作者：丁兰,王少霞,魏玉芳,袁旭丽,党伟,阮昕,许红娟,王建新

单位：

1.054000 河北省邢台市人民医院呼吸内科 2.050000 河北省石家庄市，河北医科大学第二医院营养科 3.054900 河北省邢台市 临西县人民医院内科 4.054001 河北省邢台市中医院中医内科

Units：

1.Department of Respiratory Medicine, Xingtai People's Hospital, Xingtai 054000, China 2.Department of Nutrition, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China 3.Department of Internal Medicine, Linxi County People's Hospital, Xingtai 054900, China 4.Department of Traditional Chinese Medicine, Xingtai Hospital of Traditional Chinese Medicine, Xingtai 054001, China Corresponding author: WANG Shaoxia, E-mail: 2705812803@qq.com

关键词：

慢性阻塞性肺疾病; 急性加重; 肺性脑病; 清热化痰方; 神经功能; 治疗结果;

Keywords：

Chronic obstructive pulmonary disease; Acute exacerbation; Pulmonary encephalopathy; Qingre Huatanprescription; Neurological function; Treatment outcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.289

Funds：

河北省中医药管理局科研计划项目（2019519）

摘要：

背景慢性阻塞性肺疾病急性加重期(AECOPD)并肺性脑病的西医治疗仅局限于对症处理,而中医药治疗具有明显优势,既能缓解患者的临床症状,又能增强体质,改善生活质量。目的 探讨清热化痰方治疗AECOPD并肺性脑病的临床疗效及其对患者神经功能的影响。方法 选取2018年6月至2019年10月邢台市人民医院呼吸内科收治的AECOPD并肺性脑病患者86例,按照随机数字表法将其分为对照组和试验组,各43例。对照组患者采用常规西医治疗,试验组患者在对照组基础上采用清热化痰方治疗,两组患者均持续治疗7～10 d。比较两组患者的临床疗效及治疗前后血气分析指标〔动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)〕、格拉斯哥昏迷量表(GCS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、简易精神状态检查量表(MMSE)评分及血清脑源性神经营养因子(BDNF)、S100B蛋白、神经元特异性烯醇化酶(NSE)水平。结果 试验组患者临床疗效优于对照组(P <0.05)。治疗前两组患者PaO2、PaCO2、OI、GCS评分、APACHEⅡ评分、MMSE评分及血清BDNF、S100B蛋白、NSE水平比较,差异无统计学意义(P>0.05);治疗后试验组患者PaO2、OI、GCS评分、MMSE评分及血清BDNF、S100B蛋白、NSE水平高于对照组,PaCO2、APACHEⅡ评分低于对照组(P <0.05)。两组患者治疗后PaO2、OI、GCS评分、MMSE评分及血清BDNF、S100B蛋白、NSE水平分别高于本组治疗前,PaCO2、APACHEⅡ评分分别低于本组治疗前(P <0.05)。结论 清热化痰方治疗AECOPD并肺性脑病的临床疗效确切,可有效纠正患者低氧血症,减轻神经损伤,进而改善认知及神经功能,促进意识恢复。

Abstract：

【Abstract】　Background Western medicine therapy on acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with pulmonary encephalopathy is still limited to symptomatic treatment, while traditional Chinesemedicine therapy has obvious advantages, which can not only relieve clinical symptoms of patients, but also enhance patients'physical fitness, and improve the quality of life. Objective To investigate the clinical effect of Qingre Huatan prescription ontreating AECOPD complicated with pulmonary encephalopathy and its impact on neurological function of patients. MethodsFrom June 2018 to October 2019, 86 AECOPD patients complicated with pulmonary encephalopathy admitted to Department ofRespiratory Medicine, Xingtai People's Hospital were selected, and they were divided into control group and experimental groupaccording to random number table method, 43 cases in each group. Patients in control group were given routine western medicinetreatment, patients in experimental group were given Qingre Huatan prescription based on control group, both groups were treatedfor 7-10 days. Clinical effect, blood gas indexes [arterial partial pressure of oxygen (PaO2) , arterial partial pressure of carbondioxide (PaCO2) , oxygenation index (OI) ] , Glasgow Coma Scale (GCS) score, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score, Mini-mental State Examination (MMSE) score and serum levels of brain-derived neurotrophic factor (BDNF) ,S100B protein, neuron specific enolase (NSE) before and after treatment were compared between the two groups. Results Clinicaleffect of experimental group was better than that of control group (P < 0.05) . There was no significant difference in PaO2, PaCO2,OI, scores of GCS, APACHE Ⅱ and MMSE, and serum levels of BDNF, S100B protein and NSE before treatment between thetwo groups (P > 0.05) ; after treatment, PaO2, OI, scores of GCS and MMSE and serum levels of BDNF, S100B protein and NSEof experimental group were higher than those of control group, PaCO2, APACHE Ⅱ score were lower than those of control group(P < 0.05) . PaO2, OI, GCS score, MMSE score and serum levels of BDNF, S100B protein and NSE after treatment of the twogroups were higher than those before treatment, PaCO2, APACHE Ⅱ score were lower than those before treatment, respectively(P < 0.05) . Conclusion Qingre Huatan prescription has an exact clinical effect in the treatment of AECOPD patientscomplicated with pulmonary encephalopathy, which can significantly correct hypoxemia, reduce nerve injury, improve cognitiveand neurological function, and promote the recovery of consciousness.

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