【摘要】：目的:研究滌痰通腑、益氣活血法聯(lián)合無創(chuàng)機(jī)械通氣在改善輕、中型肺性腦病中醫(yī)辯證屬于痰蒙神竅患者中醫(yī)證候積分、動(dòng)脈血?dú)�、意識(shí)恢復(fù)方面的作用,以及滌痰通腑、益氣活血法是否能減少機(jī)械通氣患者腹脹、嘔吐、誤吸等不良反應(yīng),探討中西結(jié)合治療肺性腦病的思路和方法。方法:選擇我科2014年01月至2015年12月期間住院的99例輕、中型肺性腦病患者,按計(jì)算機(jī)順序編碼隨機(jī)分成治療組66例,對(duì)照組33例。治療組在無創(chuàng)機(jī)械通氣和西藥治療基礎(chǔ)上予以承氣灌腸液保留灌腸,每日1次,7天一療程,根據(jù)患者治療反應(yīng)調(diào)整用量,對(duì)照組僅予以無創(chuàng)機(jī)械通氣和西藥治療。記錄兩組治療前、治療后中醫(yī)證候積分,動(dòng)脈血?dú)夥治鲋笜?biāo)變化(Pa CO2、Pa O2),GCS評(píng)分變化,治療前后腹脹、嘔吐、誤吸癥狀的發(fā)生率,撤機(jī)成功例數(shù)及氣管插管例數(shù),并記錄治療前及療程結(jié)束后的肝功(AST、ALT)、腎功(BUN、Cr)等安全性指標(biāo)。結(jié)果:(1)治療組治療后中醫(yī)證候積分改善程度優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(2)治療組的臨床療效優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(3)治療組治療后1天Pa CO2、Pa O2與對(duì)照組治療后Pa CO2、Pa O2比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療后7天Pa CO2、Pa O2與對(duì)照組治療后Pa CO2、Pa O2比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);(4)通氣指標(biāo)比較:治療組通氣時(shí)間少于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(5)意識(shí)恢復(fù)時(shí)間比較:治療組治療后1天GCS評(píng)分改善優(yōu)于對(duì)照組(P0.05),治療后7天兩組GCS評(píng)分比較,差異差異無統(tǒng)計(jì)學(xué)意義(P0.05);(6)并發(fā)癥比較:治療組腹脹、嘔吐、誤吸等發(fā)生率少于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(7)氣管插管例數(shù)、撤機(jī)成功例數(shù)比較:治療組氣管插管率低于對(duì)照組,撤機(jī)成功率高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(8)安全性比較:治療組治療后AST、ALT、BUN、Cr與對(duì)照組比較無差異(P0.5)。結(jié)論:滌痰通腑、益氣活血法聯(lián)合無創(chuàng)機(jī)械通氣可改善肺性腦病患者中醫(yī)證候,減少通氣時(shí)間,縮短平均意識(shí)恢復(fù)時(shí)間,降低氣管插管率及死亡率,提高撤機(jī)成功率,能有效減少腹脹、嘔吐、誤吸等并發(fā)癥的發(fā)生,對(duì)肝、腎功等安全性指標(biāo)影響較小。
[Abstract]:Objective: to study the effects of phlegm, tonifying qi and activating blood circulation method combined with noninvasive mechanical ventilation on improving TCM syndromes, arterial blood gas and consciousness recovery in patients with light and moderate pulmonary encephalopathy. Whether the method of invigorating qi and activating blood can reduce the adverse reactions such as abdominal distension, vomiting and aspiration in patients with mechanical ventilation, this paper discusses the thinking and method of treating pulmonary encephalopathy with combination of Chinese and western medicine. Methods: 99 patients with mild and moderate pulmonary encephalopathy from January 2014 to December 2015 were randomly divided into treatment group (n = 66) and control group (n = 33). The treatment group was treated with gas enema on the basis of non-invasive mechanical ventilation and western medicine. The treatment group was treated with non-invasive mechanical ventilation and western medicine only. Before and after treatment, the scores of TCM syndromes, the changes of arterial blood gas analysis index (Pa CO2,Pa O 2), the incidence of abdominal distension, vomiting and aspiration, the successful cases of weaning and tracheal intubation were recorded before and after treatment. Liver function (AST,ALT) and renal function (BUN,Cr) were recorded before and after treatment. Results: (1) the improvement of TCM syndromes in the treatment group was better than that in the control group (P0.05); (2), and the clinical effect of the treatment group was better than that of the control group. The difference was statistically significant (P0.05); (3) between the treatment group and the control group after the treatment of Pa CO2,Pa O2 1 day after treatment, the difference was statistically significant (P0.05); 7 days after the treatment of Pa CO2,Pa O2 and control group after treatment Pa CO2,Pa O2 comparison, No significant difference (P0.05); (4) ventilation index comparison: the treatment group ventilation time is less than the control group, Significant difference (P0.05); (5) consciousness recovery time comparison: the treatment group 1 day after treatment GCS score improvement than the control group (P0.05), 7 days after the treatment of the two groups GCS score comparison, the difference was not statistically significant (P0.05); (6) complications comparison: treatment group abdominal distension, vomiting, The incidence of missuction was lower than that of the control group (P0.05); (7). The successful rate of tracheal intubation in the treatment group was lower than that in the control group, and the success rate was higher in the treatment group than in the control group. The difference was statistically significant (P0.05). (8) safety comparison: the treatment group after treatment compared with the control group AST,ALT,BUN,Cr was no difference (P0. 5). Conclusion: the method of removing phlegm and activating qi and activating blood circulation combined with non-invasive mechanical ventilation can improve the syndrome of pulmonary encephalopathy, reduce the time of ventilation, shorten the time of average consciousness recovery, reduce the rate of tracheal intubation and mortality, and improve the success rate of weaning. It can effectively reduce the incidence of abdominal distension, vomiting, aspiration and other complications, and has little effect on safety indexes such as liver and kidney function.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259;R277.7

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