大黄牡丹汤对中医辨证为瘀热证的脓毒症患者临床疗效影响  

Clinical effect of Dahuang Mudan decoction on treatment of patients with sepsis and blood stasis-heat syndrome

作　　者：罗宇鸿[1] 付俊[2] 沈丽娟[1] 孙月雯[1] 关云艳[1] 吴海荣[1] Luo Yuhong;Fu Jun;Shen Lijuan;Sun Yuewen;Guan Yunyan;Wu Hairong(Department of Emergency,Wuxi Traditional Chinese Medicine Hospital,Wuxi 214000,Jiangsu,China;Department of Laboratory,Wuxi Traditional Chinese Medicine Hospital,Wuxi 214000,Jiangsu,China)

机构地区：[1]无锡市中医医院急诊科,江苏无锡214000 [2]无锡市中医医院检验科,江苏无锡214000

出　　处：《中国中西医结合急救杂志》2020年第1期64-67,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省无锡市青年医学重点人才培养项目(QNRC019);江苏省无锡市医管中心面上项目(YGZXM14029)。

摘　　要：目的观察中医辨证为瘀热证脓毒症患者应用大黄牡丹汤的临床疗效.方法采用前瞻性研究方法.选择无锡市中医医院2017年1月至2018年12月收治的中医辨证为瘀热证的脓毒症患者72例,按随机数字表法分为常规治疗组和大黄牡丹汤组,每组36例.常规治疗组给予西医常规治疗;大黄牡丹汤组在西医常规治疗基础上加用大黄牡丹汤(大黄12g、牡丹皮3g、桃仁9g、冬瓜仁30g、芒硝9g,每日1剂).两组均治疗7d.观察两组患者治疗前及治疗7d后血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、氧合指数(PaO2/FiO2)、血乳酸(Lac)、N末端脑钠肽前体(NT-proBNP)水平和治疗前及治疗1个月后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)的变化.结果与治疗前比较,两组治疗后IL-6、TNF-α、hs-CRP、PCT、NT-proBNP、Lac水平及APACHEⅡ和SOFA评分均显著降低〔常规治疗组:IL-6(ng/L)为84.86±18.82比198.48±29.12,TNF-α(ng/L)为372.83±56.32比507.89±56.41,hs-CRP(mg/L)为79.45±35.74比171.42±65.41,PCT(ng/L)为24.27±10.41比35.07±14.46,NT-proBNP(ng/L)为883.34±462.16比1826.84±765.36,Lac(mmol/L)为4.07±1.76比8.38±3.19,APACHEⅡ(分)为16.78±2.54比21.35±3.54,SOFA(分)为6.41±0.79比8.53±1.54;大黄牡丹汤组:IL-6(ng/L)为60.24±13.41比196.29±20.12,TNF-α(ng/L)为278.68±35.18比497.43±58.48,hs-CRP(mg/L)为51.46±28.48比162.18±62.75,PCT(ng/L)为16.63±9.59比36.48±16.72,NT-proBNP(ng/L)为548.43±317.47比1883.48±667.15,Lac(mmol/L)为2.58±0.72比8.08±2.94,APACHEⅡ(分)为11.46±1.74比20.84±3.54,SOFA(分)为4.28±0.64比7.27±1.23,均P<0.05〕,PaO2/FiO2均显著升高〔mmHg(1mmHg≈0.133kPa):常规治疗组为241.17±126.47比187.17±98.26,大黄牡丹汤组为292.17±146.86比191.17±101.48,均P<0.05〕;且大黄牡丹汤组的变化较西医常规治疗组更为显著(均P<0.05).结论大黄牡丹汤辅助治疗中医辨证为瘀热证的脓毒�Objective To observe the clinical effect of Dahuang Mudan decoction on treatment of patients with sepsis and blood stasis-heat syndrome.Methods A retrospective study was conducted.Seventy-two patients with sepsis and blood stasis-heat syndrome in traditional Chinese medicine(TCM)were selected from January 2017 to December 2018 in Wuxi Hospital of TCM.They were divided into a routine treatment group and a Dahuang Mudan decoction group according to random number table method,36 cases in each group.Routine treatment group was given routine Western medicine(WM)treatment;Dahuang Mudan decoction group was added with Dahuang Mudan decoction on the basis of routine WM treatment(ingredients of the decoction:rhubarb 12 g,Mudan bark 3 g,peach kernel 9 g,winter melon kernel 30 g,mirabilite 9 g,one dose a day).Both groups were treated for 7 days.The changes of serum procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),oxygenation index(PaO2/FiO2),serum N-terminal brain natriuretic peptide precursor(NT-proBNP)and blood lactic acid(Lac)were observed before and 7 days after treatment,and the changes of acute physiology and chronic health scoreⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)score were observed before treatment and 1 month after treatment in the two groups.Results Compared with those before treatment,the levels of IL-6,TNF-α,PCT,hs-CRP,NT-proBNP,Lac,APACHEⅡscore and SOFA score after treatment in both groups were significantly lower[routine treatment group:IL-6(ng/L)was 84.86±18.82 vs.198.48±29.12,TNF-α(ng/L)was 372.83±56.32 vs.507.89±56.41,hs-CRP(mg/L)was 79.45±35.74 vs.171.42±65.41,PCT(ng/L)was 24.27±10.41 vs.35.07±14.46,NT-proBNP(ng/L)was 883.34±462.16 vs.1826.84±765.36,Lac(mmol/L)was 4.07±1.76 vs.8.38±3.19,APACHEⅡwas 16.78±2.54 vs.21.35±3.54,SOFA was 6.41±0.79 vs.8.53±1.54;Dahuang Mudan decoction group:IL-6(ng/L)was 60.24±13.412 vs.196.29±20.12,TNF-α(ng/L)was 278.68±35.18 vs.497.43±58.48,hs-CRP(mg/L)was 51.46±28.

关 键 词：大黄牡丹汤 脓毒症 瘀热证 

分 类 号：R28[医药卫生—中药学]