关键词: 肺疾病, 慢性阻塞性；通气机, 机械；通气机撤除法；从脾胃论治；内外合治；经皮穴位电刺激

Abstract: Background　According to the theoretical basis of "deficiency nourishes the mother" of the five elements of traditional Chinese medicine，the method of "nourishing the spleen and benefiting the lungs" in the treatment of chronic obstructive pulmonary disease（COPD） had been widely used in clinical practice，and had been proved to be of high practical value.Objective　To investigate the effect of weaning from mechanical ventilation in patients with COPD assisted by internal and external combination of "Treatise on Spleen and Stomach".Methods　We enrolled 160 patients with acute COPD who required invasive positive pressure ventilation（IPPV） in the Intensive Care Unit（ICU） of Jiyang branch and Huandong branch of Traditional Chinese Medical Hospital of Zhuji from November 2015 to October 2017 in this prospective randomized controlled trial.Forty-two patients were assigned to the control group by using the random number table method.The remaining patients were divided into lung-spleen qi deficiency group（n=36），spleen-lung deficiency-cold group（n=45） and spleen-stomach yin deficiency group（n=37）．The patients in the control group were treated with 50 ml warm water nasal feeding twice a day.Lung-spleen qi deficiency group were treated with Shenling Atractylodes，spleen-lung deficiency-cold group with Huangqijianzhong decoction，and spleen-stomach yin deficiency group with Ophiopogon decoction.At the same time，the three groups were treated with transcutaneous electrical acupoint stimulation therapy on zusanli and fenglong for 14 days.Respiratory index（f/VT），endogenous positive end-expiratory pressure（PEEPi），lung compliance，and airway resistance at four time points：before intubation（T1），day 1 of invasive positive pressure ventilation（IPPV）（T2），day 5 of IPPV（T3），and before intubation（T4） were recorded.Levels of C-reactive protein（CRP），procalcitonin（PCT），white blood cell count（WBC），albumin（ALB），prealbumin（PA），total protein（TP）were recorded before and after treatment.The primary outcome of all patients were IPPV total time，spontaneous breathing test（SBT），non-invasive positive pressure ventilation，NPPV，utilization rate，tracheal intubation rate after 48 hours，hospital mortality，ICU stay，and hospital stay.Results　There were interactions between treatment methods and practices in f/VT，PEEPi，lung compliance，and airway resistance （P<0.05）．The main effects of treatment methods and time on f/VT，PEEPi，lung compliance and airway resistance were significant（P<0.05）.Lung compliance increased successively at T1，T2，T3 and T4（P<0.05）．At T3 and T4，f/VT of lung-spleen qi deficiency group，spleen-lung deficiency-cold group and spleen-stomach yin deficiency group was lower than that of the control group（P<0.05）．At T4，f/VT of the lung-spleen qi deficiency group was lower than that of the lung-stomach yin deficiency group（P<0.05）．At T3，PEEPi of spleen-lung deficiency-cold group was lower than that of control group（P<0.05）．At T4，PEEPi of the lung-spleen qi deficiency group，spleen-lung deficiency-cold group and long stomach yin deficiency group was lower than that of the control group（P<0.05）．At T3，lung compliance of lung-spleen qi deficiency group and spleen-lung deficiency-cold group was higher than that of control group（P<0.05）．At T4，lung compliance of lung-spleen qi deficiency group，spleen-lung deficiency-cold group and spleen-stomach yin deficiency group was higer than that of the control group（P<0.05）．At T4，airway resistance of the lung-spleen qi deficiency group and spleen-lung stomach yin deficiency group was lower than that of the control group（P<0.05）．After treatment，CRP of the lung-spleen qi deficiency group，spleen-lung deficiency-cold group and spleen-stomach yin deficiency group was lower than that of the control group（P<0.05）；PCT of the lung and stomach yin deficiency group was lower than that of the control group（P<0.05）；ALB in the lung-spleen qi deficiency group and lung-stomach yin deficiency group was lower than that in the control group（P<0.05）；PA and TP of the lung-spleen qi deficiency group，spleen-lung deficiency-cold group，splee-stomach yin deficiency group were lower than those of the control group（P<0.05）．The total IPPV time，SBT times，ICU stay and hospitalization time in the lung-spleen qi deficiency group，spleen-lung deficiency-cold group and splee-stomach yin deficiency group were less than those in the control group（P<0.05）．Conclusion　"Treatise on Spleen and Stomach" internal and external combined treatment can improve the respiratory mechanical index and nutritional index of COPD patients，weaning from mechanical ventilation，and overall prognosis.

Key words: Pulmonary disease, chronic obstructive；Ventilators, mechanical；V entilator weaning；Treatment by spleen and stomach；Internal and external combination；Percutaneous electrical stimulation