| Backgroud:Pneumonia is the most common pulmonary infectious disease among the old people. It has the characteristics of onset hidden and the clinical symptoms is not obvious. Once sick,the disease is severe and the morality rate is high. As the old people cough and smoke reflex delicine,the throat bacteira increases graft. Calia mucous delicine, sputum can’t discharge. Bacteria and ariway cerection eduction is blocked. Sputum sediment in the alveolar or small airway, lead to reducing the aera of effective breathing membrane, Increase distance between alveolar touch, gas dispersion ability to drop, poor exchange oxygen and carbon dioxide. Sputum blockage to small airway, make respiratory resistance increased. Carbon dioxide can’t efficiently discharge. Oxygen could not enter terminal airway to play its role, leading to respiratory failure and pulmonary encephalopathy. Patients with severe cases can lead to death in a short time, so a sputum plays a vital role in senile severe pneumonia. Studies have shown that the high frequency of chest wall shock discharge apparatus has an obvious curative effect in promoting the sputum of the severe pneumonia among the elder people. Through long term clinical practice,my mentor found that Lung fever phlegm card indicates the lung with pulmonary abscess pus have the same pathogenesis. Acne has a similar place with surgery. Combined with the characteristics of the Lung fever phlegm,we put forward the method of the treatment of lung fever. That is: expectoration drainage method.Under the guidance of this method,we find the way to cure this disease----- Qing-Hua decoction, which obtained satisfactory clinical effect, is worth promoting.Research purpose:1. Discuss the application of the hoa party in lung fever sputum.2. Observe the application of the high frequency chest wall oscilaion expectoration drainage device among the senile severe pneumonia.3.Compare the curative effect of the high frequency chest wall oscilaion expectoration drainage device and Qing-Hua decoction and provide basis for promoting Qing-Hua decoction and the application of expectoration drainage method.Research methods:This study is a prospective controlled study, according to include and exclude standard collect 41 patients who lives in the xi yuan hospital of China academy of traditional Chinese medicine from September in 2013 to March in 2016.These patients conform to Senile severe pneumonia diagnosis standard and lung fever sputum indicates pulmonary syndrome diagnosis.The patients are divided into two groups,22 cases of observation group,19 cases of control group.Two groups were given antibiotics, phlegm, spasmolysis to smooth wheezing such as western medicine routine treatment.The observation group with Qing-Hua decoction,control group with high frequency chest wall oscilaion expectoration drainage device.Period of this study is divided into 14 days, respectively, on fourth day, the seventh day, the tenth day, the 14th day, berore and after the treatment, we measure blood routine, biochemical nasty 12, blood gas analysis, body temperature, amount of sputum. Evaluating medical symptoms before and after the treatment, cpis score, chest radiograph, raditional Chinese medicine symptom integral, WBC count, neutrophil count, CPR, body temperature, blood oxygen partial pressure, CO2 partial pressure, discharge sputum volume changes before and after the treatment.The results of the study:1. Make a comparison between the two groups after the treatment of TCM syndrome curative effect, the observation group effective rate was 40.91%, the control effective rate was 36.8%.2. After the treatment of traditional Chinese medicine symptom integral, the measured figures of CPIS all have decreased, the concept of group comparison before and after treatment respectively, P=0.000 (<0.05), P=0.000 (<0.05); Comparison between groups, (P=0.000< 0.05), the difference is statistically significant.3. After treatment of lung infection and inflammation (1) CPIS score in both groups after treatment decreased, the comparison before and after treatment in view of P= 0.002 (< 0.05), P=0.000 (< 0.05), the difference was statistically significant. Comparison between groups, (P=0.000< 0.05), the difference is statistically significant. (2) Respectively, the two groups before and after the treatment group, the WBC counts within view of P=0.044 (< 0.05), the difference was statistically significant. P=0.147 for (> 0.05), there was no statistically significant difference; Comparison between groups, P=0.117(> 0.05), there was no statistically significant difference. Two groups after the treatment the WBC count has decreased, the figure of the observation group decreased more sharply than the control group according to the trend chart of the WBC count, and a steady decline-but there was no statistically significant difference between groups compare. (3) Respectively on two groups after treatment NEUT count within the group comparison before and after treatment, P=0.053 (> 0.05), there was no statistically significant difference; P=0.159 for (> 0.05), there was no statistically significant difference. Comparison between groups, P=0.101 (> 0.05), there was no statistically significant difference. Prompt NEUT the two groups after treatment decreased, according to the trend chart.but the observation group NEUT count droped greater than the control group, and still a steady decline, but there was no statistically significant difference between groups. (4) Respectively on two groups of CRP before and after the treatment group after treatment in comparison, the concept of P=0.044 (< 0.05), P=0.053 for (> 0.05); Comparison between groups, P=0.082 (> 0.05), there was no statistically significant difference. Two groups after the treatment of CRP decreased, the only comparative differences between groups have no statistical significance. (5) After treatment, respectively on two groups before and after treatment temperature within the group comparison, P=0.218 (> 0.05), there was no statistically significant difference; P=0.084 for (> 0.05), there was no statistically significant difference. 4. Sputum volume and respiratory function after treatment (1) The two groups after treatment in patients with blood oxygen partial pressure has increased, the observation group of blood oxygen partial pressure rise higher than the control group, but due to the lack of data in some patients, we cannot do any further study within the group and the comparison between groups. (2) Two groups of patients after treatment of CO2 partial pressure had some differences, but because of the lack of a part of experimental data, not further comparison within the group and between groups. (3) Two groups of patients after treatment were compared with the previous sputum volume change, P=0.277 (> 0.05), there was no statistically significant difference:P=0.110 for (> 0.05), there was no statistically significant difference. Comparison between groups, P=0.066 (> 0.05), there was no statistically significant difference. It can be seen from the line of sputum volume trend chart in the two groups before and after treatment that sputum volume is in a trend of gradual decline after rising first, but the peak value of the amount of expectoration drainage in observation group is earlier reached than the control group, which suggests that the sputum of promote to eject effect in observation group may be faster than the control group.Conclusion:1. Qing-Hua decoction on the basis of expectoration drainage method can improve lung fever sputum carbuncle of lung in patients with type TCM symptoms and has certain effects for those patients.It is worth widening.2. Qing-Hua decoction and the chest wall in high frequency oscillation expectoration drainage device two methods all can improve the old patients with severe pneumonia lung infection, reduce inflammatory indicators, reduce antibiotic use, has good clinical prospect.3. Qing-Hua decoction and the chest wall in high frequency oscillation expectoration drainage device two methods all can promote expectoration drainage, improve respiratory function, is expected to shorten the time of mechanical ventilation.4. The comparison between groups, two groups in clinical curative effect to improve the old patients with severe pneumonia, or even group effect in reducing inflammatory indicators are more stable, promoting productive work faster, combining with the economic benefit, for unconditional acceptance of the high frequency of chest wall oscillation expectoration drainage device therapy in elderly patients with severe pneumonia, traditional Chinese medicine medicinal broth thanh hoa is worth promoting. |
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