Clinical study on the efficacy of intervention for depression and depression in respiratory failure using modified Suzuki Qi method

Clinical study on the efficacy of intervention for depression and depression in respiratory failure using modified Suzuki Qi method

LI,Yuan,SI,Dongbo,QIAO,Huiping,XIE,Qing

Baoji Chinese Medicine Hospital of Shaanxi Province,Baoji Shanxi 721001,China

【Abstract】Objective:To observe the effect of modified supplementary Qi method on respiratory failure.Methods:A total of 58 patients with respiratory failure were randomly pided into two groups,the experimental group was administered the modified Qi formula in addition to the basic treatment,and the control group was given the basic treatment only;Efficacy measures were compared between the two groups.Results:The experimental group showed better improvements than the control group in the comprehensive effects of TCM,lung function,and blood gas analysis.Conclusion:The modified modified modified Qi method can treat dyspnea symptoms,improve blood gas analysis and lung function,and improve clinical outcomes in patients with respiratory failure.

【Key words】Respiratory failure;Traditional Chinese medicine treatment;Patch gas method

Respiratory failure is one of the most common critical illnesses threatening the life health of the people at large,with a high mortality rate of 10-50%,and currently,mechanical ventilation technology is the basic means of treating respiratory failure.However,mechanical ventilation focuses on respiratory support for the patient,addressing outer respiratory problems for a period of time,whereas inner respiratory disorders affecting patient outcome still require treatment.Therefore,we focused on this central syndrome of dyspnea,which is known as DEU in Chinese medicine(TCM),and on the basis of mining the theory of Neijing zongqi,we proposed that the modified Qi method was involved in the treatment of respiratory failure,and achieved better efficacy.Now report as follows.

1 Clinical data

1.1 diagnostic criteria

TCM diagnostic criteria1>as a result of lung diseases,the Qi is turned up and down,there is no right to Su,shortness of breath and shortness of breath,difficulty in breathing,even an open mouth with shoulders raised and cannot lie flat.Cyanosis of the lips was characteristic.

Syndromic diagnostic criteria1>syndrome of DEU(syndrome of Qi,Qi deficiency of the heart and lung,and obstruction of collaterals by phlegm stasis)is clinically characterized mainly by shortness of breath,weak shortness of breath,phlegm,white sticky or foamy appearance,cold limbs with purplish face,purplish lips,chest tightness and pain,purplish tongue or with ecchymoses or petechiae,tortuosity,coarseness and dullness of the sublingual vein.

Chief disorder:①shortness of breath or weak shortness of breath Wheezing,shortness of breath,and increased mobility;③i Fatigue or self-sweating;④Cleft lip/palate,purplish tongue colour or presence of ecchymoses or petechiae;⑤Phlegm,whitish or foamy.

Secondary symptoms:I)palpitation,chest tightness,and increased movement,II Shallow face or grey and dark surface lip④abnormalities(trance,irritability,lethargy,coma)Sweats drenching;⑤Extremities with cold seizures.

Having 2 of the major and 1 of the minor symptoms is diagnostic.

Western medical diagnostic criteria2>:①patients have a history of diseases with chronic respiratory failure and triggers for acute morbidity Have clinical manifestations of hypoxia or with carbon dioxide retention;③Arterial blood gas analysis:Patients with a PaO2<60mmhg(1kPa=7.5mmhg)under breathing air conditions(atmospheric pressure at sea level)and often with a low PaCO2(<30mmhg)were diagnosed as having acute respiratory failure type I;Respiratory failure type II was diagnosed if the concomitant PaCO2 was>50mmhg.

1.2 inclusion criteria

Fulfilled diagnostic criteria of traditional Chinese and Western medicine;Age range 40-80 years.

1.3 exclusion criteria(slightly)

1.4 stratified randomization

Stratified randomization was adopted.The included cases were pided into three strata according to the severity of respiratory failure and the presence or absence of comorbid cor pulmonale and pulmonary encephalopathy.Tier 1:arterial blood gas analysis PaCO2≤50 mmHg,PaO2≤60 mmHg without concomitant cor pulmonale and pulmonary encephalopathy;Tier 2:PaCO2>50mmhg on arterial blood gas analysis and PaO2<60mmhg without pulmonary heart disease and pulmonary encephalopathy;Layer 3:combined cor pulmonale and pulmonary encephalopathy requiring invasive mechanical ventilation.

After the included cases were stratified by the above factors,a random number table method was used to assign the cases to the experimental and control groups.

