清肺解毒汤治疗呼吸机相关性肺炎的疗效观察  

An observation on efficacy of lung detoxification soup for treatment of patients with ventilator associated pneumonia

作　　者：韩娟[1] 周大勇[1] 武慧[1] 

机构地区：[1]安徽中医药大学第一附属医院综合ICU,安徽合肥230031

出　　处：《中国中西医结合急救杂志》2014年第4期277-280,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：安徽中医药大学临床研究基金项目（2010LC-050B）

摘　　要：目的：观察清肺解毒汤治疗呼吸机相关性肺炎（VAP）的临床疗效及对血清降钙素原（PCT）、超敏C-反应蛋白（hs-CRP）及白细胞计数（WBC）的影响。方法采用前瞻性随机对照研究方法，将安徽中医药大学第一附属医院综合重症监护病房（ICU）收治的60例VAP（痰热郁肺证）患者按CASIO fx-360P函数计算器产生随机数进行简单随机化分组，分为对照组和治疗组，每组30例。对照组给予机械通气、抗感染、预防应激性溃疡、早期胃肠道营养、尽早脱机等西医常规治疗；治疗组在对照组治疗基础上加用清肺解毒汤（组成：生黄芪20 g，黄芩15 g，黄连10 g，川贝母8 g，制半夏10 g，白芥子10 g，鱼腥草15 g，金银花15 g，连翘15 g，板蓝根15 g，大黄10 g，丹参30 g）每次100 mL鼻饲，每日2次。两组疗程均为7 d，比较两组用药前后中医证候积分、WBC、血清PCT、hs-CRP及临床疗效的变化。结果两组治疗后中医证候积分、WBC、PCT、hs-CRP均较治疗前明显降低，且以治疗组降低更显著〔中医证候积分（分）：4.73±1.10比10.33±1.46，WBC（×10^9/L）：8.71±0.55比10.77±0.65，PCT（μg/L）：1.64±0.40比5.71±1.25，hs-CRP（mg/L）：4.96±1.06比8.85±1.53，均P＜0.05〕。治疗组总有效率明显高于对照组〔93.33%（28/30）比73.33（22/30），P＜0.05〕。结论清肺解毒汤能显著改善VAP（痰热郁肺证）患者的临床症状，降低WBC、血清PCT、hs-CRP水平，对VAP有良好的辅助治疗作用。Objective To observe the clinical efficacy of lung detoxification soup for treatment of patients with ventilator associated pneumonia（VAP）and its effects on serum procalcitonin（PCT）,high sensitivity C reactive protein （hs-CRP）and white blood cell count（WBC）. Methods A prospective randomized controlled trial was conducted, sixty cases of VAP with traditional Chinese medicine（TCM）syndrome of accumulation of phlegm and heat in lung from Department of Intensive Care Unit（ICU）in the First Affiliated Hospital of Anhui TCM University were enrolled, and the CASIO fx-360P function calculator was applied to generate random numbers to proceed to simple randomized dividing into two groups（each,30 cases）. In the control group,mechanical ventilation,anti-infection,prevention of stress ulcer,early enteral nutrition,early weaning of ventilator and conventional western medicine treatment were given to the patients,while in the treatment group,based on the above conventional treatments in the control group,additionally the lung detoxification soup was given（soup composition：radix astragali 20 g ,baical skullcap root 15 g,coptis 10 g,shellfish 8 g,pinelliae tuber 10 g,white mustard seed 10 g,heartleaf houttuynia herb 15 g, honeysuckle flower 15 g,forsythia 15 g,banlangen 15 g,rhubarb 10 g,salvia miltiorrhiza 30 g）by nasal feeding, once 100 mL,twice a day. The therapeutic course was 7 days in both groups. The changes of TCM syndrome integral, levels of serum PCT,hs-CRP and WBC before and after treatment and the clinical efficacy were compared between the two groups. Results After treatment,the TCM syndrome integral,the levels of WBC,serum PCT,hs-CRP were significantly lower than those before treatment in both groups,and the decrease in treatment group being more marked〔TCM syndrome integral：4.73±1.10 vs. 10.33±1.46,WBC（×10^9/L）：8.71±0.55 vs. 10.77±0.65,PCT （μg/L）：1.64±0.40 vs. 5.71±1.25,hs-CRP（mg/L）：4.96±1.06 vs. 8.85±1.53,all P〈0.05〕. The total effective rate of

关 键 词：清肺解毒汤 呼吸机相关性肺炎 降钙素原 超敏C-反应蛋白 中西医结合疗法 

分 类 号：R563.1[医药卫生—呼吸系统]