涤痰通腑、益气活血法联合机械通气治疗肺性脑病的临床研究

发布时间：2018-09-07 18:45

【摘要】：目的:研究涤痰通腑、益气活血法联合无创机械通气在改善轻、中型肺性脑病中医辩证属于痰蒙神窍患者中医证候积分、动脉血气、意识恢复方面的作用,以及涤痰通腑、益气活血法是否能减少机械通气患者腹胀、呕吐、误吸等不良反应,探讨中西结合治疗肺性脑病的思路和方法。方法:选择我科2014年01月至2015年12月期间住院的99例轻、中型肺性脑病患者,按计算机顺序编码随机分成治疗组66例,对照组33例。治疗组在无创机械通气和西药治疗基础上予以承气灌肠液保留灌肠,每日1次,7天一疗程,根据患者治疗反应调整用量,对照组仅予以无创机械通气和西药治疗。记录两组治疗前、治疗后中医证候积分,动脉血气分析指标变化(Pa CO2、Pa O2),GCS评分变化,治疗前后腹胀、呕吐、误吸症状的发生率,撤机成功例数及气管插管例数,并记录治疗前及疗程结束后的肝功(AST、ALT)、肾功(BUN、Cr)等安全性指标。结果:(1)治疗组治疗后中医证候积分改善程度优于对照组,差异有统计学意义(P0.05);(2)治疗组的临床疗效优于对照组,差异有统计学意义(P0.05);(3)治疗组治疗后1天Pa CO2、Pa O2与对照组治疗后Pa CO2、Pa O2比较,差异有统计学意义(P0.05);治疗后7天Pa CO2、Pa O2与对照组治疗后Pa CO2、Pa O2比较,差异无统计学意义(P0.05);(4)通气指标比较:治疗组通气时间少于对照组,差异有统计学意义(P0.05);(5)意识恢复时间比较:治疗组治疗后1天GCS评分改善优于对照组(P0.05),治疗后7天两组GCS评分比较,差异差异无统计学意义(P0.05);(6)并发症比较:治疗组腹胀、呕吐、误吸等发生率少于对照组,差异有统计学意义(P0.05);(7)气管插管例数、撤机成功例数比较:治疗组气管插管率低于对照组,撤机成功率高于对照组,差异有统计学意义(P0.05)。(8)安全性比较:治疗组治疗后AST、ALT、BUN、Cr与对照组比较无差异(P0.5)。结论:涤痰通腑、益气活血法联合无创机械通气可改善肺性脑病患者中医证候,减少通气时间,缩短平均意识恢复时间,降低气管插管率及死亡率,提高撤机成功率,能有效减少腹胀、呕吐、误吸等并发症的发生,对肝、肾功等安全性指标影响较小。
[Abstract]:Objective: to study the effects of phlegm, tonifying qi and activating blood circulation method combined with noninvasive mechanical ventilation on improving TCM syndromes, arterial blood gas and consciousness recovery in patients with light and moderate pulmonary encephalopathy. Whether the method of invigorating qi and activating blood can reduce the adverse reactions such as abdominal distension, vomiting and aspiration in patients with mechanical ventilation, this paper discusses the thinking and method of treating pulmonary encephalopathy with combination of Chinese and western medicine. Methods: 99 patients with mild and moderate pulmonary encephalopathy from January 2014 to December 2015 were randomly divided into treatment group (n = 66) and control group (n = 33). The treatment group was treated with gas enema on the basis of non-invasive mechanical ventilation and western medicine. The treatment group was treated with non-invasive mechanical ventilation and western medicine only. Before and after treatment, the scores of TCM syndromes, the changes of arterial blood gas analysis index (Pa CO2,Pa O 2), the incidence of abdominal distension, vomiting and aspiration, the successful cases of weaning and tracheal intubation were recorded before and after treatment. Liver function (AST,ALT) and renal function (BUN,Cr) were recorded before and after treatment. Results: (1) the improvement of TCM syndromes in the treatment group was better than that in the control group (P0.05); (2), and the clinical effect of the treatment group was better than that of the control group. The difference was statistically significant (P0.05); (3) between the treatment group and the control group after the treatment of Pa CO2,Pa O2 1 day after treatment, the difference was statistically significant (P0.05); 7 days after the treatment of Pa CO2,Pa O2 and control group after treatment Pa CO2,Pa O2 comparison, No significant difference (P0.05); (4) ventilation index comparison: the treatment group ventilation time is less than the control group, Significant difference (P0.05); (5) consciousness recovery time comparison: the treatment group 1 day after treatment GCS score improvement than the control group (P0.05), 7 days after the treatment of the two groups GCS score comparison, the difference was not statistically significant (P0.05); (6) complications comparison: treatment group abdominal distension, vomiting, The incidence of missuction was lower than that of the control group (P0.05); (7). The successful rate of tracheal intubation in the treatment group was lower than that in the control group, and the success rate was higher in the treatment group than in the control group. The difference was statistically significant (P0.05). (8) safety comparison: the treatment group after treatment compared with the control group AST,ALT,BUN,Cr was no difference (P0. 5). Conclusion: the method of removing phlegm and activating qi and activating blood circulation combined with non-invasive mechanical ventilation can improve the syndrome of pulmonary encephalopathy, reduce the time of ventilation, shorten the time of average consciousness recovery, reduce the rate of tracheal intubation and mortality, and improve the success rate of weaning. It can effectively reduce the incidence of abdominal distension, vomiting, aspiration and other complications, and has little effect on safety indexes such as liver and kidney function.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259;R277.7

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