大黄芒硝外敷具体方法 [大黄与芒硝对急性呼吸窘迫综合征伴腹高压并机械通气患者呼吸功能的影响]

　　[摘要] 目的 探讨大黄内服及芒硝神阙穴热敷对急性呼吸窘迫综合征（ARDS）伴腹高压并机械通气患者呼吸功能的影响。 方法 以治疗方案分成治疗组15例（加用大黄内服及芒硝神阙穴外敷治疗的患者），对照组8例（未加用大黄内服及芒硝神阙穴外敷治疗的患者），观察其腹内压（IAP）、腹腔灌注压（APP）、急性生理学和慢性健康状况评分系统（APACHEⅡ评分）、动脉血气分析指标（pH、PaO2、PaCO2）、吸氧浓度、呼吸频率、潮气量、气道峰压、气道平台压、气道平均压、呼气末正压、计算氧合指标等指标以评价临床疗效。 结果 治疗第7天两组较治疗前比较IAP、APP明显下降（P ＜ 0.05），治疗组较对照组IAP、APP明显下降（P ＜ 0.05），但APACHEⅡ分值较治疗组差异无统计学意义（P ＞ 0.05）；第7天两组的pH 、PaO2、氧合指标较同组治疗前有升高，且差异有统计学意义（P ＜ 0.05），PaCO2较同组治疗前比较有下降，差异有统计学意义（P ＜ 0.05）；治疗组较对照组在第7天PH值、PaCO2无统计学差异（P ＞ 0.05），PaO2、氧合指标比较有统计学差异（P ＜ 0.05）；第7天两组较本组治疗前潮气量均有增加，且差异有统计学意义（P ＜ 0.05），但两组之间比较无统计学差异（P ＞ 0.05）；第7天两组气道平台压、气道峰压、气道平均压、呼吸频率较本组治疗第1天均有下降，且差异有统计学意义（P ＜ 0.05）；治疗组气道平台压、气道峰压、气道平均压、呼吸频率较对照组在治疗第7天比较有统计学差异（P ＜ 0.05）。结论 大黄内服及芒硝神阙穴热敷对ARDS伴腹高压并机械通气患者的呼吸功能有改善作用。
　　[关键词] 大黄；芒硝；腹高压；机械通气；呼吸；功能
　　[中图分类号] R441.8 [文献标识码] A [文章编号] 1673-7210（2012）07（b）-0094-03
　　Influence of Rhubarb and Mirabilite on respiratory function of patients with acute respiratory distress syndrome associated with high abdominal pressure and mechanical ventilation
　　XUE Cuiying1 SONG Huifan2 YAN Xinhua2 QU Xiuhui2 LIU Xianghua2 WANG Jianli2 SONG Aili1 XIE Jianhui3 YANG Junhong4
　　1.Department of Respiratory, Luan People"s Hospital, Hebei Province, Luan 063700, China; 2.Intensive Care Unit, Luan People"s Hospital, Hebei Province, Luan 063700, China; 3.Department of Infection, Luan People"s Hospital, Hebei Province, Luan 063700, China; 4.Department of Endocrinology, Luan People"s Hospital, Hebei Province, Luan 063700, China
　　[Abstract] Objective To investigate the influence of Rhubarb and Mirabilite on the respiratory function of patients with acute respiratory distress syndrome (ARDS) associated with abdominal high pressure and mechanical ventilation. Methods The patients were divided into the treatment group with 15 patients (with oral administration of Rhubarb and external application of Mirabilite at the Shenque point) and the control group with 8 patients (without oral administration of Rhubarb and external application of Mirabilite at the Shenque point). The intra-abdominal pressure, abdominal perfusion pressure, APACHE II score, arterial blood gas analysis indicators (PH, PaO2 and PaCO2), oxygen concentration, respiratory rate, tidal volume, peak airway pressure, plateau airway pressure, average airway pressure, positive end-expiratory pressure, calculated oxygenation indicators and other indicators were observed to evaluate the clinical curative effects. Results On the 7th day of treatment, IAP and APP of the two groups significantly decreased compared with those before the treatment (P 0.05), but were statistically different in the PaO2 and oxygenation indicators (P 0.05). On the 7th day, plateau airway pressure, peak airway pressure, average airway pressure and respiratory rate all decreased compared with those on the first day of treatment, with statistically significant difference (P < 0.05); Plateau airway pressure, peak airway pressure, average airway pressure and respiratory rate were significantly different between the treatment group and the control group on the 7th day of treatment (P < 0.05). Conclusion Oral administration of Rhubarb and external application of Mirabilite at the Shenque point can improve the respiratory function of patients with ARDS associated with high abdominal pressure and mechanical ventilation.