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目的探讨大黄内服及芒硝神阙穴热敷对急性呼吸窘迫综合征(ARDS)伴腹高压并机械通气患者呼吸功能的影响。方法以治疗方案分成治疗组15例(加用大黄内服及芒硝神阙穴外敷治疗的患者),对照组8例(未加用大黄内服及芒硝神阙穴外敷治疗的患者),观察其腹内压(IAP)、腹腔灌注压(APP)、急性生理学和慢性健康状况评分系统(APACHEⅡ评分)、动脉血气分析指标(pH、PaO2、PaCO2)、吸氧浓度、呼吸频率、潮气量、气道峰压、气道平台压、气道平均压、呼气末正压、计算氧合指标等指标以评价临床疗效。结果治疗第7天两组较治疗前比较IAP、APP明显下降(P<0.05),治疗组较对照组IAP、APP明显下降(P<0.05),但APACHEⅡ分值较治疗组差异无统计学意义(P>0.05);第7天两组的pH、PaO2、氧合指标较同组治疗前有升高,且差异有统计学意义(P<0.05),PaCO2较同组治疗前比较有下降,差异有统计学意义(P<0.05);治疗组较对照组在第7天PH值、PaCO2无统计学差异(P>0.05),PaO2、氧合指标比较有统计学差异(P<0.05);第7天两组较本组治疗前潮气量均有增加,且差异有统计学意义(P<0.05),但两组之间比较无统计学差异(P>0.05);第7天两组气道平台压、气道峰压、气道平均压、呼吸频率较本组治疗第1天均有下降,且差异有统计学意义(P<0.05);治疗组气道平台压、气道峰压、气道平均压、呼吸频率较对照组在治疗第7天比较有统计学差异(P<0.05)。结论大黄内服及芒硝神阙穴热敷对ARDS伴腹高压并机械通气患者的呼吸功能有改善作用。
Objective To investigate the effects of rhubarb oral administration and Glauber’s salt Shenque acupuncture on respiratory function in patients with acute respiratory distress syndrome (ARDS) complicated with abdominal hypertension and mechanical ventilation. Methods The treatment group was divided into treatment group (n = 15) and control group (n = 8). Patients in the control group were treated with rhubarb and Glauber’s Shenque acupoints (external application) IAP, APP, Acute Physiology and Chronic Health Evaluation System (APACHEⅡscore), arterial blood gas analysis (pH, PaO2, PaCO2), oxygen concentration, respiratory rate, tidal volume, Pressure, airway pressure, average airway pressure, positive end expiratory pressure, oxygenation index and other indicators to evaluate the clinical efficacy. Results On the 7th day after treatment, the levels of IAP and APP in the two groups were significantly decreased (P <0.05), while the levels of IAP and APP in the treatment group were significantly lower than those in the control group (P <0.05), but there was no significant difference between the two groups (P> 0.05). On the seventh day, the pH, PaO2 and oxygenation index of the two groups were higher than those before treatment, and the difference was statistically significant (P <0.05), PaCO2 decreased compared with the same group before treatment, (P <0.05). Compared with the control group, there was no significant difference in PaCO2 (P> 0.05) and PaO2 between the treatment group and the control group on the 7th day (P <0.05); On the 7th day, the tidal volume of both groups increased compared with before treatment, and the difference was statistically significant (P <0.05), but there was no significant difference between the two groups (P> 0.05) Road platform pressure, peak airway pressure, mean airway pressure, respiratory rate compared with the first day of treatment decreased, and the difference was statistically significant (P <0.05); the treatment group, airway pressure, peak airway pressure , Mean airway pressure and respiratory rate were significantly different from the control group on the 7th day (P <0.05). Conclusion Rhubarb Oral administration and Glauber’s Shenque acupoint heat application can improve the respiratory function of ARDS patients with abdominal hyperbaric pressure and mechanical ventilation.