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Received:December 09, 2020 Published Online:July 20, 2021
Received:December 09, 2020 Published Online:July 20, 2021
中文摘要: 目的探讨清热化痰、益气活血法治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发心力衰竭的临床疗效。方法将2018年2月至2019年12月邢台市人民医院呼吸科重症监护病房接诊的92例AECOPD并发心力衰竭患者按照随机数字表法分为观察组和对照组。对照组(46例)采用常规无创正压通气、抗感染、止咳化痰平喘、强心治疗;观察组(46例)在对照组治疗基础上给予清热化痰方口服以及参麦注射液静脉注射。观察两组治疗前后心功能［二尖瓣E峰值/A峰值(E/A)比值、左室射血分数(LVEF)以及左心室Tei指数］、肺功能［第1秒用力呼气容积(FEV1),最大自主通气量(MVV)、最大自主通气量占预计值百分比(MVV%pred)］、血气指标［动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、氧合指数］、疗效及不良反应发生情况。结果(1)疗效:观察组治疗总有效率高于对照组(91.30% vs 76.09%, χ2=3.903,P<0.05)。(2)心功能指标:治疗后,两组Tei指数均较治疗前下降,E/A、LVEF均较治疗前增高,且观察组Tei指数低于对照组,E/A、LVEF高于对照组,差异有统计学意义(P<0.05)。(3)肺功能指标:治疗后,两组FEV1、MVV、MVV%pred均较治疗前增高,且观察组FEV1、MVV、MVV%pred均高于对照组,差异有统计学意义(P<0.05)。(4)血气指标:治疗后,两组PaO2、氧合指数均较治疗前升高,PaCO2较治疗前下降;且观察组PaO2、氧合指数水平高于对照组,PaCO2低于对照组,差异有统计学意义(P<0.05)。(5)不良反应:观察组和对照组不良反应发生率比较差异无统计学意义(2.17% vs 4.35%,P>0.05)。结论清热化痰、益气活血法治疗AECOPD并发心力衰竭可显著改善患者心肺动能,纠正低氧血症,提高临床疗效。
Abstract:Objective To investigate the clinical efficacy of
clearing away heat and resolving phlegm，invigorating Qi and promoting blood circulation on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with heart failure (HF).
Methods Ninety two AECOPD patients complicated with HF admitted to the respiratory intensive care unit from February 2018 to December 2019 were randomly divided into observation group and control group (n=46,each).The routine treatment of non invasive positive pressure ventilation,anti infection,resolving sputum,relieving asthma and cough and cardiotonic agent was conducted in control group.
Clearing heat and resolving phlegm decoction and Shen mai injection were given based on the routine treatment in observation group.The cardiac function［peak value of mitral valve E/A,left ventricular ejection fraction (LVEF),left ventricular Tei index］,pulmonary function ［forced expiratory volume in first second (FEV1),maximal voluntary ventilation (MVV),MVV%pred］,blood gas analysis index［PaO2,PaCO2 and oxygenation index(OI)］ before and after treatment,and the thorapeutic effect and adverse reactions were observed and compared between two groups.
Results The total effective rate in observation group was significantly higher than that in control group (91.30% vs 76.09%,χ2=3.903,P<0.05).Compared with those before treatment,Tei index decreased,and E/A and LVEF increased in both groups,and the above indicators in observation group were significantly superior to those in control group (P<0.05).After treatment,FEV1,MVV and MVV% pred were significantly higher than those before treatment in two groups and were higher in observation group than those in control group(P<0.05).Compared with those before treatment,PaO2 and OI increased,and PaCO2 decreased in two groups after treatment,and these indicators in observation group were better than those in control group (P<0.05).There was no significant difference in the [JP2]incidence of adverse reactions between observation group and control group (2.17% vs 4.35%,P>0.05).
Conclusion For AECOPD patients with HF,clearing away heat and resolving phlegm，invigorating Qi and promoting blood circulation based on routine treatment can significantly improve cardiopulmonary functions,correct hypoxemia and increase clinical efficacy.
keywords: Chronic obstructive pulmonary disease,acute exacerbation Heart failure Clearing away heat and resolving phlegm Invigorating Qi and promoting blood circulation Cardiac function Pulmonary function
文章编号： 中图分类号：R259 文献标志码：B
基金项目:河北省中医药管理局科研计划项目(2019519)
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