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目的:观察涤痰通腑、益气活血法联合无创机械通气在改善轻、中型肺性脑病中医辨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,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1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,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(P<0.05);(2)治疗组的临床疗效优于对照组,差异有统计学意义(P<0.05);(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(P<0.05);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(P>0.05);(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(P<0.05);(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(P<0.05),治疗后7天两组GCS评分比较,差异差异无统计学意义(P>0.05);(6)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(P<0.05)。(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(P>0.5)。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,对肝、肾功等安全性指标影响较小。
Objective: To observe the role of Ditan Tong Fu, Yiqi Huoxue combined with noninvasive mechanical ventilation in improving TCM syndrome score, arterial blood gas and consciousness recovery in patients with TCM syndrome of light and medium pulmonary encephalopathy, Pulmonary encephalopathy ideas and methods. Methods: A total of 99 patients with mild to moderate pulmonary encephalopathy hospitalized in our department between January 2014 and December 2015 were randomly divided into treatment group (66 cases) and control group (33 cases) according to computer code. The treatment group was given non-invasive mechanical ventilation and western medicine based on enema enema enema, once a day, 7 days and 1 course of treatment according to the patient to adjust the amount of response, the control group was only noninvasive mechanical ventilation and Western medicine. The scores of TCM syndromes, changes of arterial blood gas analysis indexes (PaCO2, PaO2), changes of GCS score, number of successful weaning and endotracheal intubation were recorded before treatment and after treatment Liver function (AST, ALT), renal function (BUN, Cr) and other safety indicators. Results: (1) The improvement of TCM syndrome score in the treatment group was better than that in the control group (P <0.05); (2) The clinical curative effect in the treatment group was better than that in the control group, with significant difference (P <0.05); (3) PaCO 2 and Pa O 2 in PaCO 2, Pa O 2 and control group after treatment for 1 day were significantly different (P <0.05); PaCO 2 and Pa There was no significant difference in PaCO 2 and Pa O 2 between the two groups after treatment (P> 0.05). (4) Comparison of ventilation indexes: The ventilation time of the treatment group was less than that of the control group, with significant difference (P0.05) (P <0.05); (5) Comparison of conscious recovery time: The improvement of GCS score in treatment group was better than that in control group on the 1st day after treatment (P <0.05). There was no significant difference in GCS score between the two groups on the 7th day after treatment (P> 0.05). (6) The number of endotracheal intubation, the number of successful weaning compared: the treatment group tracheal intubation rate was lower than the control group, the weaning success rate was higher than the control group, the difference was statistically significant (P <0.05). (8) Safety comparison: AST, ALT, BUN and Cr in the treatment group had no difference with the control group after treatment (P> 0.5). Conclusion: Ditan Tong, Yiqihuoxue combined with noninvasive mechanical ventilation can improve TCM symptoms of patients with pulmonary encephalopathy, reduce the ventilation time, shorten the average recovery time of consciousness, reduce tracheal intubation and mortality, improve the success rate of weaning, The liver, kidney function and other safety indicators less affected.