益气活血化痰汤、无创双水平气道正压通气联合纳美芬治疗老年慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭疗效研究  

Clinical of Yiqi Huoxue Huatan decoction,non-invasive bi-level positive airway pressure ventilation combined with nalmefene in the treatment of COPD combined with typeⅡrespiratory failure in elderly patients

作　　者：宋卫东[1] 赵庆忠[1] 蔡波[1] 万健[1] SONG Weidong;ZHAO Qingzhong;CAI Bo;WAN Jian(People’s Hospital of Pudong New Area,Shanghai 201299,China)

机构地区：[1]上海市浦东新区人民医院,上海201299

出　　处：《陕西中医》2023年第4期455-458,共4页Shaanxi Journal of Traditional Chinese Medicine

基　　金：上海市医学重点专科建设项目(ZK2019C08);上海市浦东新区临床医学高原学科建设项目(PWYGY2021-09)。

摘　　要：目的:探究益气活血化痰汤、无创双水平正压通气联合纳美芬治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭疗效及对患者肺功能、肺部活化调节趋化因子(PARC/CCL18)水平的影响。方法:选取152例老年COPD合并Ⅱ型呼吸衰竭患者,随机分为观察组和对照组,每组76例。两组患者均采用常规解痉、祛痰、抗感染、水电解质平衡等对症治疗和无创双水平气道正压通气,对照组给予纳洛酮治疗,观察组患者另给予益气活血化痰汤、纳美芬治疗,对比两组血气指标、肺功能指标、血清肺表面活性相关蛋白D(SP-D)、PARC/CCL18水平及临床疗效。结果:治疗前两组患者动脉血氧分压(PaO 2)、二氧化碳分压(PaCO 2)、血氧饱和度(SaO 2)、心率及呼吸频率、肺功能、SP-D、PARC/CCL18比较差异无统计学意义(P>0.05)。治疗后观察组患者血气指标水平均优于对照组(P<0.05);治疗后观察组患者心率、呼吸频率、收缩压(SBP)、舒张压(DBP)优于对照组(P<0.05);治疗后观察组患者肺活量为50%时的呼气流速(PEF50)、第1秒末用力呼气量(FEV1)、最大呼气压(PEmax)、肺总容量(TLC)均优于对照组(P<0.05);治疗后,观察组患者血清SP-D、PARC/CCL18水平低于对照组(P<0.05)。观察组总有效率高于对照组(P<0.05)。结论:益气活血化痰汤、无创双水平气道正压通气联合纳美芬可有效改善COPD合并Ⅱ型呼吸衰竭老年患者的肺功能、血气指标,降低血清SP-D和PARC/CCL18水平。Objective:To observe the clinical efficacy of Yiqi Huoxue Huatan decoction,non-invasive bi-level positive airway pressure ventilation combined with nalmefene in the treatment of COPD combined with typeⅡrespiratory failure in elderly patients.Methods:A total of 152 elderly patients with COPD combined with typeⅡrespiratory failure were selected as the study subjects and randomly divided into observation group and control group,76 cases in each group.Both groups were treated with conventional spasmodic,expectorant,anti-infection,water and electrolyte balance and other symptomatic treatments as well as non-invasive bi-level positive airway pressure ventilation.The control group was additionally given naloxone injection treatment on the basis of the above,and the observation group was additionally given Yiqi Huoxue Huatan decoction and nalmefene injection.The blood gas indexes,lung function indexes,SP-D,PARC/CCL18 levels and clinical efficacy of the two groups before and after treatment were observed and compared.Results:There were no significant differences in PaO 2,PaCO 2,SaO 2,heart rate and respiratory rate,lung function,SP-D,PARC/CCL18 between the two groups before treatment(P>0.05).After treatment,the blood gas index level of observation group was better than control group(P<0.05).After treatment,heart rate,respiratory rate,SBP,DBP in observation group were better than those in control group(P<0.05).After treatment,PEF50,FEV1,PEmax and TLC in observation group were better than those in control group(P<0.05).After treatment,the serum levels of SP-D and PARC/CCL18 in the observation group were better than those in the control group(P<0.05).The total effective rate of observation group was higher than that of control group(P<0.05).Conclusion:Yiqi Huoxue Huatan decoction,noninvasive bi-level positive airway pressure ventilation combined with nalmefene can effectively relieve the clinical symptoms of elderly patients with COPD combined with typeⅡrespiratory failure,better improve the lung function and blood gas

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 益气活血化痰汤 纳美芬 无创双水平气道正压通气 肺功能 

分 类 号：R563.8[医药卫生—呼吸系统]