| Objective:In this study,we observed the effect of TCM combined with fiberoptic bronchoscopy on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with severe respiratory failure,and explored the efficacy and safety of TCM combined with fiberoptic bronchoscopy,so as to provide clinical basis for its further application and implementation.Method:In strict accordance with.the diagnostic criteria and inclusion and exclusion criteria of this study,120 eligible patients hospitalized in respiratory department and ICU of Guangdong Hospital of Traditional Chinese Medicine from January 2013 to January 2018 were selected for retrospective analysis.Patients were divided into basic group and comprehensive group according to whether they were treated with TCM plus fiberoptic bronchoscopy.The treatment of basic group was given priority to routine treatment.The treatment group was given the treatment of basic group,and at the same time,traditional Chinese medicine combined with fiberoptic bronchoscopy was added.The changes of laboratory indicators and prognosis of the two groups were observed before and after treatment,and the occurrence of adverse reactions was recorded.At the same time,the prognosis analysis and the incidence of adverse reactions were compared between the traditional Chinese medicine group and the traditional Chinese medicine+external treatment group in the comprehensive group.The TCM syndromes of the collected case data were counted,and the results were analyzed and evaluatedResult:1.Baseline information:120 cases were divided into comprehensive group and basic group,54 cases in comprehensive group,including 45 males and 9 females;66 cases in basic group,including 49 males and 17 females.Statistical analysis showed that there was no significant difference in gender,age,course of disease and smoking index between the two groups(P>0.05),which was comparable.2.Laboratory examination results:Leukocyte count,percentage of neutrophils,C-reactive protein,erythrocyte sedimentation rate and procalcitonin in the two groups were significantly different from those before treatment,and white blood cell count,C-reactive protein and erythrocyte sedimentation rate in the comprehensive group were significantly different from those in the basic group(P<0.05);D-dimer,fibrinogen,coagulation time and erythrocyte count in the two groups were significantly different(P<0.05).Compared with before treatment,there were differences in erythrocyte count,and there was statistical significance in the comprehensive group compared with the basic group(P<0.05);the difference of acidity and alkalinity between the two groups before and after treatment was statistically significant(P<0.05),while there was no significant difference in arterial partial pressure of oxygen and partial pressure of carbon dioxide(P>0.05);the difference of albumin and total protein between the two groups before and after treatment was not significant(P>0.05).There was no significant difference between the two groups(P>0.05),but there was significant difference in hemoglobin(P<0.05);sputum culture was positive in 30 cases(45.5%)in the basic group and in 43 cases(79.6%)in the comprehensive group.There was significant difference between the two groups(P<0.05).3.Prognostic analysis:There was no significant difference in invasive/noninvasive ventilation time and hospitalization days between the two groups(P>0.05);there was no significant difference in tracheal intubation rate between the two groups(P>0.05);the mortality rate of the comprehensive group(11.1%)was lower than that of the basic group(19.7%),but there was no significant difference(P>0.05);the total effective rate of the comprehensive group was 88.9%compared with that of the basic group(74.2%).Statistical significance(P<0.05);4.Adverse reactions:23 patients(42.6%)in the comprehensive group had adverse reactions compared with 48 patients(72.7%)in the basic group(P<0.05).5.The results of comprehensive group:There was no significant difference in the total effective rate,tracheal intubation rate and mortality between TCM Decoction group and TCM+TCM external treatment group(P>0.05).There were 17 cases(60.7%)of adverse reactions in TCM Decoction group compared with 6 cases(23.1%)in TCM+TCM external treatment group(P<0.05).6.Syndromes of TCM:120 cases were collected and statistics of TCM syndromes were made.The most common TCM syndromes were deficiency of lung,spleen and kidney,phlegm and turbidity obstruction of lung(41 cases),deficiency of lung,spleen and kidney,phlegm and heat stagnation of lung(37 cases),deficiency of lung,spleen and kidney,phlegm and heat obstruction of lung(14 cases).Conclusion:Compared with the basic group,TCM combined with fiberoptic bronchoscopy can improve the clinical efficacy and reduce the incidence of adverse reactions after mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with severe respiratory failure,and the positive rate of sputum culture is higher,and the TCM syndromes are mainly composed of deficiency and excess. |
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