健脾补肺益肾法联合尼可刹米治疗慢性阻塞性肺疾病急性加重并Ⅱ型呼吸衰竭临床研究  

Clinical study on spleen-lung-kidney invigorating therapy combined with nikethamide in the treatment of acute exacerbation of chronic obstructive pulmonary disease with typeⅡrespiratory failure

作　　者：周玉中 王洪雪 薛明星 王然 田朝运 张行 ZHOU Yuzhong;WANG Hongxue;XUE Mingxing;WANG Ran;TIAN Zhaoyun;Zhang Hang(The People’s Hospital of Jizhou District, Tianjin 301900, China)

机构地区：[1]天津市蓟州区人民医院,天津301900

出　　处：《现代中西医结合杂志》2021年第14期1503-1506,1525,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：天津市蓟州区科技发展计划项目(JZKJFZJH07)。

摘　　要：目的探讨健脾补肺益肾法联合尼可刹米治疗不使用机械通气的慢性阻塞性肺疾病急性加重(AECOPD)并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2017年1月—2019年12月天津市蓟州区人民医院呼吸消化中西医结合科收治的经确诊为AECOPD并Ⅱ型呼吸衰竭且拒绝接受或不适用机械通气治疗的患者72例,按照随机数字表法将其分成对照组和中药组各36例,对照组予以吸氧、止咳祛痰、解痉平喘、抗感染等常规西医治疗,并予尼可刹米兴奋呼吸中枢,中药组在对照组治疗基础上加用自拟健脾补肺益肾汤治疗,2组疗程均为14 d。疗程结束后观察2组患者治疗效果及病死率,比较2组治疗前后体温、白细胞计数、降钙素原(PCT)水平、动脉血氧分压[p(O_(2))]、动脉血二氧化碳分压[p(CO_(2))]。结果治疗后中药组总有效率为86.1%(17/36),无效5例中死亡1例(2.8%);对照组总有效率为47.2%(31/36),无效19例中死亡15例(41.7%)。中药组临床治疗总有效率明显高于对照组(P<0.05),病死率明显低于对照组(P<0.05)。中药组治疗后体温、白细胞计数、血PCT水平、p(CO_(2))均明显低于治疗前及同期对照组(P均<0.05),p(O_(2))明显高于治疗前及同期对照组(P均<0.05)。结论健脾补肺益肾法联合尼可刹米能够有效改善AECOPD并Ⅱ型呼吸衰竭患者临床症状,纠正低氧血症及高碳酸血症,降低短期病死率。Objective It is to explore the clinical efficacy of spleen-lung-kidney invigorating therapy combined with nikethamide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and typeⅡrespiratory failure without mechanical ventilation.Methods Seventy-two patients who were diagnosed as AECOPD with type II respiratory failure in the Department of Respiratory Digestion,Integrated Traditional Chinese and Western Medicine,People’s Hospital of Jizhou District from January 2017 to December 2019,and refused or were not suitable for mechanical ventilation were selected.They were divided into a control group and a traditional Chinese medicine group by random number table method,with 36 cases in each group.The control group was treated with conventional western medicine such as oxygen inhalation,antitussive and expectorant drugs,antispasmodic and anti-asthmatic drugs,anti-infection,etc.,and given nikethamide to stimulate the respiratory center,the treatment group was treated with self-made decoction for invigorating spleen-lung-kidney.The treatment course of the two groups was 14 days.At the end of treatment,the curative effect and mortality of the two groups were observed,the body temperature,white blood cell count,procalcitonin(PCT)level,arterial blood oxygen partial pressure[p(O_(2))],arterial carbon dioxide partial pressure[p(CO_(2))]before and after treatment were compared in the two groups.Results After treatment,the total effective rate in the traditional Chinese medicine group was 86.1%(17/36),and 1 case(2.8%)died among 5 invalid cases;the total effective rate in the control group was 47.2%(31/36),15 cases died(41.7%)among the 19 invalid cases.The total effective rate of clinical treatment in the Chinese medicine group was significantly higher than that of the control group(P<0.05),and the fatality rate was significantly lower than that of the control group(P<0.05).White blood cell count,blood PCT level,and p(CO_(2))after treatment in the Chinese medicine group were si

关 键 词：健脾补肺益肾 尼可刹米 慢性阻塞性肺疾病急性加重 Ⅱ型呼吸衰竭 

分 类 号：R563[医药卫生—呼吸系统]