摘要
目的观察无创正压通气(NIPPV)联合何氏加味定喘汤治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭(痰热壅肺证)患者临床疗效及安全性。方法将46例入组患者随机分为观察组27例与对照组19例,对照组给予西医常规治疗及无创正压通气,观察组在对照组治疗基础上加服何氏加味定喘汤,每日1剂。两组均从入组治疗开始观察1周,比较治疗前后中医证候积分、COPD评估测试(CAT)评分,检测血气分析指标[包括酸碱度(pH值)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))等]、气道重塑指标[包括基质金属蛋白酶2(MMP2)、金属蛋白酶组织抑制剂1(TIMP1)、缺氧诱导因子1α(HIF-1α)]、血常规白细胞(WBC)及C反应蛋白(CRP);治疗1周后比较6 min步行距离(6MWT),并观察药物不良反应。结果治疗后组间比较,观察组患者pH值及PaO_(2)改善明显优于对照组,PaCO_(2)、中医证候积分、CAT评分、MMP2、HIF-1α、WBC明显低于对照组(P<0.05或P<0.01),而6MWT显著高于对照组(P<0.01)。与治疗前相比,观察组治疗后的pH值及PaO_(2)明显改善,PaCO_(2)、中医证候积分、CAT评分、MMP2、HIF-1α、WBC、CRP明显下降(P<0.01)。对照组治疗后中医证候积分及CAT评分较治疗前明显下降(P<0.05或P<0.01)。结论无创正压通气联合何氏加味定喘汤治疗COPD合并Ⅱ型呼吸衰竭(痰热壅肺证)患者疗效优于单纯西医治疗,其可能通过抑制MMP2、HIF-1α表达来减轻气道重塑,改善肺通气,提高运动耐力,且用药安全性良好。
Objective:To observe the clinical efficacy and safety of non-invasive positive pressure ventilation(NIPPV)combined with He's Modified Dingchuan Decoction in treating patients with chronic obstructive pulmonary disease(COPD)complicated by type Ⅱ respiratory failure(syndrome of phlegm-heat obstructing lung).Methods:A total of 46 enrolled patients were randomly divided into an observation group(n=27)and a control group(n=19).The control group received conventional western medical treatment and NIPPV,while the observation group additionally took He's Modified Dingchuan Decoction once daily based on the control group's regimen.Both groups were observed for one week from the start of treatment.Comparisons were made before and after treatment regarding TCM syndrome scores,COPD assessment test(CAT)scores,blood gas analysis indicators[including pH,partial pressure of oxygen(PaO,),partial pressure of carbon dioxide(PacO_(2))],airway remodeling indicators[including matrix metalloproteinase-2(MMP2),tissue inhibitor of metalloproteinases-1(TIMP1),hypoxia-inducible factor lα(HIF-1α)J,white blood cell count(WBC),and C-reactive protein(CRP).Six-minute walking test(6MWT)was compared after one week of treatment,and adverse drug reactions were monitored.Results:After treatment,significant improvements in pH and PaO,were observed in the observation group compared with the control group(P<0.05 or P<0.01).Levels of PaCO_(2),TCM syndrome scores,CAT scores,MMP2,HIF-1α,and WBC were significantly lower in the observation group than in the control group(P<0.05 or P<0.01),while the 6MWT was significantly higher(P<0.01).Compared with before treatment levels,results in the observation group after treatment showed significant improvements in pH and PaO_(2),and significant reductions in PaCO_(2),TCM syndrome scores,CAT scores,MMP2,HIF-1α,WBC,and CRP(P<0.01).In the control group,there were also significant reductions in TCM syndrome scores and CAT scores after treatment compared with before treatment(P<0.05 or P<0.01).Conclusion:The combination of NIPPV and He's Modified Dingchuan Decoction is more effective than conventional western medicine alone in treating COPD patients with type Ⅱ respiratory failure(syndrome of phlegm-heat obstructing lung).It may improve lung ventilation and exercise endurance by inhibiting MMP2 and HIF-1αexpression,reducing airway remodeling,improving pulmonary ventilation and increasing exercise tolerance,with good medication safety.
作者
余松
周运海
彭文潘
冉大伟
浦明之
Yu Song;Zhou Yunhai;Peng Wenpan;Ran Dawei;Pu Mingzhi(The Affiliated Suzhou Hospital of Nanjing University of Chinese Medicine,Jiangsu,Suzhou 215000,China)
出处
《中国中医急症》
2025年第7期1184-1187,1192,共5页
Journal of Emergency in Traditional Chinese Medicine
基金
国家自然科学基金项目(82305152)
苏州市科技发展计划项目(SKJYD2021124)
苏州市“科教兴卫”青年科技项目(KJXW2021048)
苏州市医学重点学科建设项目(SZXK202112)
苏州市科技计划项目(SKY2021012)
苏州市姑苏卫生人才计划(GSWS2022080)。
关键词
慢性阻塞性肺疾病
Ⅱ型呼吸衰竭
何氏加味定喘汤
气道重塑
临床研究
Chronic obstructive pulmonary disease
Type Ⅱ respiratory failure
He's Modified Dingchuan Decoction
Airway remodeling
Clinical study
