大剂量生黄芪对呼吸机相关膈肌功能障碍的影响
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摘要
目的观察大剂量生黄芪对呼吸机相关膈肌功能障碍的作用及对撤机的影响。方法选取2016年1月至2017年12月江苏省靖江市中医院重症医学科58例因呼吸衰竭而行有创通气的患者,统一采用辅助通气模式,在机械通气6 h后随机分为2组,各29例。对照组以早期目标导向镇静方法予以浅镇静,气道管理;同时予氨溴索化痰,能全力胃肠营养支持,枯草杆菌肠球菌二联活菌肠溶胶囊防止肠道细菌的移位等。实验组在对照组治疗基础上加用生黄芪120 g、川芎10 g,每日1剂,分2次鼻饲,每次50 mL,疗程7 d。比较2组患者治疗前后的呼吸力学指标、膈肌功能以及撤机成功率。结果实验组的最大吸气压力(MIP)、潮气量(Vt)、膈肌增厚分数(DTF)、膈肌活动度(DE)在治疗后明显高于对照组;DE对预后的判断价值较高(P=0.000);且实验组的呼吸机相关膈肌功能障碍发生率低于对照组(χ~2=4.614,P=0.032),撤机成功率高。结论大剂量生黄芪能够改善呼吸机相关膈肌功能障碍,改善预后。
Objective To explore the therapeutic efficacy of large dose Astragalus Membranaceus on ventilator-induced diaphragmatic dysfunction and weaning of intubation. Methods 58 patients of respiration failure with mechanical ventilation in ICU of Jingjiang Hospital of TCM were randomly divided into the treatment group(29 cases) and the control group(29 cases). The control group was given shallow sedation and airway management with early goal-oriented sedation. At the same time, the ambroxol sputum is used to support the gastrointestinal nutrition, and the Bacillus subtilis enteric capsule can prevent the intestinal bacteria from shifting. The control group was given routine treatment,while the treatment group were received nasal feeding decoction for 50 mL each time with astragalus membranaceus 120 g and rhizome of chuanxiong 10 g twice one day on the basis of the control group's treatments. Then compare the results of breathing mechanics, diaphragmatic functionand and the success rate of ventilator weaning in both groups. Results After the treatment, the results of Vt, MIP, DTF and DE of the experimental group were significantly higher than the control group. ROC suggested that DE was of high value in predicting prognosis(AUC of DE:0.949±0.032,P=0.000). The incidence of VIDD of the experimental group was lower than that of the control group(χ~2=4.614,P=0.032). And the success rate of weaning and detaching ventilator was higher. Conclusion High dosage of Astragalus Membranaceus can improve the ventilator-induced diaphragmatic dysfunction and improve the prognosis.
Objective To explore the therapeutic efficacy of large dose Astragalus Membranaceus on ventilator-induced diaphragmatic dysfunction and weaning of intubation. Methods 58 patients of respiration failure with mechanical ventilation in ICU of Jingjiang Hospital of TCM were randomly divided into the treatment group(29 cases) and the control group(29 cases). The control group was given shallow sedation and airway management with early goal-oriented sedation. At the same time, the ambroxol sputum is used to support the gastrointestinal nutrition, and the Bacillus subtilis enteric capsule can prevent the intestinal bacteria from shifting. The control group was given routine treatment,while the treatment group were received nasal feeding decoction for 50 mL each time with astragalus membranaceus 120 g and rhizome of chuanxiong 10 g twice one day on the basis of the control group's treatments. Then compare the results of breathing mechanics, diaphragmatic functionand and the success rate of ventilator weaning in both groups. Results After the treatment, the results of Vt, MIP, DTF and DE of the experimental group were significantly higher than the control group. ROC suggested that DE was of high value in predicting prognosis(AUC of DE:0.949±0.032,P=0.000). The incidence of VIDD of the experimental group was lower than that of the control group(χ~2=4.614,P=0.032). And the success rate of weaning and detaching ventilator was higher. Conclusion High dosage of Astragalus Membranaceus can improve the ventilator-induced diaphragmatic dysfunction and improve the prognosis.
引文
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[3] 郭丽青,刘向国.膈肌疲劳与慢性阻塞性肺疾病[J].中医药临床杂志,2017,29(10):1575-1578.
[4] 李亚.慢性阻塞性肺疾病大鼠模型的优化与评价及补肺健脾方对膈肌功能的影响[D]. 北京:北京中医药大学,2011.
[5] 徐坡,孙腾.大剂量生黄芪对慢性阻塞性肺疾病稳定期患者呼吸肌肌力的影响[J].陕西中医,2016,37(9):1124-1127.
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[9] 王慧,薛乾隆,王霞,等.膈肌功能对慢性阻塞肺疾病加重期插管患者撤机的指导价值分析[J].临床肺科杂志, 2015,20(3):465-468.
