高江宝 李辉 杨英艺 吴少丽 宋斐

摘要：目的 探究采用益氣活血法治疗对重症肺炎机械通气患者临床疗效的影响。方法 选择重症肺炎患者61例作为研究对象，采用随机数表法将其随机分为对照组（n=30）和治疗组（n=31），其中对照组根据临床指南进行常规西医治疗，治疗组在常规西医治疗的基础上加用自拟益气活血方治疗。比较2组患者治疗1、5d外周血炎症指标（CRP、PCT、WBC）、免疫指标（LYM、CD4细胞）、肺顺应性、氧合指数、CIPS评分变化情况以及膈肌功能障碍发生率、有创机械通气时间、血管活性药物使用时间。结果 治疗5d后，治疗组患者的外周血CRP、PCT、WBC、LYM、CD4细胞水平以及肺顺应性、氧合指数、CIPS评分均较对照组有显著的改善（P<0.05）;治疗组膈肌功能障碍总发生率38.71%，明显低于对照组的73.33%（P<0.05）;治疗组患者的有创机械通气时间、血管活性药物使用时间明显短于对照组（P<0.05）。结论 益气活血法辅助治疗既能够减轻重症肺炎机械通气患者的炎症反应，改善其免疫功能和呼吸功能，又可减少膈肌功能障碍发生，缩短机械通气时间，对于改善患者预后具有积极的意义。

关键词：重症肺炎;益气活血法;有创机械通气治疗;炎症因子;膈肌

中图分类号：R563.1   文献标志码：B   文章编号：1007-2349（2021）12-0040-05

Observation on Therapeutic Effect of Yiqi Huoxue Prescription on Patientswith Severe Pneumonia Mechanical Ventilation

GAO Jiang-bao， LI Hui， YANG Ying-yi， WU Shao-li， SONG Fei

（Panyu District Hospital of Traditional Chinese Medicine of Guangzhou City， Guangzhou 511400， China）

【Abstract】Objective： To study the clinical effect of Yiqi Huoxue Prescription on the the patients with severe pneumonia mechanical ventilation. Methods： 61 patients with severe pneumonia were selected as the research objects， and they were randomly divided into a control group （n=30） and a treatment group （n=31） by using a random number table. The control group was treated with conventional western medicine according to clinical guidelines and the treatment group was treated with self-made Yiqi Huoxue Prescription on the basis of conventional western medicine treatment. The changes of the peripheral blood inflammation indicators （CRP， PCT， WBC）， immune indicators （LYM， CD4 cells）， lung compliance， oxygenation index， CIPS score changes as well as  the incidence of diaphragmatic dysfunction and invasive mechanical ventilation time and vasoactive drug use time of the two groups were compared on the 1st and 5th day of treatment. Results： After 5-day treatment， the peripheral blood CRP， PCT， WBC， LYM， CD4 cell levels， lung compliance， oxygenation index， and CIPS score changes of the treatment group were significantly improved when compared with those of the control group （P<0.05）. The total incidence of diaphragmatic dysfunction was 38.71%， which was significantly lower than 73.33% of the control group （P<0.05）. The invasive mechanical ventilation time and the vasoactive drug use time in the treatment group were significantly shorter than those in the control group （P<0.05）. Conclusion： Yiqi Huoxue Prescription can not only reduce the inflammatory response of severe pneumonia patients with mechanical ventilation， improve their immune function and respiratory function， but also reduce the occurrence of diaphragmatic dysfunction and shorten the mechanical ventilation time， which has positive significance for improving the prognosis of patients.

【Key words】Severe Pneumonia; Yiqi Huoxue Prescription; Invasive Mechanical Ventilation Treatment; Inflammatory Factor; Diaphragm

重症肺炎为临床常见的重症感染性呼吸系统疾病，由肺炎发展而来，并伴有持续性高热、呼吸困难、痰液黏稠难以咳出等临床表现，严重的可引起多个组织脏器功能衰竭或全身炎性反应综合征，威胁患者生命安全。相关数据显示[1]，重症肺炎的病死率高于50%，为ICU患者死亡的主要病因之一。有创机械通气是当前临床治疗重症肺炎的主要手段，能够快速纠正低氧血症，稳定患者的呼吸、循环功能。但由于重症肺炎好发于老年人群，其肺部结构较差，会出现不同程度的呼吸肌肉的萎缩，使患者机械通气时间延长，甚至出现困难脱机情况，增加呼吸机相关性肺炎等并发症发生率及患者病死率[2]。……