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加味升陷汤辅助治疗ICU机械通气患者获得性衰弱的疗效观察

Observation on the curative effect of Jiawei Shengxian decoction in the treatment of acquired weakness in patients with mechanical ventilation in ICU

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目的 分析加味升陷汤辅助治疗ICU机械通气患者获得性衰弱的临床疗效.方法 采用前瞻性研究方法,选取2022年5月至2023年5月入住南充市中医医院重症医学科的68例符合ICU获得性衰弱(ICU-AW)诊断标准的重症机械通气患者为研究对象,按随机数字表法分为观察组、对照组,每组34例.对照组采用常规西医治疗和康复治疗,观察组在对照组基础上辨证使用加味升陷汤治疗.评估对比两组患者治疗前后的肌力指标、症状评分、炎症因子、康复时间、血清生化指标和安全性指标等.结果 治疗前两组肌力指标、症状评分、炎症因子、血清生化指标差异无统计学意义(均P>0.05).治疗后,观察组的医学研究委员会(MRC)肌力评分、膈肌厚度、膈肌活动度均高于对照组(均P<0.05).治疗后,观察组急性生理学与慢性健康状况(APACHE Ⅱ)评分、多脏器功能衰竭(MODS)评分、中医症候评分均低于对照组,日常生活活动能力Barthel指数(BI)评分高于对照组(均P<0.05).治疗后,观察组血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)水平低于对照组(均P<0.05).观察组患者的机械通气时间、入住ICU时间、开始下床活动时间、住院时间均短于对照组(均P<0.05).治疗后,观察组血红蛋白(HGB)、血小板计数(PLT)水平均高于对照组,血清总胆红素(TBIL)、尿素氮(BUN)、肌酐(Scr)水平均低于对照组(均P<0.05).结论 加味升陷汤辅助治疗ICU机械通气患者获得性衰弱效果良好,可增强患者肢体肌力和膈肌活动能力,改善患者的症状评分,降低炎症因子水平,缩短患者的康复进程,改善患者血清生化指标.
Objective To analyze the clinical effect of Jiawei Shengxian decoction in the treatment of acquired weakness in patients with mechanical ventilation in intensive care unit(ICU).Methods A prospective study method was used to select 68 patients with severe mechanical ventilation who met the diagnostic criteria of ICU acquired weakness(ICU-AW)and were admitted to the Department of Critical Care Medicine,Nanchong Hospital of Traditional Chinese Medicine from May 2022 to May 2023 as the study objects,and were divided into observation group and control group according to random number table method,with 34 cases in each group.The control group was treated with conventional Western medicine treatment and rehabilitation treatment,and the observation group was treated with Jiawei Shengxian decoction based on syndrome differentiation of the control group.The muscle strength indexes,symptom scores,inflammatory factors,recovery time,serum biochemical indexes and safety indexes of the two groups were evaluated and compared before and after treatment.Results Before treatment,there was no statistically significant difference in muscle strength indicators,symptom scores,inflammatory factors,and serum biochemical indicators between the two groups(all P>0.05).After treatment,the Medical Research Council(MRC)muscle strength score,diaphragm thickness and diaphragm motion of observation group were higher than those of control group(all P<0.05).After treatment,the scores of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ),multiple organ failure(MODS)and traditional Chinese medicine syndrome in the observation group were lower than those in the control group,and the Barthel index(BI)score of activities of daily living in the observation group was higher than that in the control group(all P<0.05).After treatment,the serum levels of procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)and white blood cell count(WBC)in the observation group were lower than those in the control group(all P<0.05).The mechanical ventilation time,ICU admission time,getting out of bed activity time and hospital stay time of the observation group were shorter than those of the control group(all P<0.05).After treatment,the levels of hemoglobin(HGB)and platelet count(PLT)in the observation group were higher than those in the control group,and the levels of serum total bilirubin(TBIL),blood urea nitrogen(BUN)and serum creatinine(Scr)in the observation group were lower than those in control group(all P<0.05).Conclusions Jiawei Shengxian decoction has a good effect in the adjuvant treatment of acquired asthenia in ICU patients with mechanical ventilation,which can enhance the muscle strength of limbs and the activity ability of diaphragm,improve the symptom score of patients,reduce the expression level of inflammatory factors,shorten the rehabilitation process of patients,and improve the serum biochemical indexes of patients.

J Intensive care unitsAcquired weaknessMechanical ventilationJiawei Shengxian decoction

李波、宋雪联、田敬、唐洪位、吴鸣

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南充市中医医院重症医学科,南充 637000

重症监护病房 获得性衰弱 机械通气 加味升陷汤

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(12)