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目的:观察大承气汤联合肺复张治疗肺外源性急性呼吸窘迫征(ARDS)患者的临床疗效。方法:选择2003年10月—2007年9月收入本院重症监护室(ICU)的47例肺外源性ARDS患者,随机分为治疗组24例,采取肺复张及西医常规治疗加用大承气汤灌肠,每日2次,疗程3~5天;对照组23例,仅采取肺复张及西医常规治疗。于治疗后24h、48h和72h分别观察两组患者的肺静态顺应性(Cstat)、氧合指数(PaO2/FiO2)、平台压(Pplat)、气道峰压(Ppeak)、呼气末正压(PEEP);治疗结束后观察机械通气并发症发生率及病死率的变化。结果:治疗组在治疗后48h和72h的Cstat、PaO2/FiO2均显著高于对照组,而Pplat、Ppeak均显著低于治疗前,PEEP于治疗后72h显著低于对照组,差异均有显著性(P<0.05)。治疗组患者机械通气并发症(腹胀、呼吸机相关性肺炎)发生率及病死率均优于对照组,差异均有显著性(P<0.05)。结论:大承气汤灌肠可改善肺外源性ARDS患者Cstat、氧合指数,减少机械通气并发症。
Objective: To observe the clinical effect of Dachengqi decoction combined with pulmonary reexpansion in the treatment of exogenous acute respiratory distress syndrome (ARDS). Methods: Forty-seven patients with exogenous ARDS who were admitted to intensive care unit (ICU) in our hospital from October 2003 to September 2007 were randomly divided into treatment group (24 cases), pulmonary reexpansion and conventional western medicine plus large Chengqi soup enema, 2 times a day, course of treatment of 3 to 5 days; control group of 23 cases, only take pulmonary reabsorption and Western conventional treatment. Cstat, PaO2 / FiO2, Pplat, Ppeak, and positive end expiratory pressure were observed at 24h, 48h and 72h after treatment. (PEEP). After treatment, the incidence of mechanical ventilation complication and mortality were observed. Results: The Cstat and PaO2 / FiO2 of the treatment group were significantly higher than those of the control group at 48h and 72h after treatment, while Pplat and Ppeak were significantly lower than those before treatment, and PEEP at 72h after treatment was significantly lower than that of the control group (P <0.05). The incidence of mechanical ventilation complications (abdominal distension, ventilator-associated pneumonia) and mortality in the treatment group were better than those in the control group, the difference was significant (P <0.05). Conclusion: Dachengqi Decoction can improve Cstat and oxygenation index of pulmonary exogenous ARDS patients and reduce the complications of mechanical ventilation.