中国中西医结合急救杂志2025，Vol.32Issue(5)：544-549,6.DOI:10.3969/j.issn.1008-9691.2025.05.006
基于培土生金法的中医综合方案联合早期肺康复治疗AECOPD呼吸机依赖患者的临床疗效研究
摘要
Abstract
Objective To investigate the efficacy of an integrated traditional Chinese medicine protocol based on the principle of reinforcing earth to generate metal combined with early pulmonary rehabilitation for ventilator-dependent acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients.Methods A total of 164 AECOPD patients admitted to the department intensive care unit(ICU)of Chengdu First People's Hospital from April 2023 to December 2024 were selected as the study subjects.All patients met the traditional Chinese medicine(TCM)diagnostic criteria for lung-spleen qi deficiency syndrome and required invasive mechanical ventilation.The patients were divided into control group and treatment group according to random number table method,with 82 cases in each group.Patients in both groups received basic treatment for AECOPD.On this basis,the treatment group was additionally given Shenling Baizhu powder combined with early pulmonary rehabilitation.Both groups were treatd for 7 days,the differences in clinical pulmonary infection score(CPIS),oxygenation index(PaO2/FiO2),maximum inspiratory pressure(MIP),peak expiratory flow(PEF),diaphragmatic displacement,diaphragmatic thickening fraction(DTF),C-reactive protein(CRP),procalcitonin(PCT),CD4+,CD8+,CD4+/CD8+,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),modified Medical Research Council dyspnea scale(mMRC),nutrition risk screening 2002(NRS 2002),the length of invasive mechanical ventilation,the length of stay in ICU,the success ratio of Weaning from mechanical ventilation,the incidence of ventilator-associated pneumonia(VAP)and the 28-day mortality were compared between the two groups.Results The indexes of lung function,inflammation markers,immune function and nutrition status in the two groups were significantly improved after treatment.The improvement of various indexes in the treatment group was better than that in the control group[CPIS score:2.35±1.46 vs.4.46±1.60,PaO2/FiO2(mmHg,1 mmHg≈0.133 kPa):356.68±83.20 vs.318.98±80.11,MIP(cmH2O,1 cmH2O≈0.098 kPa):53.38±1.26 vs.42.35±1.96,PEF(L/min):83.42±8.45 vs.76.84±3.45,diaphragmatic displacement(mm):20.86±2.68 vs.16.86±2.43,DTF:(42.26±2.21)%vs.(33.16±2.16)%,CRP(mg/L):9.94±2.41 vs.12.12±3.86,PCT(μg/L):1.82±0.86 vs.3.88±1.08,CD4+:0.51±0.04 vs.0.46±0.06,CD8+:0.22±0.04 vs.0.23±0.05,CD4+/CD8+:2.34±0.36 vs.2.06±0.26,APACHEⅡscore:9.85±1.36 vs.13.46±1.60,mMRC score:1.88±0.40 vs.2.18±0.21,NRS 2002 score:2.83±0.63 vs.3.85±0.76,all P<0.05].Regarding clinical outcomes,the treatment group had significantly shorter durations of mechanical ventilation and ICU stay[durations of mechanical ventilation(days):5.80±1.68 vs.10.68±2.28,ICU stay(days):9.68±2.57 vs.15.25±3.80,both P<0.05],a significantly lower incidence of VAP and 28-day mortality[incidence of VAP:6.10%(5/82)vs.9.76%(8/82),28-day mortality:6.10%(5/82)vs.18.29%(15/82),both P<0.05],and a significantly higher weaning success rate than the control group[92.68%(76/82)vs.56.10%(46/82),P<0.05].Conclusion Integrated traditional Chinese medicine protocol based on the principle of reinforcing earth to generate metal combined with early pulmonaryre habilitation has a therapeutic effect in ventilator-dependent patients with AECOPD,and can improve the lung function index and the nutritional status,reduce mechanical ventilation-related complications and increase the success rate of weaning from mechanical ventilation.关键词
慢性阻塞性肺病急性加重期/呼吸机依赖/早期肺康复/培土生金法Key words
Acute exacerbation of chronic obstructive pulmonary disease/Ventilator-dependent/Early pulmonary rehabilitation/Reinforcing earth to generate metal引用本文复制引用
周智恩,严善秀,卢萍,姚娟,侯娟,简漪沫,蒋燕琳,张雨尧..基于培土生金法的中医综合方案联合早期肺康复治疗AECOPD呼吸机依赖患者的临床疗效研究[J].中国中西医结合急救杂志,2025,32(5):544-549,6.基金项目
四川省中医药管理局中医药科研专项(2023MS017) （2023MS017）
四川省成都市中医重点专科(专病)建设项目(20200929) （专病）
四川省成都市首批中医临床优秀人才项目(20220509) （20220509）
成都中医药大学"杏林学者"学科人才科研提升计划(YYZX2022046) Sichuan Provincial Administration of Traditional Chinese Medicine's Subject(2023MS017) （YYZX2022046）
Chengdu Construction Project of Key Specialty(Special Disease)of Traditional Chinese Medicine of Sichuan Province(20200929) （Special Disease）
The First Batch of Excellent Traditional Chinese Medicine Clinical Talents Training Project of Chengdu,Sichuan Province(20220509) （20220509）
"Xinglin Scholar"Project of Chengdu University of Traditional Chinese Medicine(YYZX2022046) （YYZX2022046）
