Drug-induced respiratory failure

　　There are many drugs that can induce or precipitate respiratory failure, and their mechanisms of action are also different. However, their basic changes mainly include acute non-cardiogenic pulmonary edema, bronchospasm, central or peripheral alveolar hyperventilation, and alveolar hemorrhage. The exact mechanism of these pathological changes is unclear and may be related to the direct toxic effect of drugs on alveolar capillary endothelial cells or the damage caused by their indirect inflammatory or immune reactions.

　　There are many drugs that can induce or precipitate respiratory failure, and drug-induced respiratory failure mainly complicates with pulmonary encephalopathy, gastrointestinal bleeding, shock, and metabolic acidosis. The specific details are as follows:

　　1. Pulmonary encephalopathy

　　Pulmonary encephalopathy, also known as pulmonary heart encephalopathy syndrome, is brain tissue damage and brain circulation disorder caused by chronic bronchitis complicated with emphysema, pulmonary heart disease, and pulmonary function failure. The main criteria include chronic pulmonary disease with pulmonary function failure; clinical manifestations include disturbance of consciousness, neurological and psychiatric symptoms, and localization of neurological signs; blood gas analysis shows signs of pulmonary insufficiency and hypercapnia; diagnosis is made by excluding other causes of neurological and psychiatric disorders.

　　2. Gastrointestinal bleeding

　　The clinical manifestations depend on the nature, location, amount, and speed of bleeding, and are also related to the patient's age, cardiac and renal function, and other systemic conditions. Acute massive bleeding is mostly manifested as hematemesis; chronic small amount of bleeding is manifested as positive occult blood in feces; when the bleeding site is above the Treitz ligament of the jejunum, the clinical manifestation is hematemesis. If the blood in the stomach remains for a long time after bleeding, it becomes acidic hemoglobin due to the action of gastric acid and appears as coffee-colored.

　　3. Shock

　　It is a clinical syndrome caused by insufficient tissue perfusion, which is a common complication in severe diseases in various clinical departments. The common feature of shock is insufficient effective blood volume. Although tissue and cell blood perfusion is compensated, it is still severely restricted, leading to poor blood perfusion of the whole body and organs, causing a series of pathophysiological changes such as tissue hypoxia, microcirculatory stasis, organ dysfunction, and abnormal cell metabolic function.

　　4. Metabolic acidosis

　　It is the most common type of acid-base imbalance, characterized by primary decrease in HCO3- (less than 21 mmol/L) and decrease in pH value (less than 7.35) due to increased extracellular H+ or loss of HCO3-.

　　The diagnosis of drug-induced respiratory failure should first confirm the existence of respiratory failure. The diagnosis of respiratory failure is generally not difficult, and early diagnosis mainly depends on clinical manifestations. When patients have symptoms such as dyspnea, shortness of breath, and difficult breathing, the possibility of respiratory failure should be considered. In severe cases, there may be symptoms such as confusion, irritability, drowsiness, coma, shallow breathing, or irregular breathing rhythm. At this time, blood gas analysis can be used to make a clear diagnosis.

　　During the rescue of respiratory failure, the correction of hypoxia and CO2 retention, it is also necessary to pay attention to the correction of acid-base imbalance and electrolyte disorder, prevent gastrointestinal bleeding, maintain the normal function of major organs, and ensure the success of treatment and recovery of patients with respiratory failure.

　　The main clinical examination methods for drug-induced respiratory failure include blood gas analysis and X-ray chest film, as follows:

　　1. Blood gas analysis

　　Blood gas analysis is commonly used in medicine to judge whether there is acid-base imbalance, hypoxia, and the degree of hypoxia in the body. When the PaO2 in blood gas analysis is less than 8.0 kPa, and the PaCO2 is reduced, it is normal (Type I), or greater than 6.67 kPa (Type II).

　　2. X-ray chest film

　　No abnormalities were observed in the early stage, and the evolution of X-ray chest films was related to the severity of the disease.

