加味千金苇茎汤对重症肺炎患者血气分析指标及炎症反应的影响  

Effects of modified Qianjin Weijing Decoction on blood gas analysis indexes and inflammation in patients with severe pneumonia

作　　者：马旭灿[1] 唐霞 Ma Xucan;Tang Xia(Department of Emergency,Jinhua Central Hospital,Jinhua 321000,Zhejiang,China;Department of Internal Medicine(Second Part),Lanxi Ruikang Hospital,Lanxi 321100,Zhejiang,China)

机构地区：[1]金华市中心医院急诊科,浙江金华321000 [2]兰溪瑞康医院内二科,浙江兰溪321100

出　　处：《中国中西医结合急救杂志》2019年第6期650-654,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省医学会临床科研基金项目(浙医会[2018]212号)。

摘　　要：目的观察加味千金苇茎汤对重症肺炎患者血气分析指标及炎症反应的影响.方法选择2017年1月至2019年4月金华市中心医院收治的重症肺炎患者120例,按治疗方式不同将患者分为两组,每组60例.西医常规治疗组患者接受常规西医治疗;中西医结合治疗组患者在常规西医治疗基础上给予加味千金苇茎汤(组成:芦根、慧政仁各30 g,桃仁、冬瓜仁各15 g,黄蔑、苦杏仁各10 g,炙麻黄8 g,甘草5 g),每日1剂,浸泡60 min,水煎后取汁20 mL,分2次每日早晚经胃管注入.连续治疗2周后,比较两组治疗前后血气分析指标、血清炎症指标、外周血信号通路功能指标和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、临床肺部感染评分(CPIS)、Murray肺损伤评分的差异.结果两组患者治疗后动脉血氧分压(PaO2)较治疗前明显升高,动脉血二氧化碳分压(PaCO2)、CD11b+中性粒细胞比例、可溶性髓系细胞触发受体-1(sTREM-1)、高迁移率族蛋白B1(HMGB-1)、APACHEⅡ、CPIS、Murray肺损伤评分均较治疗前明显降低;巨中西医结合治疗组治疗后PaO2明显高于西医常规治疗组[mmHg(1 mmHg=0.133 kPa):93.11±9.52比73.54±9.01],PaCO2、CD11b+中性粒细胞比例、sTREM-1、HMGB-1和磷脂酚肌醇3激酶(PI3K)、细胞外调节激酶(ERK)、c-Jun氨基末端激酶(JNK)、丝裂原活化蛋白激酶1(BMK1)的mRNA表达水平以及APACHEⅡ、CPIS、Murray肺损伤评分均明显低于西医常规治疗组[PaCO2(mmHg):42.62±4.07比50.61±5.42,CD11b+中性粒细胞比例:0.39±0.04比0.72±0.06,sTREM-1(ng/L):14.82±2.91比28.68±4.46,HMGB-1(μg/L):104.12±11.79比188.24±20.83,PI3K mRNA:(32.56±4.17)%比(99.26±8.85)%,ERK mRNA:(25.54±3.73)%比(100.26±7.51)%,JNK mRNA:(40.70±4.55)%比(99.41±4.98)%,BMK1 mRNA:(24.43±4.14)%比(98.97±6.69)%,CPIS(分):1.47±0.31比2.92±0.37,APACHEⅡ(分):11.55±0.36比12.95±1.31,Murray肺损伤评分(分):3.49±0.32比5.96±1.33,均P<0.05].结论加用加味千金苇茎汤能更有效地改�Objective To observe the modified of Jiawei Qianjin Weijing Decoction on blood gas analysis indexes and inflammatory reaction in patients with severe pneumonia.Methods One hundred and twenty patients with severe pneumonia admitted to Jinhua Central Hospital from January 2017 to April 2019 were enrolled,and according to the different treatment methods,they were divided into two groups:a conventional Western medicine(WM)group and an integrated traditional Chinese medicine(TCM)+WM group,60 cases in each group.The patients in WM group were treated with the conventional WM,and in the integrated TCM+WM and treatment group,additionally they were treated with modified Qianjin Weijing decoction on the basis of WM(Ingredients of the decoction:reed root and coix seed each 30 g,peach seed and winter melon seed each 15 g,astragalus and bitter almond each 10 g,roasted ephedra 8 g,liquorice 5 g)one dose per day,dipped for 60 minutes,20 mL of juice after decocting was injected into a tube to the stomach twice a day,10 mL in the morning and 10 mL in the evening.After 2 weeks of continuous treatment,the differences in index levels of blood gas analysis,serum inflammation,peripheral blood signal pathway function,and acute physiology and chronic health evaluationⅡ(APACHEⅡ),clinical pulmonary infection scores(CPIS)and Murray lung injury scores before and after treatment between the two groups were compared.Results After treatment,the arterial partial pressures of oxygen(PaO2)of the two groups were significantly higher than those before treatment,and the arterial partial pressure of carbon dioxide(PaCO2),the proportion of CD11b+neutrophils,soluble myeloid cell trigger receptor-1(sTREM-1),high mobility group box-1 protein(HMGB-1),APACHEⅡ,CPIS and Murray lung injury scores after treatment were all significantly lower than those before treatment;PaO2 in the integrated TCM+WM group after treatment was significantly higher than that in the WM group[mmHg(1 mmHg=0.133 kPa):93.11±9.52 vs.73.54±9.01,P<0.05],while the PaCO2,CD11b+neutro

关 键 词：加味千金苇茎汤 重症肺炎 血气分析指标 炎症反应 外周血信号通路 肺损伤评分 

分 类 号：R56[医药卫生—呼吸系统]