补肺汤加减对脑卒中气管切开肺部感染脾肺气虚证患者免疫炎症的影响  

Effect of Addition and Subtraction Adjuvant Therapy of Bufeitang on Immune Inflammation After Tracheotomy in Stroke Patients with Syndrome of Deficiency of Spleen and Lung Qi

作　　者：李小山 周晓晖[2] 范倩倩 潘晶晶 宋振华[1] LI Xiao-shan;ZHOU Xiao-hui;FAN Qian-qian;PAN Jing-jing;SONG Zhen-hua(Haikou Hospital Affiliated to Xiangya Medical College of Central South University,Haikou 570208,China;Hainan Hospital of Traditional Chinese Medicine,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院,海口570208 [2]海南省中医院,海口570208

出　　处：《中国实验方剂学杂志》2020年第18期111-116,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：海南省卫生计生行业科研项目(16A200094)。

摘　　要：目的:探讨补肺汤加减辅助治疗脑卒中气管切开肺部感染(脾肺气虚证)的疗效及对免疫炎症的影响。方法:将100例患者随机按数字表法分为对照组和观察组各50例。两组患者均给予注射用盐酸头孢吡肟,2 g/次,静脉滴注,每12h1次,并给予对症、支持等综合治疗。对照组经胃管给复方甘草口服溶液,10mL/次,3次/d;观察组采用补肺汤加减,1剂/d,分早、晚2次经胃管给药。两组疗程均为连续治疗14 d。于治疗1d,治疗7d和治疗14d进行临床肺部感染评分(CPIS),急性病生理和长期健康Ⅱ(APACHEⅡ)评分;记录肺部感染控制时间和抗生素使用时间;检测治疗前后T淋巴细胞亚群(CD3+,CD4+,CD8+,CD4+/CD8+),调节性T细胞(Treg细胞)和免疫球蛋白免疫球蛋白A(IgA),免疫球蛋白G(IgG),血清免疫球蛋白M(IgM)水平;检测治疗前后降钙素原(PCT),肿瘤坏死因子-α(TNF-α),白细胞介素(IL)-1β,IL-6和IL-10水平;进行安全评价。结果:观察组患者在治疗后7d和14d,CPIS评分均低于对照组(P<0.01);观察组患者肺部感染控制时间和抗生素使用时间均短于对照组(P<0.01);观察组患者在治疗后7d和14d,APACHEⅡ评分均低于对照组(P<0.01);观察组患者Treg细胞,CD4+细胞和CD4+/CD8+均高于对照组(P<0.05),CD8+细胞低于对照组(P<0.05);观察组患者IgA,IgM水平均较高于对照组(P<0.01);观察组患者PCT,TNF-α,IL-1β,IL-6和IL-10水平均低于对照组(P<0.01);研究期间未发现与补肺汤相关不良反应。结论:在西医抗感染和对症支持等综合治疗的基础上,补肺汤加减能更有效控制脑卒中气管切开肺部感染的严重程度,减少咳嗽、咳痰,缩短了肺部感染的病程和抗生素的使用时间,并能调节免疫功能,抑制炎症反应。Objective:To discuss the efficacy of addition and subtraction adjuvant therapy of Bufei decoction for pulmonary infection after tracheotomy in stroke patients(syndrome of deficiency of spleen and lung Qi)and investigate its effect on immune inflammation.Method:One hundred patients were randomly divided into control group(50 cases)and observation group(50 cases)by random number table.The patients in both groups got cefepime hydrochloride for injection,once every 12 hours,2 g/time,at the same time,symptomatic and supportive comprehensive treatment was given.Patients in control group additionally got compound glycyrrhiza oral solution via gastric tube,10 mL/time,3 times/day.Patients in observation group got addition and subtraction adjuvant therapy of Bufeitang every morning and night via gastric tube,1 dose/day.The treatment course was 14 days in both groups.At the 1st,7th and 14th day after treatment,scores of clinical pulmonary infection scale(CPIS)and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)were graded.The time to control pulmonary infection and the antibiotics use time were recorded.Before and after treatment,levels of T lymphocyte subsets(CD3^+,CD4^+,CD8^+and CD4^+/CD8^+),regulatory T cells of(Treg cells),immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-1β,IL-6 and IL-10 were detected,and safety was evaluated.Result:At the 7th and 14th day after treatment,scores of CPIS and APACHEⅡin observation group were lower than those in control group(P<0.01).The time to control pulmonary infection and antibiotics use time were shorter than those in control group(P<0.01).Levels of Treg cells,CD4^+and CD4^+/CD8^+were higher than those in control group(P<0.05).Levels of CD8^+,PCT,TNF-α,IL-1β,IL-6 and IL-10 were lower than that in control group(P<0.01),while levels of IgA and IgM were higher than those in control group(P<0.01).There was no adverse reaction related to Bufeitang.Conclusion:Based on comprehensive treatment

关 键 词：脑卒中 气管切开 肺部感染 脾肺气虚证 补肺汤 免疫功能 炎症反应 

分 类 号：R289[医药卫生—方剂学] R25[医药卫生—中药学]