大承气汤治疗机械通气严重脓毒症患者38例疗效观察  

Clinical investigation on effect of Dachengqi decoction （大承气汤） in 38 patients with severe sepsis under mechanical ventilation

作　　者：余丹凤[1] 胡马洪[1] 金东[1] 翁银燕[1] 张庚[1] 

机构地区：[1]浙江省立同德医院急诊内科,浙江杭州310012

出　　处：《中国中西医结合急救杂志》2010年第4期199-201,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：基金项目：浙江省中医药管理局课题（2006C150）

摘　　要：目的探索一种有效提高行机械通气严重脓毒症患者抢救成功率的中西医结合方法。方法将75例行机械通气的严重脓毒症患者随机分为对照组（37例）和观察组（38例），对照组采用西医常规治疗（抗感染、液体复苏、激素、机械通气、营养支持等），观察组在西医常规治疗基础上加中药大承气汤鼻饲；观察比较两组患者淋巴细胞亚群CD3＋、CD4＋、CD8＋在入院治疗前及治疗后1周、2周的变化情况；28d终点时评价机械通气时间、住重症监护病房（ICU）时间、气压伤发生率、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）和多器官功能障碍综合征（MODs）评分改善情况及28d病死率。结果两组患者入院治疗前淋巴细胞亚群CD3＋、CD4＋、CD8＋比较差异无统计学意义（均P〉0．05）；在治疗后1周时即降至最低值，2周后开始回升，两组同期比较差异有统计学意义（均P〈0．01）；两组患者28d终点时机械通气时间、住ICU时间、APACHEⅡ和MODS评分改善情况及28d病死率比较差异均有统计学意义（均P〈0．05），而气压伤发生率无明显差异（P〉0．05）。结论大承气汤有免疫调节功能，可以缩短行机械通气严重脓毒症患者的机械通气及住ICU时间，改善APACHEⅡ和MODS评分，提高治愈率；但并不能减少气压伤的发生率。Objective To explore a more effective therapeutic method of integrated traditional Chinese and Western medicine with higher successful rate of saving the patients of severe sepsis under mechanical ventilation （MV）. Methods Seventy-five MV patients with severe sepsis were randomly divided into two groups. The control group （n = 37） accepted the routine western therapies, including anti-infection, liquid infusion in resuscitation, glucocorticoid, MV and nutrition support. The treatment group （n = 38） received similar western routine therapies with addition of traditional Chinese medicine [TCM, nasal feeding with Daehengqi decoction （大承气汤）]. CD3＋, CD4＋, CD8＋ lymphocytes numbers of patients in the two groups were recorded before and after the treatment at 1 week and 2 weeks. At the study endpoint, the time of MV support, time in intensive care unit （ICU）, incidence of barotrauma, acute physiology and chronic health evaluation II （APACHE II ） score, multiple organ dysfunction syndrome （MODS） score and 28-day mortality were also recorded after the treatment. Results CD3＋ , CD4＋ and CD8＋ lymphocytes of all patients decreased to the minimum after 1 week of treatment, from 2 weeks they began to elevate. In the comparisons between the two groups in these lymphocyte subgroups at admission before the treatment, there were no statistical significant differences （all P〉 0. 05）; after treatment, the differences were statistically significant in the comparisons at corresponding time points （all P〈0. 01）. At the 28-day endpoint, the time of MV support, time in ICU and 28-day mortality were decreased, and the improvement in APACHE II score and MODS score was seen in the treatment group; in the comparisons of the above factors between the two groups, there were statistical significant differences （all P 〈 0. 05）, but the incidence of barotrauma showed no statistical significance （P〈0.05）. Conclusion Dachengqi decoction has immunological regulatory functions. Fo

关 键 词：严重脓毒症 机械通气 中药 大承气汤 

分 类 号：R285.6[医药卫生—中药学] R631[医药卫生—中医学]