通腑泄肺法在急性呼吸衰竭有创机械通气中的应用  

The Application of Tongfu Xiefei Method in Invasive Mechanical Ventilation of Acute Respiratory Failure

作　　者：周莉[1] 江涛[1] 廖晓华[1] 张江[1] 赵秋霞[1] Zhou Li;Jiang Tao;Liao Xiaohua;Zhang Jiang;Zhao Qiuxia(Zigong Hospital of Traditional Chinese Medicine,Sichuan,Zigong 643000,China)

机构地区：[1]四川省自贡市中医医院,四川自贡643000

出　　处：《中国中医急症》2020年第5期887-890,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：自贡市卫计委2015年度卫生系统科研课题(自卫办发[2015]70号)。

摘　　要：目的观察通腑泄肺法对急性呼吸衰竭有创机械通气患者的临床疗效。方法患者91例随机分为治疗组45例与对照组46例。两组均常规给予小潮气量(5~8 m L/kg)和高呼气末正压(PEEP)有创机械通气,治疗组给予加味宣白承气汤通腑泄肺。观察两组患者治疗前及治疗后24、48 h动脉血酸碱度(pH)、氧分压(PO2)、二氧化碳分压(PCO2)等动脉血气指标及气道峰压(Ppeek)、平台压(Pplat)、呼气末正压(PEEP)、氧浓度(FiO2)、气道阻力(Raw)等通气指标;并比较两组患者机械通气时间及住ICU时间、呼吸机相关性肺炎(VAP)的发生率、因为ARF导致的28 d死亡率。结果治疗后24、48 h两组pH、PO2、PCO2水平均较治疗前改善(P <0.05),组间差异无统计学意义(P> 0.05)。治疗后24、48 h两组Ppeek、Pplat、PEEP、FiO2、Raw均较治疗前改善(P <0.05),治疗后24 h两组差异无统计学意义(P> 0.05);治疗组治疗后48 h通气指标均显著低于对照组(P <0.05);两组肠道功能(插管后首次排大便时间)、腹腔内压(经膀胱测压法)、有创机械通气时间、住ICU时间、VAP的发生率比较,治疗组更佳(P <0.05);两组28 d死亡率差异无统计学意义(P> 0.05)。结论通腑泄肺法用于急性呼吸衰竭行有创机械通气的患者效果满意,能有效改善患者血气和通气指标,能减少患者有创机械通气时间及住ICU时间,对行有创机械通气的急性呼吸衰竭患者具有保护作用。Objective:To observe the clinical effect of Tongfu Xiefei method on patients with acute respiratory failure(ARF). Methods:91 patients with ARF undergoing invasive mechanical ventilation were randomly divided into the treatment group(45 cases)and the control group(46 cases). Both groups were given conventional mechanical ventilation with low tidal volume(5~8 m L/kg)and high PEEP. The treatment group received Jiawei Xuanbai Chengqi Decoction. The arterial blood gas indicators,such as arterial blood pH(pH),PCO2,and the ventilator parameters,such as Ppeek,Pplat,PEEP,FiO2,Raw,were observed in two groups before treatment and after treatment of 24 hours and 48 hours. The duration of MV,ICU time,incidence of VAP and 28-day mortality due to ARF were compared between groups. Results:The arterial blood gas indicators and the ventilator parameters of two groups showed no statistical difference before treatment. 24 and 48 hours after treatment,pH,PO2,PCO2 of two groups were improved(P < 0.05),but there were no significant differences between 2 groups. Ppeek,Pplat,PEEP,FiO2 and Raw of two groups were improved in 24 hours and 48 hours after treatment,but there were no statistically significant differences between the groups in 24 hours after treatment. The ventilation index of the treatment group improved 48 hours after treatment(P < 0.05). The treatment group was better than the control group in intestinal function(First defecation time after intubation),abdominal pressure(transvesical manometry),MV time,ICU time and VAP incidence(P < 0.05). There was no significant difference between the two groups in 28-day mortality rate(P > 0.05). Conclusion:The patients are satisfied with the effect of Tongfu Xiefei method on invasive mechanical ventilation for ARF. It can effectively improve blood gas indicators and ventilator parameters,reduce MV time and ICU time,and protect ARF patients undergoing invasive mechanical ventilation.

关 键 词：急性呼吸衰竭 通腑泄肺 有创机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]