Clinical Study On The Treatment Of Severe Pneumonia Patients With Multiple Drug Resistance And Difficulty Weaning By Yiqi Huoxue(Huaxian Capsule Prescription)

Severe pneumonia is a common disease in intensive care medicine.In the face of multi-drug-resistant bacteria,the therapeutic effect of antibiotics is not ideal,which makes the treatment time more complicated and changeable.Mechanical ventilation is an effective treatment to correct respiratory failure,which can be quickly and effectively corrected in the early stage.Patients with severe pneumonia accompanied by multiple drug resistance are more and more difficult to be taken offline.In the department of intensive care medicine,the number of patients with severe pneumonia accompanied by multiple drug resistance is increasing.The treatment effect of Western medicine alone is weak for such patients,and the combination of traditional Chinese and Western medicine has become an effective entry point for the treatment of such patients.This study firstly studied the treatment of pneumonia by invigorating qi and activating blood through meta-analysis.Secondly,by referring to a large number of literatures,the Chinese medicine research and Western medicine research on severe pneumonia were described comprehensively.Finally,a randomized controlled clinical study was conducted to explore the therapeutic effect of supplementing qi and activating blood circulation(Huaxian capsule prescription)on patients with severe pneumonia with multiple drug resistance and difficulty in withdrawing the machine.(一)Meta-analysis of the treatment of pneumonia by TCM invigorating Qi and activating bloodObjective: To study the effect of supplementing qi and activating blood circulation in the treatment of pneumonia by Meta-analysis,the relevant studies on the treatment of pneumonia with supplementing qi and activating blood circulation in traditional Chinese medicine(TCM)were comprehensively sorted out.Methods: 1.Formulate the search terms,search strategies,and inclusion and exclusion criteria of the literature.2.In the domestic and foreign biomedical databases,the randomized controlled trials of supplementing qi and activating blood circulation in the treatment of pneumonia were comprehensively searched.The control group was treated with conventional western medicine,and the experimental group was treated with traditional Chinese medicine based on supplementing qi and activating blood circulation.The databases included Pubmed,EMBASE and Cochrane Library,Web of Science,CBM,CNKI,Wanfang,VIP,etc.3.Quality assessment and data extraction were conducted for the included literature.Rev Man 5.3 software was used to analyze the clinical efficacy,pulmonary function,CRP,PCT,WBC,IL-6,APACHEⅡ score,CPIS score and other outcome indicators.Count data were analyzed by risk ratio(RR),continuous variables were analyzed by standard mean difference(SMD),both were expressed as 95% confidence interval(CI).Results: 1.Effective rate: The results of 19 literatures were compared and analyzed.The results showed that the effective rate of the treatment group with TCM Yiqi Huoxue method combined with conventional western medicine treatment was better than that of the control group with western medicine treatment alone.2.Lung function: The comparison and analysis of lung function in the 5 literatures included in the study showed that the traditional Chinese medicine method of supplementing qi and activating blood circulation could improve lung function.3.PCT: The PCT level was compared and analyzed in the 7 literatures included in the study,and the results showed that the method of supplementing qi and activating blood circulation had obvious advantages in reducing PCT index.4.CRP: The comparison and analysis of CRP in the 14 literatures included in the literature showed that Yiqi Huoxue method had advantages in reducing CRP in patients.5.WBC: The comparison and analysis of WBC levels in 7 literatures included in the study showed that Yiqi Huoxue method had advantages in reducing WBC.6.APACHEⅡ score: The comparison and analysis of APACHEⅡ level in the 4 included literatures showed that Yiqi Huoxue method had advantages in reducing APACHEⅡ score.7.Safety: 6 studies reported adverse reactions,and 3 studies reported that there was no significant difference in adverse reactions between the control group and the treatment group.Three studies reported that the incidence of adverse reactions in the treatment group was lower than that in the control group.Conclusion: TCM Yiqi Huoxue method has a good effect in the treatment of patients with qi deficiency and blood stasis,and has advantages in improving the effective rate,lung function,PCT,CRP,WBC,APACHEⅡ score,etc.It is safe in the treatment process,and no serious adverse reactions are observed.(二)Review:This paper discusses the research of TCM on severe pneumonia from the aspects of disease name,etiology and pathogenesis,syndrome differentiation and treatment,and comprehensively discusses the research progress of western medicine on severe pneumonia from the aspects of epidemiology,etiology,pathogenesis and treatment.(三)A randomized controlled clinical trial of TCM Yiqi Huoxue method(Huaxian capsule prescription)in the treatment of severe pneumonia patients with multiple drug resistance and difficult weaningObjective: To study the clinical efficacy of Huaxian capsule prescription for nourishing qi and activating blood circulation in the treatment of severe pneumonia patients with multiple drug resistance and difficult ventilator weaning.Methods: A total of 68 patients were randomly assigned to the treatment group(n = 34)and the control group(n = 34).The control group was treated with conventional western medicine,and the experimental group was treated with Huaxian capsule prescription,150 ml bid orally or by nasal feeding for14 days.There were 32 cases in the treatment group and 31 cases in the control group.The TCM symptom score,CPIS score,APACHEⅡ score,PSI score,inflammatory factor levels,liver and kidney function,coagulation function,blood gas analysis,lung function indication of ventilator weaning,hospitalization time and ventilator use time of the two groups were observed.SPSS 27.0 statistical software was used for statistical analysis to evaluate the differences in baseline indicators and efficacy indicators between the two groups.Result:1、 Baseline comparison: there were no significant differences in gender,vital signs,underlying diseases,comorbidities,sputum culture,antibiotic application,other treatment,liver and kidney function between the two groups at baseline.2.Comparison of curative effect:(1)Clinical effect:the effective rate of the treatment group was better than that of the control group.(2)The TCM syndrome scores of the two groups were significantly decreased,and the experimental group was better than the control group.(3)The CPIS score,APACHEⅡ score and PSI score of the two groups decreased after treatment,and the experimental group was better than the control group.(4)Inflammatory indicators: WBC,CRP,PCT,IL-6 and other inflammatory indicators of the two groups were improved after treatment,and there were differences between the two groups,and the experimental group was better than the control group.(5)Blood gas analysis: compared with the control group,Pa O2 and Pa CO2 in the treatment group were significantly improved,but PH was not significantly improved.(6)Liver and kidney function and coagulation function: compared with the control group,the effect of the experimental group on ALB,PA,DBIL,UREA and CREA levels was better than that of the control group,but the effect on AST and TBIL levels was not significant.The improvement of PT,APTT,FIB and DDIMER in the experimental group was better than that in the control group.(7)The pulmonary function indexes of the experimental group were better than those of the control group.(8)The length of hospital stay and ventilator application time in the experimental group were better than those in the control group.Conclusion: The application of Huaxian capsule prescription formula of Yiqi Huoxue method in the treatment of severe pneumonia patients with multiple drug resistance and difficult weaning can improve the CPIS score,APACHEⅡ score and PSI score.Significantly reduced the levels of inflammatory factors;Improve Pa O2,Pa CO2 levels;Improve liver and kidney function,coagulation function;It can shorten the duration of ventilator treatment and hospital stay,and reduce the mortality of patients.