With Method of Strengthening Spleen and Tonifying Lung to Help "White Lung" Off-line Extubation
1.Department of Critical Care medicine, The Third People's Hospital affiliated to Fujian University of Chinese Medicine, Fuzhou, 350108, China
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ZHANG Jiansheng, WANG Qing, WEI Xuwei. With Method of Strengthening Spleen and Tonifying Lung to Help "White Lung" Off-line Extubation[DB/OL].(2023-10-08)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=42510795&Fpath=home&index=0
DOI:
ZHANG Jiansheng, WANG Qing, WEI Xuwei. With Method of Strengthening Spleen and Tonifying Lung to Help "White Lung" Off-line Extubation[DB/OL].(2023-10-08)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=42510795&Fpath=home&index=0DOI:
With Method of Strengthening Spleen and Tonifying Lung to Help "White Lung" Off-line Extubation
Summary of case history, Ren Huiying, male, 71 years old, was admitted to the hospital at 12:06 a.m. March 7, 2023 from the outpatient department with the complaint of "repeated asthma for more than 2 months". The patient was admitted to ,the First Affiliated Hospital of Fujian Medical University, for chest CT examination, which showed multiple spots in both lungs and interstitial changes. The phlegm was yellow in color, medium in quantity and viscous in quality, and was not easy to cough up, accompanied by disturbance of consciousness, no headache, dizziness, convulsions, upturned eyes, hemiplegia, hot flushes, night sweats, hemoptysis, etc. After the treatment of tracheal intubation, mechanical ventilation, antiviral, anti-infection, etc., the patient's consciousness became clear and the nucleic acid of the novel coronavirus turned negative after retest, but he was still wheezing and had a lot of sputum. He could not pull the tube offline in a short time, and the transition of bedside tracheotomy was performed. Since then, the patient has repeated asthma and cannot withdraw the machine. Later, in order to seek traditional Chinese medicine diagnosis and treatment, the patient's family members consulted the outpatient department of our hospital, which planned to admit "severe pneumonia" to the Intensive care Medicine Department. Since the onset of the disease, the patient was conscious, mental fatigue, weight decreased about 10 kg. Chen Xia: wheezing (ventilator assisted breathing), the movement is very wheezing, phlegm is not easy to cough up, fatigue, occasional sweat, muscle thinning, lower limb impotence weak, less, sleep and sleep, indent catheter, loose stool when constipation, light red tongue thin white pulse fine number. She has a history of "hypertension" for more than 10 years. She takes amlodipine 5 mg,once a day, regularly to control blood pressure, but does not monitor blood pressure regularly.,TCM diagnosis, Gasp syndrome(Lung Spleen Deficiency Syndrome),Western medicine diagnosis, 1. Severe pneumonia Respiratory failure 2. Difficulty in extubation after tracheotomy 3. Hypertension,Therapeutic methods, 1. Western medicine: (1) early treatment of ventilator-assisted breathing (alternate P-SIMV and SPONT modes), analgesia and sedation, anti-pulmonary fibrosis, intermittent tracheoscopy, enteral nutrition support, external diaphragm pacing and prone ventilation. (2) Mid-stage off-line training, alternating between ventilator (SPONT mode) and HFNC. (3) In the later stage, the half-full sealing training of gas cutting casing mouth and ordinary oxygen inhalation were carried out until tube extraction was completed. 2. Traditional Chinese medicine: with the method of invigorating spleen and lungs, dispelling dampness and eliminating phlegm, Shenling Baizhu SAN combined with supplementing Zhongyiqi Decoction, Huangqi Jianzhong Decoction combined with supplementing Zhongyiqi Decoction, supplementing Zhongyiqi Decoction combined with Erchen Decoction, Sanzi Yangqin Decoction, and a series of measures including acupuncture and rehabilitation were introduced.,Clinical outcomes, The patient's nutritional condition was improved, the lung inflammation was absorbed, and the spontaneous respiration was gradually stable. The patient was successfully removed from the ventilator, and was successively transferred to HFNC and ordinary oxygen inhalation. The half-complete sealing training of gas incision cannula was performed, and finally the gas incision cannula was successfully removed.
关键词
重症肺炎脱机困难肺脾气虚证健脾益肺
Keywords
severe pneumoniaoff-line difficultylung spleen deficiency syndromestrengthening spleen and tonifying lung