摘要
目的观察参麦注射液联合针刺干预慢性阻塞性肺疾病(COPD)合并呼吸衰竭机械通气撤机困难的疗效及对膈肌功能、N-末端脑钠肽前体(NT-proBNP)和超敏C反应蛋白(hs-CRP)的影响。方法将91例COPD合并呼吸衰竭机械通气撤机困难患者随机分为观察组(46例)和对照组(45例)。对照组给予常规治疗,观察组在对照组基础上给以参麦注射液联合针刺治疗,治疗至撤机时。观察2组治疗过程中呼吸机呼吸力学参数、血气分析指标、膈肌功能、NT-proBNP和hs-CRP水平的变化,记录2组撤机时间、撤机成功率、住院时间和费用。结果2组治疗第3天、第5天、撤机前的肺顺应性(Cdyn)较治疗前显著升高,呼吸做功(WOB)、气道峰压(PIP)、气道阻力(Raw)较治疗前显著降低(P均<0.05),观察组在治疗第3天、第5天、撤机前的以上呼吸力学参数均优于对照组(P均<0.05);2组治疗第3天、第5天、撤机前的动脉血氧饱和度[S a(O 2)]、动脉血氧分压[p(O 2)]、二氧化碳分压[p(CO 2)]、pH、血乳酸(Lac)、氧合指数、膈肌运动度(DE)、膈肌增厚率(DTF)、膈肌浅快呼吸指数、膈肌收缩速度均较治疗前显著改善(P均<0.05),观察组以上指标在上述时间点均显著优于对照组(P均<0.05)。2组治疗第3天、第5天、撤机前的血清NT-proBNP和hs-CRP水平较治疗前显著降低(P均<0.05),观察组以上指标在以上时间点均显著低于对照组(P均<0.05)。观察组VAP发生率显著低于对照组(P<0.05),撤机时间、住院时间均短于对照组(P均<0.05),住院费用显著少于对照组(P<0.05),撤机成功率显著高于对照组(P<0.05)。结论参麦注射液联合针刺疗法可显著改善COPD合并呼吸衰竭机械通气撤机困难患者呼吸力学和肺氧合功能,提高膈肌功能,并降低NT-proBNP和hs-CRP水平,从而有利于提高撤机成功率,降低VAP发生率,缩短住院时间和减少费用,具有较高的效价比。
Objective It is to observe the efficacy of Shenmai injection combined with acupuncture on the difficulty of mechanical ventilation weaning in chronic obstructive pulmonary disease(COPD)with respiratory failure and its effects on the function of diaphragmatic muscle,N-terminal pro-brain natriuretic peptide(NT-proBNP)and high sensitive C-reactive protein(hs-CRP).Methods Ninety-one patients with COPD and respiratory failure with difficulty of mechanical ventilation weaning were randomly divided into observation group(46 cases)and control group(45 cases).The control group was given conventional treatment,and the observation group was given Shenmai injection combined with acupuncture on the basis of the control group,and the treatment was performed until the machine was withdrawn.The changes of ventilator respiratory mechanics parameters,blood gas analysis index,diaphragm function,levels of NT-proBNP and hs-CRP were observed during the treatments.The time of weaning,the success rate of weaning,the length of hospital stay and the cost were recorded in the two groups.Results On the 3rd day,the 5th day and before weaning,the lung compliance(Cdyn)was significantly higher while the respiratory work(WOB),peak inspimtory pressure(PIP)and airway resistance(Raw)were lower than those before treatment in the two groups(P<0.05),and the improvements of the above respiratory mechanics parameters of the observation group were better than those of the control group(P<0.05);arterial oxygen saturation[S a(O 2)],arterial oxygen partial pressure[p(O 2)],carbon dioxide partial pressure[p(CO 2)],pH,blood lactate(Lac),oxygenation index,diaphragmatic motor mobility(DE),diaphragm thickening fraction(DTF),the superficial fast breathing index,and the diaphragmatic contraction rate were significantly improved in the two groups(P<0.05),the above indicators in the observation group were superior to the control group at the above time points(P<0.05);the levels of serum NT-proBNP and hs-CRP were significantly lower than those before treatment in the
作者
吴玲玲
郭红云
WU Lingling;GUO Hongyun(Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,Inner Mongolia,China)
出处
《现代中西医结合杂志》
CAS
2019年第29期3233-3238,3268,共7页
Modern Journal of Integrated Traditional Chinese and Western Medicine