　　Patients with drug-induced respiratory failure should mainly consume light and healthy foods and pay attention to regular dietary habits. This disease does not have too many dietary taboos, and a reasonable diet should be followed according to the doctor's advice. In addition to traditional Chinese and Western medical treatments for drug-induced respiratory failure, the symptoms can also be significantly improved through the following dietary methods.

　　1. For those with respiratory failure and kidney-yin deficiency:One turtle killed and cleaned, 60g of sea cucumber, 10g of fritillaria, add ginger, cooking wine, and an appropriate amount of water, boil and then simmer over low heat for 1 hour, add an appropriate amount of rock sugar and serve (not suitable for those with poor appetite).

　　2. Placenta porridge:One cow or pig placenta, 100g of glutinous rice. Clean the cow or pig placenta, cut it into pieces, cook it until soft with an appropriate amount of water, then cook it with glutinous rice to make porridge, and eat it with seasonings. Eat for breakfast and dinner.

　　3. Loquat pear:One pear, 30g of loquat. Wash the pear, drain the hollow part, remove the core, add loquat, a little sugar, steam it, and eat it warm. Once a day, for several days.

　　4. Frog white pepper:10 grams of white pepper, one frog. Put 10 grams of white pepper in the frog's mouth, sew it up with a needle, place it in a bowl with an appropriate amount of water, and steam it. Drink the soup and eat part of the frog meat (intestines and stomach should not be eaten), once every two days, for 5-8 times.

　　In addition to Western medical treatment methods for drug-induced respiratory failure, traditional Chinese medicine treatment methods can also be used, as follows:

　　1. Acute phase of respiratory failure:

　　1. Phlegm dampness transforming into heat, blocking the lung: Treatment: Clear the lung and resolve phlegm, stop cough, and relieve asthma.

　　The formula consists of 3g of white桑皮, 30g of melon, 10g of scutellaria, 30g of Houttuynia, 10g of Platycodon grandiflorus, 10g of杏仁, 10g of tangerine peel, 10g of pinellia, 10g of radish seed, 12g of Chuanxiong, 20g of Salvia miltiorrhiza, and 10g of red peony.

　　The formula emphasizes clearing heat and resolving phlegm, stopping cough, and relieving asthma, supplemented by Salvia miltiorrhiza and red peony to activate blood circulation and remove blood stasis to enhance efficacy. This condition is an early stage of acute respiratory failure, and early detection and treatment can prevent the deterioration of the disease.

　　2. Yang deficiency of the spleen and kidney, water Qi oppressing the heart: Treatment: Invigorate the spleen and drain dampness, warm Yang and promote diuresis.

　　The formula includes 6g of prepared aconite (decocted first), 15g of Codonopsis, 12g of atractylodes, 20g of coix seed, 20g of Plantago, 15g of pericarpium amomi, 10g of prepared Ephedra, 12g of white peony, 10g of Platycodon grandiflorus, 12g of杏仁, 12g of tangerine peel, 10g of pinellia, and 15g of Salvia miltiorrhiza.

　　The formula uses prepared aconite to warm and invigorate the spleen and kidney, Codonopsis, atractylodes, and coix seed to invigorate the spleen, Ephedra to stop asthma, Plantago and pericarpium amomi to promote Qi and diuretic, white peony to harmonize the营, Platycodon grandiflorus,杏仁, tangerine peel, and pinellia to ventilate the lung, relieve cough, and resolve phlegm, and Salvia miltiorrhiza to activate blood circulation. If there is a thin yellow coating, remove the prepared aconite and add Chuanxiong and Houttuynia to clear the lung and resolve phlegm.

