清金化痰汤与盐酸氨溴索联合无创机械通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床研究

摘要

Objective:To investigate the clinical effect of Qingjin Huatan Decoction and ambroxol combined with noninvasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease with severe res-piratory failure in the elderly. Methods:120 cases were divided into different groups according to the treatment of the patients,60 cases in the conventional treatment group and 60 cases in the combined treatment group. The conventional treatment group received conventional basic treatment,while the combined treatment group received Qingjin Huatan Decoction and ambroxol combined with noninvasive mechanical ventilation. The clinical efficacy of two groups were compared before and after treatment,as well as the changes of the blood gas parameters,pul-monary function,respiratory rate,heart rate and inflammatory factor. Results:The effective rate of the combined treatment group (86.67%) was obviously higher than the conventional treatment group group (65.00%). After treatment,paCO2,breathing rate,heart rate,IL-6,IL-17,IL-23,TNF-α and CRp were lower than before treatment (P<0.05),and pH,paO2,SaO2,MMEF,pEF,FEV1 and FEV1/FVC were higher than before treatment (P<0.05). The combined treatment group was lower than the conventional treatment group in paCO2,breathing rate,heart rate,IL-6,IL-17,IL-23,TNF-α and CRp(P<0.05). The combined treatment group was higher than the conven-tional treatment group in pH,paO2,SaO2,MMEF,pEF,FEV1 and FEV1/FVC(P<0.05). The rate of tracheal intu-bation,the incidence of VAp,the rate of adverse reaction and mortality in the combined treatment group were lower than those in the conventional treatment group (P<0.05).Conclusion:Qingjin Huatan Decoction and am-broxol hydrochloride combined with noninvasive mechanical ventilation on chronic obstructive pulmonary disease with respiratory failure can effectively improve clinical symptoms of patients,and restore blood gas analysis and pulmonary function,respiratory rate,heart rate and inflammatory cytokines,worthy to be promoted.%目的 观察清金化痰汤与盐酸氨溴索清联合无创机械通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床疗效.方法 选取120例老年慢性阻塞性肺疾病合并重症呼吸衰竭患者,依据随机数字表法分为常规治疗组和联合治疗组各60例.常规治疗组接受基本的常规治疗,联合治疗组患者在常规治疗组基础上接受清金化痰汤与盐酸氨溴索联合无创机械通气治疗.比较两组患者的临床疗效,以及治疗前后的血气参数、肺功能指标、呼吸频率、心率和炎症因子变化情况.结果 联合治疗组的总有效率为86.67%,明显高于常规治疗组的65.00%;治疗后两组二氧化碳分压(paCO2)、呼吸频率、心率、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、白细胞介素-23(IL-23)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRp)均低于治疗前(P<0.05), pH、paO2、动脉血氧饱和度(SaO2)、MMEF、pEF、FEV1和FEV1/FVC均高于治疗前(P<0.05).联合治疗组患者治疗后paCO2、呼吸频率、心率、IL-6、IL-17、IL-23、TNF-α和CRp均低于常规治疗组(P<0.05),pH、paO2、SaO2、MMEF、pEF、FEV1和FEV1/FVC均高于常规治疗组(P<0.05).联合治疗组气管插管率、VAp发生率、不良反应率和死亡率均低于常规治疗组(P<0.05).结论 清金化痰汤与盐酸氨溴索清联合无创通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床症状改善明显,血气参数、肺功能、呼吸频率、心率和炎症因子得到恢复,疗效良好,安全性较高.