人参四逆汤联合无创呼吸机对AECOPD并呼衰患者HPT轴激素水平及认知功能的影响  

Effects of Modified Renshen Sini Decoction Combined with Noninvasive Ventilation on the Function of Hypothalamic-pituitary-thyroid(HPT)Axis Hormone Level and Cognitive Function in AECOPD Patients Complicated with Respiratory Failure

作　　者：朱立成[1] 朱文娟[2] 朱麒霖 尚云飞[1] Zhu Licheng;Zhu Wenjuan;Zhu Qilin;Shang Yunfei(Nantong Third Hospital Affiliated to Nantong University,Jiangsu,Nantong 226000,China)

机构地区：[1]南通大学附属南通第三医院,江苏南通226000 [2]江西中医药大学附属医院,江西南昌330006

出　　处：《中国中医急症》2021年第12期2182-2185,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：江西省卫生计生委中医药科研课题(2016A55);南通市科技局计划项目(YYZ10739)。

摘　　要：目的观察人参四逆汤加减联合无创呼吸机对合并呼吸衰竭的慢性阻塞性肺疾病急性加重(AECOPD)患者下丘脑-垂体-甲状腺轴的影响并探讨其作用机制。方法患者70例随机分为两组,均使用双水平正压通气无创呼吸治疗,对照组给予西医常规治疗,治疗组在对照组的基础上加用人参四逆汤加减,14 d后评定疗效。治疗前后进行血气分析及血清甲状腺功能检测,采用蒙特利尔认知评估量表进行认知功能评估。结果治疗组总有效率为94.29%,明显高于对照组的85.71%(P<0.05)。治疗后两组PH及氧分压(PaO_(2))数值水平较治疗前均上升(P<0.05),二氧化碳分压(PaCO_(2))水平较治疗前均下降(P<0.05),治疗组各项水平均优于对照组(P<0.05)。治疗后两组的促甲状腺激素释放激素(TRH)及促甲状腺素(TSH)水平与治疗前无明显差异(P>0.05),两组游离甲状腺素(FT4)、游离三碘甲状腺素(FT3)水平均较治疗前上升(P<0.05),治疗组高于对照组(P<0.05)。两组治疗后的MoCA评估量表各项评分及总评分均高于治疗前(P<0.05),治疗组在定向力、延迟记忆、抽象理解、注意力与计算力、视空间与执行能力、总评分均高于对照组(P<0.05)。FT3水平与此类患者的定向力、延迟记忆、注意力与计算力、视空间与执行能力的量表分呈正相关(P<0.05),而与命名、语言、抽象理解评分无明显相关(P>0.05)。结论AECOPD并Ⅱ型呼衰患者HPT轴甲状腺激素水平同认知功能密切相关,人参四逆汤加减联合呼吸机具有显著疗效并可调整下丘脑-垂体-甲状腺轴激素水平并改善认知功能。Objective:To explore the clinical efficacy of modified Renshen Sini Decoction combined with non-invasive ventilation on hypothalamic-pituitary-thyroid axis in AECOPD patients complicated with respiratory failure.Methods:A total of 70 AECOPD patients with TypeⅡrespiratory failure were randomly divided into 2 groups,all of whom were treated with non-invasive bi-level positive pressure ventilation.The control group was given conventional western medicine,and the treatment group was given modified Renshen Sini Decoction based on the control group.The curative effect was evaluated after 14 days of treatment.Blood gas analysis and serum thyroid function test were performed before and after treatment,and cognitive function was assessed using the Montreal Cognitive Assessment(MoCA)Scale.Results:After treatment,the effective rate of the treatment group was significantly better than that of the control group(P<0.05);the improvement of blood gas was better than that of the control group(P<0.05).The levels of FT3 and FT4 in the two groups increased after treatment and were both better than before treatment(P<0.05),and the treatment group was better than the control group(P<0.05).The scores of the MoCA evaluation scale of the two groups also showed that the treatment group was better than the western medicine control group(P<0.05).The traditional Chinese medicine combination treatment group is superior to the western medicine control group in terms of orientation,delayed memory,abstract understanding,attention and calculation,visual space and execution ability(P<0.05),and it is positively correlated with the level of HPT axis thyroid hormone FT3(r=0.46,0.51,0.44,0.55,P<0.05).The Control Group was given routine treatment of Western medicine,the Chinese Medicine Combined Treatment Group was given Ginseng Sini decoction on the basis of the Control Group.The clinical efficacy was observed after 14 day treatment.The specimen was collected before and after treatment to detect blood gas analysis and thyroid function,and cognitive

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 下丘脑-垂体-甲状腺轴 认知功能 人参四逆汤加减 

分 类 号：R5639[医药卫生—呼吸系统]