1.5 case materials

Fifty eight patients with respiratory failure admitted to the Department of respiratory medicine of our hospital from October 2013 to September 2015 were selected.The treatment group consisted of 30 patients,19 males and 11 females;Age(69.78±5.76)years,stratified by illness grade I,II,and III were 18,12,and 0,respectively,APACHE II score(4.27±2.51)points,19 patients suffered from type I respiratory failure,11 patients suffered from type II respiratory failure,11 patients suffered from acute exacerbation of chronic obstructive pulmonary disease(AECOPD),4 patients suffered from bronchiectasis and infection,4 patients suffered from pulmonary interstitial fibrosis,5 patients suffered from bacterial pneumonia,4 patients suffered from chronic bronchitis,and 2 patients suffered from pulmonary embolism.The control group consisted of 28 patients,18 males and 10 females;Age(70.29±7.67)years,stratified by illness grade I,II,and III were 16,12,and 0,respectively,APACHE II score(4.22±2.14)points were recorded in 16 patients with respiratory failure type I,12 patients with respiratory failure type II,11 patients with AECOPD as primary disease,4 patients with bronchiectasis and infection,5 patients with pulmonary interstitial fibrosis,2 patients with bacterial pneumonia,5 patients with chronic bronchitis,and 1 patient with pulmonary embolism.The data of the two groups were not significantly different(P>0.05)and were comparable.

1.6 methods

1.6.1 basic treatment regimen

The control group was given the basal treatment regimen only

①Primary care Inspired oxygen,3-5 L/min Correction of water,electrolyte and acid base imbalance;④⑤for nutritional supportanti infective Mechanical ventilation.

1.6.2 experimental treatment protocol

The experimental group was treated with the experimental regimen added on top of the basic treatment regimen.

Experimental protocol:tune buzongqi formula:raw Astragalus 20 g red ginseng additional Decoction 10 g Danggui 12 g Cornus meat 20 g full guar 20 g zhbe15 g Chuanxiong 10 g Danshen 15 g Zelan 15 g Baihua Hedyotis 30 g Polygonum cuspidatum 15 g salidroside 15 g Ganzhi 10 g indigenous 10 g Zhigancao 5 g.1600 ml was added to each 2 doses,soaked first for 30 min and decocted for 40 min,and the vacuum plastic packaging was pided into 6 bags of 100 ml each,3 times a day and 1 bag each time.

1.6.3 course:7 days.

1.7 outcome measures and methods

General items:name,gender,age,disease course,previous history,etc.

Efficacy indicators:

Western medicine efficacy indicators:arterial blood gas analysis of pH,partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),bicarbonate(HCO3-),oxygen saturation(O2Sat%);Oxygenation index;Forced vital capacity(FVC),forced expiratory flow in 1 s(FEV1),peak expiratory flow(PEF),diffusing capacity for carbon monoxide;Dyspnea index(using criteria established by the British Medical Association);Noninvasive mechanical ventilation was performed with the following parameters:respiratory rate,inspiratory airway pressure,expiratory airway pressure,inspired oxygen concentration,duration of ventilation,and duration of ventilation at which oxygenation returned to normal.

Traditional Chinese medicine(TCM)efficacy indicators:To evaluate the main symptoms of diz syndrome:wheezing,shortness of breath,face color and labial tearful violet,unconsciousness,sweating,limb convulsion and expectoration,the change of the score before and after treatment was observed,and the level of development,effectiveness,ineffectiveness and aggravation was determined according to the efficacy index.

Safety indicators:blood routine,urine routine,fecal routine and occult blood test,liver function,renal function,electrocardiogram.

1.8 statistical methods

Statistical software SPSS 11.0 was used,among which,t-test was used for metrology data;Count data were obtained usingχ2-test,and the rank data were analyzed by Ridit.P<0.05 was taken as the difference,which was statistically significant.

1.9 efficacy evaluation criteria

Syndrome score=(syndrome score before treatment-syndrome score after treatment)/score before treatment 100%,as proposed with reference to the relevant standards of the Chinese Academy of new drugs for clinical research(Trial).Clinical control:clinical signs or symptoms disappear or basically disappear,the syndrome score rate is≥95%;Marked effect:significant improvement of clinical symptoms and signs with a syndrome score≥70%;Effective:all clinical symptoms and signs improve,with a syndrome score≥30%;No effect:no clear improvement or aggravation of clinical signs and symptoms,less than 30%of the syndrome score.

2 Results

Treatment outcomes of cases in the two groups are shown in supplementary table.

