大黄附子汤对失血性休克急性肺损伤患者的保护作用  

Protective effect of DaHuang Fuzi Decoction on hemorrhagic shock secondary to acute lung injury in patients

作　　者：路晓光[1] 康新[1] 战丽彬[2] 于健[3] 杨荣利[4] 范治伟[1] 肖威强 李思瑶[6] 梁正凯[6] 余洁[1] 于亮亮[1] 

机构地区：[1]大连大学附属中山医院,116000 [2]大连医科大学中西医结合研究院 [3]大连医科大学附属第二医院 [4]大连市中心医院 [5]大连医科大学研究生院 [6]遵义医学院

出　　处：《中华急诊医学杂志》2013年第12期1383-1387,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金项目（81173397、81202831、30672767、30971626）;辽宁省科技攻关层次计划课题（2007E21SF198）

摘　　要：目的探讨大黄附子汤防治失血性休克并发急性肺损伤的保护作用及其机理。方法采用前瞻性、多中心、随机对Ntis床试验。收集2010年6月至2013年4月大连地区3所三级甲等医院87例失血性休克并发急性肺损伤患者的临床资料，采用随机数字法分为对照组（n=42）和大黄附子汤灌肠组（试验组，n=45）。于患者入组时及治疗1、3、7d分别取静脉血测定肿瘤坏死因子仅（TNF—d）、C反应蛋白（CRP）、血乳酸、内毒素质量浓度；测定血管外肺水指数（EVLWI）、EVLW／ITBV（胸腔内总血容量）、平均动脉压（MAP）、心脏指数（CI）；测定静态肺顺应性、呼吸道阻力以及呼吸机撤离时间、低氧血症纠正时间，计算患者病死率。采用SPSS17．0软件分析实验数据，组内比较采用方差分析，两两比较采用LSD—t检验。结果与对照组比较，试验组在大黄附子汤治疗后各时间点血清TNF一仪、CRP、内毒素、血乳酸、EVLWI及EVLW／ITBV显著降低（P〈0．05或P〈0．01）。与对照组比较，试验组静态肺顺应性在大黄附子汤治疗3、7d后明显增强（P〈0．01），气道阻力则在治疗7d后有所降低（P〈0．05）。对照组与试验组比较，呼吸机撤离时间[（7．82±1．54）dVS．（5．26±1．28）d，P〈0．05]、低氧血症纠正时间[（82．42±14．61）hVS．（62．34±11．27）h，P〈0．01]、住院时间[（13．85±2．94）dVS．（10．57±2．05）d，P〈0．05]、病死率（7．5％VS．2．5％，P〈0．01）。结论大黄附子汤通过降低肠源性内毒素和促炎因子TNF—d的释放，降低血管外肺水和呼吸道阻力，提高静态肺顺应性，改善机体氧合指数，进而缩短呼吸机撤离时间和低氧纠正时间，降低失血性休克并急性肺损伤患者的病死率。Objective To discuss protective effect of DaHuang Fuzi Decoction （a Chinese herbal preparation made of Rheum palmatum L and Aconitum carmichaeli Debx） on hemorrhagic shock induced by acute lung injury in patients. Methods A prospective, multiple-center, randomized （ random number） and controlled clinical trial was carried out in 87 adult patients with hemorrhagic shock secondary to acute lung injury admitted io intensive care unit （ICU） of 3 tertiary care hospitals in Dalian city. Patients were randomly （random number） divided into control group （n = 42 ） and DaHuang Fuzi Decoction enemas group （experimental group, n = 45）. Of 42 patients of control group, there were 28 male and 14 female with average age （39.68 ± 15.77 ） years ranged from 20 to 64 years, and in experimental group, there were 30male and 15 female with average age （42. 12 ± 14. 87） years ranged from 20 to 68 years. The serum levels of TNF-a, C-reactive protein （CRP） , lactic acid and endotoxin, and extravascular lung water index, ratio of extravascular lung water to intrathoracic blood volume （ EVLW/ITBV）, MAP, cardiac index （CI） , and static lung compliance and airway resistance were determined in each group before and ld, 3d, 7d after treatment. The data including the length of time consumed for respiration support with mechanical ventilation and length of time required for correction of hypoxemia to normal oxygenation resumed and length of hospital stay and mortality were analyzed. Results Compared with control group, DaHuang Fuzi Decoction decreased the levels of serum TNF-a, CRP, blood lactic acid, endotoxin, VLWI and EVLW ITBV in experimental group （P 〈 0. 05 or P 〈 0. 01 ）. Static lung compliance in experimental group were enhanced on 3 d, 7 d after treatment, but 7 days after treatment with DaHuang Fuzi Decoction, the airway resistance in experiment group were lower than that in control group on 7 day without DaHuang Fuzi Decoction treatment. Compared with control group, in experimental

关 键 词：失血性休克 急性肺损伤 大黄附子汤 内毒素 血管外肺水 静态肺顺应性 呼 吸道阻力 病死率 患者 

分 类 号：R563.8[医药卫生—呼吸系统]