| ObjectiveTo preliminary study the important risk factors of prognosis of actue respiratory failure, while investigate the change of TCM syndrome type on the actue respiratory failure patients and the influence of TCM syndrome type on prognosis.MethodsThis research’s object is the acute respiratory failure patients from Guangdong Provincial Hospital of TCM comprehensive ward and ICU. Using a randomized method to devide100patients into the group that with mechanical ventilation support and the group that with convetional drug treatment with the1:1ratio. And the actue respiratory failure patients are divided into8different TCM syndrome types base on the previous studies and present domestic clinical research experience. The8types are:Qi deficiency syndrome, yang deficiency syndrome, yin deficiency syndrome, phlegm-turbid syndrome, toxic-heat syndrome, blood-stasis syndrome, mental unconscious syndrome, excess syndrome of Fu-organ. Gather the in-hospital patients who were diagnosed as acute respiratory failure, including sex, age, smoking history, protopathy, underying disease, complicationg, RR, HR, blood gas analysis, APACHEⅡ score, TCM four diagnostic methods information, TCM syndrome type, whether use mechanical ventilation or not, hospital stays, ICU stsys, and prognosis. Analysis the correlation of the smoking history, protopathy, underying disease, complicationg, RR, HR, blood gas analysis, APACHE Ⅱ score, mechanical ventilation and the prognosis. And analysis the change of TCM syndrome type on the actue respiratory failure patients and the influence of TCM syndrome type on prognosis. Results1. Patients of acute respiratory failure are mainly elderly people over75years, male over numbered female, Ⅰ type over numbered Ⅱ type. The protopathy of actue respiratory failure includes pulmonary diseases, heart diseases, CNS diseases, renal disorder, etc. The underlying diseases includes hypertension, coronary heart disease, DM, COPD, etc.The complication includes respiratory tract infection, abnormal renal function, abnormal liver function,shock etc.2. Comparing the RR, blood gas analysis, APACHE Ⅱ score,28days survival rate within the two groups, there are significant differences (P<0.05). The mechanical ventilation support group is better than that of the group that with convetional drug treatment.3. Finally,30cases successfully ventilator-weaned, weaning success rate was60%,18cases happened ventilator associated complications,10cases death, fatality rate was55.6%, there are significant differences with those patients who had no ventilator associated complications(P<0.05)4. Nivariate analysis showed that age, smoking history, lung cancer, acute left ventricular failure, coronary heart disease, store sequel, cancer, AHDT, abnormal renal function, abnormal liver function, shock, RR, APACHEⅡ score, patients who give up mechanical ventilation were the influencing factors of poor prognosis for ARF.(P<0.05). Multivariate logistic regression analysis showed that smoking history, lung cancer, AHDT, abnormal renal function, shock, patients who give up mechanical ventilation were independent influencing factors of death.5. Lung, spleen, kidney are the mainly viscera location of the ARF in early onset. With the developmen of the course, the cases of kidney gradually increasing, the cases of brain showed decreasing trends.6. Qi deficiency syndrome, phlegm-turbid syndrome, blood-stasis syndrome are the mainly syndrome of the ARF in early onset. With the developmen of the course, all the deficiency syndromes showed increasing trends. Toxic-heat syndrome, mental unconscious syndrome, excess syndrome of Fu-organ gradually decreasing. The change of phlegm-turbid syndrome and blood-stasis syndrome did not appear to be so obvious. But in death cases, the change of yang deficiency syndrome and yin deficiency syndrome were obviously, The change of toxic-heat syndrome, mental unconscious syndrome, excess syndrome of Fu-organ did not appear to be so obvious, Qi deficiency syndrome, phlegm-turbid syndrome and blood-stasis syndrome were always there.7. Qi deficiency syndrome, yang deficiency syndrome, blood-stasis syndrome and excess syndrome of Fu-organ have a poor prognosis in early onset, mental unconscious syndrome had a poor prognosis later, and the effect of blood-stasis syndrome was gradually decreasing. Conclusion1. Age over75years old, acute left ventricular failure, coronary heart disease, store sequel, cancer, abnormal renal function, abnormal liver function, RR≥30times/min, or≤9times/min, APACHE Ⅱ score>21were the influencing factors of poor prognosis for ARF. Smoking history, lung cancer, AHDT, abnormal renal function, shock were independent influencing factors of death.2. Patients who use mechanical ventilation have a good prognosis, ventilator associated complications are mainly VAP. And Patients who have ventilator associated complications usually have a poor prognosis.3. Lung, spleen, kidney are the mainly viscera location of the ARF, latly involve kidney, the deficiency of kidney energy usually indicates a poor prognosis.4. TCM syndrome types tend to change back to the origin of the acute respiratory failure, which means the zang and fu is deficient and the evil (heat, phlegm, blood stasis) is prosperous.And the prognosis relates to the level of vital Qi loss and the transmission of large intestine. He who has much vital Qi will have a better prognosis. It indicates that reinforcing vital Qi and preserve the transmission of large intestine are important TCM treatments for acute respiratory failure patients. And the apperance of mental unconscious syndrome later indicates dangerous illness, who had a poor prognosis。... |
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