Table 1 Comparison of curative effects of two groups of TCM syndromes(cases,100%)

Note:p<0.001

Table 2 Comparison of changes in TCM syndrome scores between the two groups(±S)

Note:intra-group comparison,p<0.001;Comparison between groups,before treatment,p>0.05;After treatment,p<0.001

Table 3 Comparison of blood gas analysis and lung function changes between the two groups(±S)

Note:intra-group comparison,p<0.001;Comparison between groups,before treatment,p>0.05;After treatment,p<0.001

Table 4 Comparison of dyspnea index changes between the two groups(±S)

Note:intra-group comparison,p<0.001;Comparison between groups,before treatment,p>0.05;After treatment,p<0.001

Table 5 Comparison of parameters related to non-invasive mechanical ventilation between the two groups(±S)

Note:p>0.05

The clinical observation results showed that the TCM syndrome integral of the patients in the experimental group with wheezing,shortness of breath,face color and cyanosis of lips and nails,mental awareness,sweating,limb syncope and expectoration were significantly lower than those in the control group,and the effective rate and effective rate of TCM syndrome treatment were also significantly higher than those in the control group,with statistical significance(p<0.001).At the same time,the improvement of TCM clinical syndromes is positively correlated with the improvement of dyspnea index.In addition,the improvement of Western medicine indexes such as pH value,arterial oxygen partial pressure,arterial oxygen saturation,forced vital capacity,forced expiratory flow in the first second,and lung diffusion in the experimental group were better than those in the control group,and there was statistical significance(p<0.001).Some cases in the two groups met the indications of non-invasive mechanical ventilation and were treated with non-invasive mechanical ventilation.The non-invasive mechanical ventilation patients in the experimental group seemed to be superior to the control group in terms of inhaled oxygen concentration and oxygenation recovery time after getting on the machine,but there was no statistical significance(p>0.05),which might be related to the small number of cases observed.

3Discussion

Respiratory failure refers to the pathological process that the arterial partial pressure of oxygen(PaO2)is lower than the lower limit of the normal range due to the serious disturbance of respiratory function,with or without the increase of arterial partial pressure of carbon dioxide(PaO2).Adults generally use PaO2＜50mmHg and PaCO2＞45mmHg as the criteria for judging respiratory failure at sea level.Respiratory failure is not an independent disease,but a syndrome with dysfunction and high mortality.There is no name of respiratory failure in traditional Chinese medicine,but according to its symptoms,it can be classified as"asthma","asthma","phlegm drink","lung distension","palpitation","edema","convulsion","closed syndrome","out of syndrome"and other critical diseases in traditional Chinese medicine,characterized by asthma,syncope,spasm,closed syndrome,and withdrawal.The clinical symptoms are complex and changeable.Among them,dyspnea,cyanosis,and psychiatric disorders are more prominent and common.Therefore,these three are often treated dialectically as the central syndromes in clinical practice.And dyspnea is the main feature of respiratory failure,the decisive factor of patients'quality of life and prognosis,and also an important basis for judging whether to carry out respiratory support,and often becomes the most important consideration factor in the process of offline and extubation of patients with mechanical ventilation,which is worthy of in-depth clinical research.Dyspnea can be summarized by the syndrome of Qi Ju in traditional Chinese medicine.Qi Ju can be seen in the"Synopsis of the Golden Chamber"by Yu Zaijing of the Qing Dynasty:"Cold leads to Qi Ju".It not only emphasizes that the deficiency of qi,especially the deficiency of qi,is the key point of TCM pathogenesis of dyspnea,but also summarizes the characteristics of TCM syndromes of dyspnea,which is mainly manifested by shallow shortness of breath,increased frequency,increased dyspnea in severe cases,or like sobbing,or sudden phlegm and sudden asthma,black nose and lips,sweaty forehead,and faint pulse.

