大黄对重症监护室医院获得性肺炎患者免疫功能及预后的影响  

Effect of Radix et Rhizoma Rhei on the Immunologic Function and Prognosis of Patients with Hospital Acquired Pneumonia in Intensive Care Unit

作　　者：夏世宏 封启明[1] 倪菊平[2] 张璐[2] 李响[2] 沈国锋[2] 姜丽静[2] XIA Shi-hong;FENG Qi-ming;NI Ju-ping;ZHANG Lu;LI Xiang;SHEN Guo-feng;JIANG Li-jing(Department of Emergency Medicine,Shanghai Jiaotong University Affiliated Sixth People’s Hospital,Shanghai 200233;Department of Critical Care Medicine,Minhang Hospital,Fudan University,Shanghai 201199)

机构地区：[1]上海交通大学附属第六人民医院急诊医学科,上海200233 [2]复旦大学附属闵行医院重症医学科,上海201199

出　　处：《中国中西医结合杂志》2020年第7期774-777,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：2013-2014年度国家临床重点专科建设项目(No.2013544)。

摘　　要：目的观察大黄对重症监护室医院获得性肺炎(HAP)患者免疫功能及预后的影响。方法选取2018年9月—2019年8月复旦大学附属闵行医院重症医学科住院治疗的65例HAP患者,随机分为药物组(34例)和对照组(31例)。所有患者按照HAP诊治指南规范治疗,药物组在此基础上给予大黄泡水灌肠治疗,均持续7天。治疗前后检测血清IgG、IgM、IgA含量,流式细胞仪测定CD4^+T淋巴细胞、CD8^+T淋巴细胞、B细胞、NK细胞计数。比较两组机械通气时间、ICU住院时间及28天病死率,评价临床疗效。结果与本组治疗前比较,药物组外周血免疫球蛋白IgG、IgM及IgA升高(均P<0.05),且治疗后与对照组比较,药物组外周血免疫球蛋白IgG、IgM、IgA升高(均P<0.05)。治疗前后外周血淋巴细胞亚群计数差异均无统计学意义(P>0.05)。与对照组比较,药物组患者机械通气时间缩短(200.57±61.45 hvs.260.00±64.58 h,P<0.05),ICU住院时间亦缩短(323.20±84.97 hvs.378.40±114.27 h,P<0.05),药物组治疗后症状改善率提高(P<0.05);两组患者28天病死率比较,差异无统计学意义(P>0.05)。结论规范治疗基础上加用大黄泡水灌肠治疗7天,能提高HAP患者IgG、IgM、IgA水平,缩短机械通气时间与ICU住院时间,但未降低28天病死率。Objective To investigate the effect of Radix et Rhizoma Rhei on the immunologic function and prognosis of the patients with hospital acquired pneumonia(HAP)in intensive care unit(ICU).Methods From September 2018 to August 2019,totally 65 HAP patients,who were hospitalized in the Department of Critical Care Medicine,Minhang Hospital,Fudan University,were recruited and randomly assigned to the drug group(34 cases)and the control group(31 cases).All patients were treated according to the HAP diagnosis and treatment guidelines.In addition,the drug group was given Radix et Rhizoma Rhei water enema.Both groups were treated for 7 days.The serum IgG,IgM,and IgA contents were determined,and CD4^+T lymphocytes,CD8^+T lymphocytes,B cells,and NK cell counts were measured by flow cytometry.The mechanical ventilation time,the length of stay in the ICU,and mortality in 28 days were compared between the two groups to evaluate the clinical efficacy.Results Compared with before treatment,the peripheral blood immunoglobulin,such as IgG,IgM,and IgA increased in the drug group significantly(P<0.05).Compared with the control group after treatments,the peripheral blood immunoglobulin was increased after treatments in the drug group(P<0.05).There was no statistical difference in peripheral blood lymphocyte subpopulation counts before and after treatment(P>0.05).Compared with the control group,the mechanical ventilation time was shortened in the drug group(200.57±61.45 h vs.260.00±64.58 h,P<0.05);the length of stay in the ICU was also shortened(323.20±84.97 h vs.378.40±114.27 h,P<0.05).The rate of symptom improvement was improved after treatment in the drug group(P<0.05),there was no statistical difference of mortality in 28 days between the two groups(P>0.05).Conclusion The Radix et Rhizoma Rhei water enema treatment for 7 days on the basis of standardized treatment might increase the levels of IgG,IgM,and IgA in HAP patients,shorten mechanical ventilation time and length of stay in the ICU,but it did not show the reduce of the mort

关 键 词：大黄 医院获得性肺炎 免疫功能 预后 

分 类 号：R563.1[医药卫生—呼吸系统]