),治疗组改善优于对照组(P<0.05)。治疗1疗程(7d),1周拔管治疗组优于对照组(P<0.05)。拔管时间治疗组优于对照组(P<0.05)。[结论]涤痰汤联合常规疗法治疗慢性阻塞性肺疾病合并呼吸衰竭,疗效满意,无严重不良反应,值得推广。[Objective] Observation the curative effect by phlegm-removing decoction combined conventional therapy treatment of chronic obstructive pulmonary disease with respiratory failure. [Method] Methods 60 cases were randomly divided into two groups by random parallel control method. The control group of 30 cases of conventional therapy. All patients were treated with indwelling gastric tube, deep venous catheter; tracheal intubation, mechanical ventilation, assisted sputum, sputum aspiration, airway nursing; according to the condition and parameters of ventilator weaning; sputum culture and drug sensitivity test of antibiotics;antispasmodic phlegm： aminophylline, beta 2-receptor agonists,hormone and ambroxol; maintain adequate nutrition and energy, but to avoid too much sugar, fat and protein increase; brain edema, mannitol, glycerol, furosemide dehydration, diuresis etc; Stress ulcer （upper gastrointestinal bleeding）, acid suppression, hemostasis, acid-base imbalance： the generation of acid, alkali, acid, call generation respiratory alkalosis, correction of electrolyte imbalance.30 patients in the treatment group were given phlegm-removing decoction： Zhibanxia, Dannanxing each 10g, Fulingl5g, Zhuru,Juhuong, Chaozhishi,each 10g, Shicangpul5g, Renshen 6g, Danshen, Chuanxiong each 10g, Gancao 6g, Shengjiang 3g, 1 agent/d, decoct with water 200mL, and the two feeding, 100mL/time; western medicine treatment with the control group. Continuous treatment of 7d for 1 courses. Observe clinical symptoms, Blood pH, PaO2, PaCO2, Success rate of weaning, extubation time, adverse reaction. 1 course of treatment （7d）, curative effect. [Result] The treatment group was markedly effective in 17 cases, effective in 9 cases, ineffective in 14 cases, the total effective rate was 86.67%;in the control group, 10 cases were markedly effective, effective in 8 cases, ineffective in 12 cases, the total effective rate was 60%;The curative effect of the treatment group was better than that of the control group（P〈0.05）. Arteria

关 键 词：慢性阻塞性肺疾病合并呼吸衰竭 肺胀 喘症 涤痰汤 气管插管 营养支持 抗感染 血气分析 血pH 血氧分压(Pa O2) 血二氧化碳分压(Pa CO2) 脱机拔管成功率 最终拔管时间 中西医结合治疗 随机平行对照研究 

分 类 号：R563[医药卫生—呼吸系统]