At present,traditional Chinese medicine generally believes that the pathological changes of respiratory failure are mainly in the lung,involving the spleen,kidney and liver,and affect the heart in the later stage.The nature of the disease belongs to the deficiency of the essence and the deficiency of the essence.The deficiency of the essence is the damage of the lung,spleen,kidney,liver and heart,and the deficiency of the essence is the external invasion of the evil toxin,the phlegm and turbidity block the lung,the blood stasis and water drink block the collaterals,the phlegm and blood stasis block each other in the process of the disease,the deficiency and the excess are mixed,and the vicious cycle,ultimately damaging the yin and yang qi and blood,and involving the five visceras3.When it comes to Qi Ju syndrome,it is related to Zongqi.In the chapter of Lingshu·Evil Guest,there is"Zongqi is accumulated in the chest and out of the throat,and it can breathe through the heart and veins."Zhang Xichun also proposed that Zongqi"sincerely supports the whole body and serves as the guiding principle of all qi,including the outside of the lung and the pivot of breathing."This shows that the reason why the lung can control qi,manage breathing,connect with the outside and the atmosphere,and help the heart to circulate qi and blood is because it has the assistance of the biochemical power of Zongqi.The absorption and exhalation of turbidity in the lung are realized through the function of lung qi,and it is the zong qi that drives the movement of lung qi.zong qi becomes the fundamental power to stimulate,promote and maintain the lung.The rhythm and frequency of breathing depend on the regulation and control of zong qi.In addition,the lung governs the spleen,meets the hundreds of meridians,and helps the heart to promote blood circulation without the support of zong qi.In short,Zongqi plays a leading role in the transformation of breath from qi to blood and from lung to heart.When the function of Zongqi is abnormal,there will be respiratory disorders and qi ju syndrome.Therefore,the pathological basis of Qi Ju syndrome is abnormal Zongqi,which is mainly manifested by insufficient generation and circulation barrier.The deficiency of Zongqi is due to chronic lung disease,which will inevitably damage the lung and cause deficiency of lung qi,and then the spleen and spleen qi.With the gradual aggravation of deficiency of lung and spleen qi,biochemical deficiency of source,the damage of Zongqi will gradually appear,affecting its function and the emergence of Qi Ju syndrome.On the basis of deficiency of lung and spleen qi,feel the warm and evil toxin,the external evil invades the lung,the lung loses its clarity,the phlegm is generated internally,blocks the breath path,affects the circulation of the zong qi,and then impairs the function of the zong qi to pass through the heart and blood,and the qi and blood in the veins run astringently and form blood stasis.Therefore,the obstruction of qi circulation caused by phlegm,turbid blood stasis and toxin blocking the respiratory tract and vein is also the pathological factor of qi ju.To sum up,the pathogenesis of Qi Ju syndrome is deficiency of qi in the lung and spleen,and phlegm and blood stasis poison block the breath path and vein.Therefore,the treatment principle of Qi Ju syndrome focuses on regulating and replenishing the vital energy,invigorating the lung and spleen to activate the biochemical source of the vital energy,clearing heat and detoxifying,removing phlegm and dampness,activating blood circulation and removing blood stasis to unblock the breath channels and veins,and restoring the circulation of the vital energy.Tonifying,activating blood,unblocking collaterals and detoxifying are the basic methods of regulating and replenishing the qi of the clan.Therefore,it is proposed to set the tone to replenish the qi.Among them,Radix Astragali,Radix Ginseng and Fructus Corni are the monarch drugs for invigorating the spleen and Qi,replenishing the deficiency and cultivating the vitality;Trichosanthes kirilowii and Fritillaria thunbergii are official drugs,which can clear the lung and dissipate phlegm,and Chuanxiong and Salvia miltiorrhiza can promote blood circulation and remove blood stasis;Angelica can nourish blood and promote blood circulation,Zelan can promote blood circulation and promote water circulation,Tuyuan can remove blood stasis and collaterals,and Tiger Stick can promote blood circulation and reduce phlegm.It is used as an adjuvant medicine to promote blood circulation,reduce phlegm and unblock collaterals;Rhodiola and ganoderma lucidum can replenish qi,relieve fatigue,help the monarch to take medicine,and are also adjuvants;The above drugs are slightly warm,and the Qi Ju syndrome also contains the pathogenic factors of heat toxin blocking the lung.Therefore,hedyotis diffusa can clear heat,detoxify and remove dampness,which can not only remove the damp-heat toxin in the lung,but also restrict the warmness of the drugs.It is an adjuvant.Throughout this prescription,attack and supplement are used together,cold and warm are applied together,attack and cut do not hurt the right,supplement the deficiency and do not leave the evil,and better solve the problem of regulating and replenishing the qi.Moreover,modern pharmacological research shows that astragalus can reduce the content of collagen in the lung,alleviate lung injury and improve lung function.It can also reduce the respiratory rate,the wet/dry value of lung tissue,the ratio of Bax/Bc1 cells,increase Pa02,and improve the symptoms of acute lung injury caused by lipopolysaccharide.Ginseng decoction can significantly increase 2,3-diphosphoglycerate(2,3-DPG)in red blood cells of rats in hypoxic and non-hypoxic groups,while the increase of 2,3-DPG content can reduce the affinity of red blood cells to oxygen,and increase the amount of oxygen released when blood flows through the tissue,thus improving the hypoxia tolerance of the tissue 5.The effect of cornus officinalis on increasing the content of hemoglobin is extremely obvious,and it can significantly enhance the physical strength,anti-fatigue,hypoxia tolerance and memory of mice.6.Salvia miltiorrhiza,Tuyuan and Ganoderma lucidum also have the effect of enhancing the ability of tissue to resist hypoxia.Rhodiola can significantly improve the body's exercise ability under hypoxic conditions,and has protective effects on diaphragm fatigue and diaphragm cell injury 7.Therefore,Tiaobuzongqi formula not only conforms to the principle of consistent prescription of traditional Chinese medicine,but also has the support of modern pharmacological research of traditional Chinese medicine.Through our clinical observation,it can improve the symptoms of dyspnea,lung function,blood gas analysis and other related physical and chemical indicators of patients with respiratory failure.It has a good application prospect and is worthy of further study.

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