潜阳丹加半夏汤对无创通气的AECOPD伴呼衰患者下丘脑垂体肾上腺轴影响的研究  

Study of the Effects of Qianyangdan Decoction plus Pinelia on Function of HPAA in Patients with AECOPD and Respiratory Failure Requiring Non-invasive Ventilation

作　　者：朱立成[1] 吴传中 黄敏[2] Zhu Licheng;Wu Chuanzhong;Huang Min(The Third Hospital of Nantong Affiliated to Nantong University,Jiangsu,Nantong 226006,China)

机构地区：[1]南通大学附属南通第三医院,江苏南通226000 [2]南通大学附属医院,江苏南通226000

出　　处：《中国中医急症》2019年第10期1785-1787,1791,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：南通市科技局科技计划项目（YYZ17039）

摘　　要：目的观察潜阳丹加半夏汤对需无创机械通气治疗的慢性阻塞性肺疾病急性发作伴呼吸衰竭患者下丘脑垂体肾上腺轴的影响。方法将60例慢性阻塞性肺疾病急性发作合并Ⅱ型呼吸衰竭需使用无创呼吸机的患者随机分为两组,治疗组给予无创机械通气及常规治疗的基础上使用潜阳丹加半夏汤加减,对照组按西医常规治疗,14 d后评定疗效。治疗前、治疗第3日及治疗后采集标本进行常规检测及皮质醇、促肾上腺皮质激素检测,给予急性生理与慢性健康Ⅱ(APACHEⅡ)评分及中医证候评分。结果两组治疗后治疗组总有效率为93.33%,高于对照组的86.67%(P <0.05),两组动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)均显著改善,治疗组改善更为显著(P <0.05)。两组经治疗APACHEⅡ评分及中医总证候评分均减低,治疗组优于对照组(P <0.01)。治疗组在调节应激时HPAA轴方面升高COR降低ACTH的作用优于对照组(P <0.05)。结论潜阳丹加半夏汤加减可有效改善病情及中医阳气虚证候,改善缺氧及二氧化碳潴留,通过调整HPAA轴的状态提高皮质醇降低ACTH水平,安全有效。Objective:To explore the effect of Qianyangdan Decoction plus Pinelia on function of HPAA in patients with AECOPD and respiratory failure requiring non-invasive ventilation.Methods:60 patients were ran domly divided into two groups.The treatment group was given non-invasive mechanical ventilation and conventional treatment based on the use of Qianyangdan Decoction plus Pinelia.The control group was treated with Western medicine.The clinical efficacy was observed after 14-day treatment.Before treatment,on the 3rd day of treatment and after treatment,samples were collected for routine detection,cortisol and adrenocorticotropic hormone detection,and APACHE Ⅱscore and TCM syndrome score were given.Results:After treatment,the curative effect of the treatment group was better than that of the control group(P<0.05).The treatment group increased the level of PaO2 and decreased the level of PaCO2,better than that of the control group(P<0.05).After treatment,APACHE Ⅱscore and TCM syndrome score of both groups decreased,and the treatment group was better than the control group(P<0.01).In the treatment group,the effect of increasing COR and decreasing ACTH in regulating HPAA axis during stress was better than that in the control group(P<0.05).Conclusions:Qianyangdan Decoction plus Pinelia can effectively improve the condition of the disease and Yangqi deficiency syndrome of TCM,hypoxia and carbon dioxide retention,and cortisol to reduce ACTH level by adjusting the state of HPAA axis,safe and effective.

关 键 词：慢性阻塞性肺疾病急性发作 潜阳丹加半夏汤 无创机械通气 呼吸衰竭 下丘脑垂体肾上腺轴 

分 类 号：R563.9[医药卫生—呼吸系统]