[10] 李钰,徐建国,徐敏,等.不同机械通气模式对呼吸机相关性膈肌功能障碍的影响[J].实用医学杂志,2017,33(2):238-242.
[11] 罗杰英,韩小彤,樊麦英,等.膈肌功能评估在撤机中的指导意义[J].中华危重病急救医学,2017,29(11):1035-1038.
[12] UMBRELLO M,FORMENTI P,LONGHI D,et a1.Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation:a pilot clinical study[J].Crit Care,2015,19(4):161-170.
[13] DININO E,GARTMAN E J,SETHI J M,et al.Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation[J]. Thorax,2014,69(5):423-427.
[14] 陆志华,徐秋萍,袁月华,等.膈肌增厚分数指导慢性阻塞性肺疾病机械通气患者撤机的临床研究[J].中华急诊医学杂志,2016,25(4):491-494.
[15] 胡仕静,周树生,吴丹,等.膈肌超声预测机械通气撤机结果的价值[J].安徽医科大学学报,2016,51(5):673-677.
[16] 郑虎占.黄芪在不同配伍中的用量探讨[J].现代中医临床,2004,11(4):23-24.
[17] 李洋.不同配伍比例的黄芪当归药对对废用性肌萎缩的影响[D].西安:西北大学,2015.
[18] 周惠芬,何昱,张宇燕,等.黄芪川芎主要有效成分配伍的转运研究[J].中华中医药学刊,2015,33(4):868-871.
[19] SWETS J.Measuring the accuracy of diagnostic systems[J].Science,1988, 240(4857):1285-1293.
[2] 张常晶,马少林,朱晓萍.危重病膈肌功能障碍的影响因素及其机制[J].中华结核和呼吸杂志,2015,38(3):215-218.
[3] 郭丽青,刘向国.膈肌疲劳与慢性阻塞性肺疾病[J].中医药临床杂志,2017,29(10):1575-1578.
[4] 李亚.慢性阻塞性肺疾病大鼠模型的优化与评价及补肺健脾方对膈肌功能的影响[D]. 北京:北京中医药大学,2011.
[5] 徐坡,孙腾.大剂量生黄芪对慢性阻塞性肺疾病稳定期患者呼吸肌肌力的影响[J].陕西中医,2016,37(9):1124-1127.
[6] 孙腾,徐坡.大剂量生黄芪对慢性阻塞性肺病患者呼吸肌肌力及预后的影响[J]. 陕西中医,2015,36(6):660-662.
[7] SAMIR J,BORIS J,STEFAN M,et al.Clinical review:Ventilator-induced diaphragmatic dysfunction-human studies confirm animal model findings[J].Critical care,2011,15(1):206.
[8] MROZEK S,JUNG B,PETROF B J,et al.Rapid onset of specific diaphragm weakness in a healthy murine model of ventilator-induced diaphragmatic dysfunction[J]. Crit Care Med,2012,117(3):560-567.
[9] 王慧,薛乾隆,王霞,等.膈肌功能对慢性阻塞肺疾病加重期插管患者撤机的指导价值分析[J].临床肺科杂志, 2015,20(3):465-468.
[10] 李钰,徐建国,徐敏,等.不同机械通气模式对呼吸机相关性膈肌功能障碍的影响[J].实用医学杂志,2017,33(2):238-242.
[11] 罗杰英,韩小彤,樊麦英,等.膈肌功能评估在撤机中的指导意义[J].中华危重病急救医学,2017,29(11):1035-1038.
[12] UMBRELLO M,FORMENTI P,LONGHI D,et a1.Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation:a pilot clinical study[J].Crit Care,2015,19(4):161-170.
[13] DININO E,GARTMAN E J,SETHI J M,et al.Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation[J]. Thorax,2014,69(5):423-427.
[14] 陆志华,徐秋萍,袁月华,等.膈肌增厚分数指导慢性阻塞性肺疾病机械通气患者撤机的临床研究[J].中华急诊医学杂志,2016,25(4):491-494.
[15] 胡仕静,周树生,吴丹,等.膈肌超声预测机械通气撤机结果的价值[J].安徽医科大学学报,2016,51(5):673-677.
[16] 郑虎占.黄芪在不同配伍中的用量探讨[J].现代中医临床,2004,11(4):23-24.
[17] 李洋.不同配伍比例的黄芪当归药对对废用性肌萎缩的影响[D].西安:西北大学,2015.
[18] 周惠芬,何昱,张宇燕,等.黄芪川芎主要有效成分配伍的转运研究[J].中华中医药学刊,2015,33(4):868-871.
[19] SWETS J.Measuring the accuracy of diagnostic systems[J].Science,1988, 240(4857):1285-1293.