作者：杨海霞，王生伟，汤炜炜

单位：

210029 江苏省南京市，南京医科大学附属脑科医院胸科院区急诊科；通信作者：杨海霞，E-mail：yanghx8801@163.com

关键词：

慢性阻塞性肺疾病；急性加重期；呼吸功能不全；清金化痰活血方；无创正压通气；炎性反应；治疗结果

Keywords：

Chronic obstructive pulmonary disease；Acute exacerbation；Respiratory insufficiency；QingjinHuatan Huoxue Recipe；Noninvasive positive pressure ventilation；Inflammatory response；Treatment outcome

CLC：

R 563.9　R 563.8

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.015

Funds：

摘要：

目的　探讨清金化痰活血方联合无创正压通气（NIPPV）治疗慢性阻塞性肺疾病急性加重期（AECOPD）并Ⅱ型呼吸衰竭患者的临床疗效及安全性。方法　选取 2017 年 11 月—2019 年 8 月在南京医科大学附属脑科医院胸科院区急诊科就诊的 AECOPD 并Ⅱ型呼吸衰竭患者 80 例，根据随机数字表法分为对照组和治疗组，各 40 例。患者入院后均给予常规治疗及 NIPPV 治疗，其中对照组患者给予中药对照剂治疗，治疗组患者采用清金化痰活血方治疗；两组患者均持续治疗 2 周。比较两组患者治疗前后中医症候积分、动脉血气分析指标〔包括 pH 值、动脉血氧分压（PaO 2 ）、动脉血二氧化碳分压（PaCO 2 ）〕、炎性指标〔包括白细胞计数（WBC）、中性粒细胞分数（N）、超敏 C 反应蛋白（hs-CRP）、降钙素原（PCT）、血清淀粉样蛋白 A（SAA）及白介素 8（IL-8）〕，并观察患者治疗期间不良反应发生情况。结果　两组患者治疗前中医证候积分、pH 值、PaO 2 、PaCO 2 、WBC、N、hs-CRP、PCT、SAA、IL-8 及治疗后 pH 值、WBC 比较，差异无统计学意义（P>0.05）；治疗组患者治疗后中医症候积分、PaCO 2 、N、hs-CRP、PCT、SAA、IL-8 低于对照组，PaO 2 高于对照组（P<0.05）。两组患者治疗期间不良反应发生率均为 25.0%（10/40）。结论　清金化痰活血方联合 NIPPV 治疗可改善 AECOPD 并Ⅱ型呼吸衰竭患者的临床症状及动脉血气分析，减轻炎性反应，且安全性较高。

Abstract：

Objective　To observe the clinical efficacy and safety of Qingjin Huatan Huoxue Recipe combined withnon-invasive positive pressure ventilation （NIPPV） in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）patients complicated with type Ⅱ respiratory failure.Methods　80 AECOPD patients complicated with type Ⅱ respiratoryfailure in the Department of Emergency of Thoracic Medicine，the Affiliated Brain Hospital of Nanjing Medical Universityfrom November 2017 to August 2019 were selected，and they were divided into control group and treatment group according torandom number table method，40 cases in each group.Both groups were treated with basic treatment and NIPPV，patients incontrol group were given contrast of Chinese medicine，patients in treatment group were treated with Qingjin Huatan HuoxueRecipe，both groups were treated for 2 weeks.TCM symptom score，arterial blood gas analysis indicators（including pH value，PaO 2 ，PaCO 2 ），inflammation indicators（including WBC，N，hs-CRP，PCT，SAA，IL-8） were compared between thetwo groups，and incidence of adverse reactions were observed.Results　There was no significant difference in TCM syndromescore，pH value，PaO 2 ，PaCO 2 ，WBC，N，hs-CRP，PCT，SAA and IL-8 before treatment and pH value and WBC aftertreatment between the two groups （P>0.05）；after treatment，TCM syndrome score，PaCO 2 ，N，hs-CRP，PCT，SAA andIL-8 in treatment group were lower than those in control group，PaO 2 in treatment group was higher than that in control group（P<0.05）.The incidence of adverse reactions in the two groups was 25.0%（10/40）.Conclusion　Qingjin Huatan HuoxueRecipe combined with NIPPV can improve the clinical symptoms and arterial blood gas analyse of AECOPD patients complicatedwith type Ⅱ respiratory failure，reduce inflammatory response，and with higher safety.

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