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目的探讨在现有内科治疗基础之上,给予中医药“补中益气”辅助治疗,对改善重症慢性阻塞性肺疾病患者的有创通气(invasive positive pressure ventilation,IPPV)撤离效果及改善患者预后的作用。方法采用前瞻性随机对照研究的设计方案,将患者随机分为中药组和对照组。中药组患者鼻饲中药补中益气合剂(10ml/次,3次/日),对照组患者鼻饲温开水(10ml/次,3次/日);补中益气合剂与温开水均给予鼻饲至拔除气管插管为止。记录并比较两组患者基本情况、每天主要呼吸力学指标、进入撤机阶段前IPPV时间、IPPV撤离时间、IPPV总时间、自主呼吸试验次数、未达到撤机标准患者比例、拔管后无创通气(noninvasive positive pressure ventilation,NPPV)使用率、48小时后重新气管插管率、呼吸机相关肺炎(ventilator associated pneumonia,VAP)发生率、院内病死率、住重症监护病房(intensive care unit,ICU)时间及住院时间。结果研究期间共有60例符合研究条件的患者入选,其中中药组30例,对照组30例。在接受气管插管时,两组患者的基础情况差异无显著性。在IPPV前3天及进入撤机阶段时,两组患者最大吸气压均逐渐增加,呼吸频率均逐渐降低,潮气量均逐渐增加,浅快呼吸指数均逐渐降低,两组各项指标改善程度相似。与对照组相比,中药组有创通气撤离时间显著缩短[1.0(1.0)vs 2.0(1.8),P<0.05],自主呼吸试验需求次数显著降低[2.0(1.8)vs 3.0(1.8),P<0.05];中药组在进入撤机阶段前IPPV时间及IPPV总时间有降低趋势,但差异无显著性(P>0.05)。两组患者未达到撤机标准率、NPPV使用率、48小时后再次插管率、VAP发生率、院内病死率、住ICU时间、住院时间等医疗指标比较差异无显著性(P>0.05)。结论补中益气合剂可安全应用于辅助重症慢性阻塞性肺疾病患者的有创通气撤离,可有效改善撤机效果,并有望改善患者整体预后。
Objective To explore the effect and improvement of invasive positive pressure ventilation (IPPV) evacuation in patients with severe chronic obstructive pulmonary disease (TCM) on the basis of existing medical treatment. The role of patient prognosis. Methods The prospective randomized controlled design of the study, the patients were randomly divided into traditional Chinese medicine group and control group. Chinese medicine group nasal feeding Buzhongyiqi mixture (10ml / time, 3 times / day), patients in the control group nasal feeding warm water (10ml / time, 3 times / day); Buzhongyiqi mixture and warm water were given nasal feeding Remove the tracheal intubation so far. Record and compare the basic situation of the two groups of patients, daily major respiratory mechanics indicators, IPPV time before entering the weaning phase, IPPV withdrawal time, total IPPV time, number of spontaneous breathing test, patients who did not meet the standard of weaning, non-invasive ventilation after extubation noninvasive positive pressure ventilation (NPPV), rate of intubation after 48 hours, incidence of ventilator associated pneumonia (VAP), natal hospital mortality, intensive care unit (ICU) time, and Hospitalization time. Results A total of 60 patients were eligible during the study period, of which 30 were in the traditional Chinese medicine group and 30 in the control group. At the time of endotracheal intubation, there was no significant difference in the basic conditions between the two groups. In the first 3 days of IPPV and into the weaning stage, the maximal inspiratory pressure of both groups increased gradually, the respiratory rate gradually decreased, the tidal volume increased gradually and the respiration index gradually decreased. The improvement of each index similar. Compared with the control group, the time of invasive ventilation evacuation was significantly shorter in the traditional Chinese medicine group [1.0 (1.0) vs 2.0 (1.8), P <0.05], and the number of spontaneous breathing tests significantly decreased [2.0 <0.05]. The IPPV time and the total IPPV time of the TCM group decreased before entering the weaning stage, but the difference was not significant (P> 0.05). The two groups of patients did not meet the standard rate of weaning, NPPV utilization, re-intubation rate after 48 hours, VAP incidence, hospital mortality, ICU time, hospital stay and other medical indicators was no significant difference (P> 0.05). Conclusion Buzhong Yiqi mixture can be safely applied to patients with severe chronic obstructive pulmonary disease with invasive ventilation evacuation can effectively improve the weaning effect and is expected to improve the overall prognosis of patients.