　　3. Phlegm turbidity blocking the orifices: Treatment: Clear the lung and open the orifices, aromatic opening.

　　The formula consists of 10g of tangerine peel, 10g of pinellia, 15g of poria, 10g of Platycodon grandiflorus, 10g of fritillaria, 10g of dandelion, 12g of costus, 12g of amomum cardiaco-protect, 10g of atractylodes, 10g of gardenia, 6g of licorice, and 10g of scutellaria.

　　The formula includes dried tangerine peel, pinellia, poria, Platycodon grandiflorus, and fritillaria to dry dampness and resolve phlegm, while dandelion, costus, and amomum cardiaco-protect and clear the orifices. Atractylodes, scutellaria, gardenia, and licorice clear the bowels and relieve heat. For those with white and greasy coating, take Suhe Xiang Wan, one pill each time, twice a day. If there is a yellow and greasy coating, use 250ml of 5% glucose and 40ml of Qingkailing for intravenous drip, twice a day.

　　4. Internal movement of liver wind: Treatment: Clear the lung and resolve phlegm, nourish Yin and calm the liver, activate blood circulation and stop wind.

　　Prescription: Zhigancao 10g, Xingren 10g, Shengshi 30g, Lianhua 30g, Gancao 10g, Shengdi 15g, Maidong 15g, Shenglongmu each 12g, Quanxie 10g, Jiangcan 6g, Changpu 15g, Gouteng 15g, Danshen 15g, Chuanxiong 12g.

　　In the prescription, Mahuang, Xingren, Shengshi, and Gancao clear the lung and resolve phlegm to stop asthma. Shengdi and Maidong nourish the liver Yin. Shenglongmu, Quanxie, Jiangcan, Changpu, Gouteng calm the liver and stop wind to open the orifices. Danshen and Chuanxiong activate blood circulation.

　　5. Heat and blood stasis causing collateral damage: Treatment: Clear the lung and resolve phlegm, activate blood circulation and unblock collaterals.

　　Prescription: Zhigancao 6g, Shengshi 30g, Xingren 10g, Chenpi 10g, Banxia 10g, Qianhu 10g, Zicao 15g, Danshen 15g, Yuanhu 10g, Dazai and Xiaozai each 12g, Baiji 12g, Xianhecao 12g, Sanqi powder taken internally.

　　6. Yang deficiency with a tendency to collapse: Treatment: Invigorate Qi and nourish Yin, restore Yang and secure the Looseness.

　　Prescription: Duhuang decoction administered internally, simultaneously, 250ml of 5% glucose and 40ml of Shengmai liquid administered intravenously. Fuzi 10g decocted first, Ganjiang 6g, Zhigancao 10g.

　　Second, the remission period of respiratory failure:

　　1. Deficiency of both the lung and kidney: Treatment: Tonify the lung and kidney.

　　Prescription: Dangshen 15g, Maidong 15g, Wuweizi 6g, Baizhu 10g, Zicao 10g, Beimu 10g, Zhigancao 6g, Buguzhi 10g, Xianlingpi 12g, Xianmao 12g.

　　In the prescription, Dangshen, Maidong, Wuweizi, Baizhu, and Zhigancao tonify the lung and kidney, and astringe the Qi. Buguzhi, Xianlingpi, and Xianmao tonify the kidney. Zicao and Beimu relieve cough and dissolve phlegm. If the patient is more yin-deficient, the prescription includes Beishashen 20g, Maidong 15g, Yuzhu 15, Shengshuidi each 15g, Shanyao 15g, Shanyu 10g, Gouqizi 15g, Guiguanjiao 15g.

　　2. Yang deficiency of the heart, spleen, and kidney, with internal retention of fluid: Treatment: Warm the Yang and promote diuresis, activate blood circulation and unblock collaterals.

　　Prescription: Chuanxiong 10g decocted first, Rougui 6g, Shudadi 12g, Shanyao 15g, Shanyu 10g, Danshen 15g, Fuling 20g, Zexie 15g, Danshu 10g, Buguzhi 10g, Wuweizi 6g, Chuanxiong 10g.