Clinical study on treatment of senile severe pneumonia by Qingre-Tongfu enema combined with non-invasive ventilation with syndrome of excess of Yangming fushi / 国际中医中药杂志

ABSTRACT

Objective:To investigate the effect of Qingre-Tongfu enema combined with noninvasive positive pressure ventilation on the ventilation function of elderly patients with severe pneumonia. Methods:A total of 60 elderly patients with severe pneumonia with syndrome of excess of Yangming fushi from September 2017 to August 2019 in the respiratory department of the First People’s Hospital of Dongcheng District, Beijing were randomly divided into two groups, 30 cases in each group. The control group was treated with western medicine to control infection and noninvasive positive pressure ventilation. The treatment group was treated with Qingre-Tongfu enema on the basis of the control group. The Traditional Chinese Medicine Syndrome score (TCMSSS), Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ) and Clinical Pulmonary Infection Score (CPIS) were compared before and after treatment, The Pneumonia Severity Index (PSI) was compared. Serum procalcitonin (PCT) was detected by upconversion luminescence immunoassay, CRP was detected by double antibody sandwich ELISA, WBC was detected by automatic hematology analyzer; partial pressure of carbon dioxide (PaCO 2), oxygen saturation (SaO 2), partial pressure of oxygen (PaO 2) were detected by blood gas analyzer, oxygenation index (OI) and respiratory rate (RR) were calculated. The complications were investigated and the clinical efficacy was evaluated. Results:The total effective rate was 96.7% (29/30) in the treatment group and 73.3% (22/30) in the control group, with significant difference between the two groups ( χ2=4.706, P=0.030). After treatment, the levels of serum PCT, CRP and WBC in the treatment group were significantly lower than those in the control group ( t=15.359, 25.784 and 13.460, respectively, P<0.01); after treatment, the levels of SaO 2 [(93.18 ± 3.79)% vs. (88.78 ± 5.56)%, t=3.584], PaO 2 [(86.81 ± 4.01) mmHg vs. (80.01 ± 4.76) mmHg, t=5.975], OI [(285.53 ± 15.05) mmHg vs. (227.65 ± 12.37) mmHg, t=16.272] in the treatment group significantly were higher than those in the control group ( P<0.01); PaCO 2 [(43.28 ± 6.84) mmHg vs. (48.83 ± 7.66) mmHg, t=-2.956], RR [(22.00 ± 3.79) times/min vs. (26.30 ± 3.73) times/min, t=-4.434] in the treatment group were significantly lower than those in the control group ( P<0.05). After treatment, the scores of TCMSSS, APACHE-Ⅱ, CPIS and PSI in the treatment group were significantly lower than those in the control group ( t=41.310, 11.035, 8.399, 5.752, P<0.01). The treatment group in the course of antibiotics, mechanical ventilation time, hospital stay were significantly shorter than the control group ( P<0.01). Conclusion:Qingre-Tongfu enema combined with noninvasive positive pressure ventilation can improve the clinical symptoms of elderly patients with severe pneumonia, reduce inflammatory reaction, shorten the time of mechanical ventilation and antibiotic treatment, and improve the clinical efficacy.