| 摘要: |
| 目的：基于支饮理论探究苓桂术甘汤对阳虚水泛型心源性撤机困难患者的临床疗效。方法：将80例阳虚水泛型心源性撤机困难患者随机分为治疗组与对照组，每组各40例。对照组给予西医常规治疗，治疗组在对照组基础上予以苓桂术甘汤治疗，2组疗程均为2周。比较2组治疗前后中医证候评分、N末端B型利钠肽原（N-terminal pro-B-type natriuretic peptide，NT-proBNP）、血红蛋白（hemoglobin，Hb）、中心静脉血氧饱和度（central venous oxygen saturation，ScvO2）、心肺超声指标、急性生理与慢性健康Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）评分、序贯器官衰竭（Sequential Organ Failure Assessment，SOFA）评分、入组后机械通气时间、撤机成功率、28 d病死率与药物不良反应。结果：2组治疗后，中医证候评分、NT-proBNP、ScvO2均较治疗前改善，且治疗组优于对照组（P＜0.05）；心肺超声指标方面，2组左心室舒张末期内径（left ventricular end-diastolic diameter，LVEDD）、左心室收缩末期内径（left ventricular end-systolic diameter，LVESD）、左心室射血分数（left ventricular ejection fraction，LVEF）、肺部超声（lung ultrasound，LUS）积分治疗前后组内比较及治疗后组间比较，差异均有统计学意义（P＜0.05）；2组治疗后APACHE Ⅱ评分、SOFA评分均较治疗前下降，且治疗组优于对照组（P＜0.05）；治疗组入组后机械通气时间短于对照组，撤机成功率高于对照组，28 d病死率低于对照组（均P＜0.05）；治疗期间，2组均未观察到药物相关不良反应。结论：以支饮理论为指导，在西医常规治疗基础上加用苓桂术甘汤治疗，能温阳化饮，明显改善阳虚水泛型心源性撤机困难患者的心功能，减轻肺水肿，增加撤机成功率，降低28 d病死率，且无明显不良反应，值得临床推广应用。 |
| 关键词: 心源性撤机困难 阳虚水泛型 苓桂术甘汤 支饮理论 |
| DOI： |
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| Clinical effect of Linggui Zhugan decoction in treatment of cardiogenic difficult ventilator weaning with water overflowing due to Yang deficiency based on the theory of thoracic fluid retention：An analysis of 40 cases |
| XU Hui,HE Hao,ZHANG Huiming |
| (The Fourth Hospital of Changsha/Changsha Hospital of Integrated Traditional Chinese and Western Medicine，Changsha 410006，Hunan，China;School of Medicine，Changsha Social Work College，Changsha 410004，Hunan，China) |
| Abstract: |
| Objective：To investigate the clinical effect of Linggui Zhugan decoction in the treatment of cardiogenic difficult ventilator weaning with water overflowing due to Yang deficiency based on the theory of thoracic fluid retention.Methods：A total of 80 patients with cardiogenic difficult ventilator weaning with water overflowing due to Yang deficiency were randomly divided into treatment group and control group，with 40 patients in each group.The patients in the control group were given conventional Western medicine treatment，while those in the treatment group were given Linggui Zhugan decoction in addition to the treatment in the control group；the course of treatment was 2 weeks for both groups.The two groups were compared in terms of traditional Chinese medicine (TCM) syndrome score，N-terminal pro-brain natriuretic peptide (NT-proBNP)，hemoglobin (Hb)，central venous oxygen saturation (ScvO2)，cardiopulmonary ultrasound parameters，Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score，Sequential Organ Failure Assessment (SOFA) score，duration of mechanical ventilation after enrollment，success rate of ventilator weaning，28-day mortality rate，and adverse drug reactions.Results：After treatment，both groups had an improvement in TCM syndrome score，a reduction in NT-proBNP，and an increase in ScvO2，and the treatment group had significantly better improvements than the control group (P < 0.05).As for cardiopulmonary ultrasound parameters，both groups had significant changes in left ventricular end-diastolic diameter，left ventricular end-systolic diameter，lung ultrasound score，and left ventricular ejection fraction after treatment，and there were significant differences in these parameters between the two groups after treatment (P < 0.05).After treatment，both groups had significant reductions in APACHE Ⅱ score and SOFA score，and the treatment group had significantly better improvements than the control group (P < 0.05).Compared with the control group，the treatment group had a significantly shorter duration of mechanical ventilation after enrollment，a significantly higher success rate of ventilator weaning，and a significantly lower 28-day mortality rate (P < 0.05).No adverse drug reaction was observed in either group during treatment.Conclusion：Under the guidance of the theory of thoracic fluid retention，Linggui Zhugan decoction combined with conventional Western medicine treatment can warm Yang and transform water，and it can also significantly improve cardiac function，alleviate pulmonary edema，increase the success rate of ventilator weaning，and reduce 28-day mortality rate in patients with cardiogenic difficult ventilator weaning，without obvious adverse reactions.Therefore，it holds promise for clinical application. |
| Key words: cardiogenic difficult ventilator weaning edema syndrome due to Yang deficiency Linggui Zhugan decoction theory of thoracic fluid retention |
