理肺平喘汤联合无创辅助通气治疗慢性阻塞性肺疾病急性加重期并发Ⅱ型呼吸衰竭患者的效果观察

Efficacy of Lifei Pingchuan Decoction combined with non-invasive ventilation in treating patients with AECOPD complicated by type Ⅱ respiratory failure

摘要:

目的 探讨理肺平喘汤与无创通气联用对慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者的治疗效果。方法 选取2023年9月—2024年9月在常州市中医医院就诊的AECOPD合并Ⅱ型呼吸衰竭患者84例，按随机数字表法分为对照组（常规西医治疗联合无创辅助通气）和观察组（在对照组基础上加用孟河医派理肺平喘汤），各42例。比较两组患者治疗2周后的中医疗效、慢性阻塞性肺疾病评估测试（CAT）评分、改良版英国医学研究会呼吸问卷（mMRC）、肺功能［第1秒用力呼气量（FEV₁）、FEV₁与用力肺活量比值（FEV_l/FVC）、呼气峰流速（PEF）］、血气分析［动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）及氧合指数］、炎症指标［白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、C反应蛋白（CRP）］及治疗期间机械通气时间、重症监护室（ICU）住院时间、年急性加重次数。结果 观察组临床总有效率高于对照组（P 0.05）。观察组治疗后CAT、mMRC评分均低于对照组（P 0.05）；观察组治疗前后CAT、mMRC评分的差值均大于对照组（P 0.05）。观察组治疗后FEV₁、FEV_l/FVC、PEF均高于对照组（P 0.05）；观察组治疗前后FEV₁、FEV_l/FVC、PEF的差值均大于对照组（P 0.05）。观察组治疗后PaO₂、氧合指数均高于对照组，PaCO₂低于对照组（P 0.05）；观察组治疗前后PaO₂、PaCO₂、氧合指数的差值均大于对照组（P 0.05）。观察组治疗后IL-6、IL-8、CRP均低于对照组（P 0.05）；观察组治疗前后IL-6、IL-8、CRP的差值均大于对照组（P 0.05）。观察组机械通气时间和ICU住院时间均短于对照组，1年内急性加重次数少于对照组（P0.05）。结论 AECOPD合并Ⅱ型呼吸衰竭患者应用理肺平喘汤联合无创辅助通气可有效改善临床症状、肺通气功能与氧合状态，减轻机体炎症反应，并能缩短机械通气和ICU住院时间，降低远期急性加重风险，是一种值得临床推广的中西医结合治疗方案。

Abstract:

Objective To investigate the clinical efficacy of Lifei Pingchuan Decoction combined with non-invasive ventilation in treating patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by type II respiratory failure.Methods Eighty-four patients with AECOPD complicated by type II respiratory failure, who were treated at Changzhou Hospital of Traditional Chinese Medicine from September 2023 to September 2024, were selected and divided into a control group (conventional Western medicine treatment combined with non-invasive ventilation) and an observation group (additional Menghe Medical School's Lifei Pingchuan Decoction) using a random number table method, with 42 cases in each group. After two weeks of treatment, the two groups were compared in terms of traditional Chinese medicine efficacy, Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scores, modified British Medical Research Council (mMRC) questionnaire scores, lung function [forced expiratory volume in one second (FEV₁), FEV₁/forced vital capacity (FEV₁/FVC), and peak expiratory flow (PEF) ], blood gas analysis [arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and oxygenation index], inflammatory markers [interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP) ], as well as the duration of mechanical ventilation, length of intensive care unit (ICU) stay, and annual frequency of acute exacerbations during the treatment period.Results The overall clinical effective rate in the observation group was higher than that in the control group (P 0.05). After treatment, the CAT and mMRC scores in the observation group were lower than those in the control group (P 0.05). The differences in CAT and mMRC scores before and after treatment in the observation group were greater than those in the control group (P 0.05). After treatment, FEV₁, FEV₁/FVC, and PEF in the observation group were higher than those in the control group (P 0.05). The differences in FEV₁, FEV₁/FVC, and PEF before and after treatment in the observation group were greater than those in the control group (P 0.05). After treatment, PaO₂ and the oxygenation index in the observation group were higher than those in the control group, while PaCO₂ was lower than that in the control group (P 0.05). The differences in PaO₂, PaCO₂, and the oxygenation index before and after treatment in the observation group were greater than those in the control group (P 0.05). After treatment, IL-6, IL-8, and CRP levels in the observation group were lower than those in the control group (P 0.05). The differences in IL-6, IL-8, and CRP levels before and after treatment in the observation group were greater than those in the control group (P 0.05). The duration of mechanical ventilation and the length of ICU stay in the observation group were shorter than those in the control group, and the number of acute exacerbations within one year was fewer than that in the control group (P 0.05).Conclusion Lifei Pingchuan Decoction combined with non-invasive ventilation can effectively alleviate clinical symptoms, improve lung ventilation function and oxygenation status, reduce systemic inflammatory response, shorten the duration of mechanical ventilation and ICU stay, and lower the long-term risk of acute exacerbations in patients with AECOPD complicated by type II respiratory failure. This integrated Chinese and Western medicine approach is worthy of clinical application.