通腑泻下活血法治疗肺热腑实型脓毒症肺损伤的临床研究  

Clinical Study on Treatment of Lung Injury in Sepsis of Syndrome of Lung Heat and Bowel Excess by Fu-Organs-Ourging and Blood-Activating Therapy

作　　者：李辉[1] 吴少丽 陈佳杰 LI Hui;WU Shao-li;CHEN Jia-jie(Panyu District Hospital of Traditional Chinese Medicine,Guangzhou Guangdong 511400,China;Huangpu Branch of Guangdong Second Hospital of Traditional Chinese Medicine,Guangzhou Guangdong 510700,China)

机构地区：[1]广州市番禺区中医院,广东广州511400 [2]广东省第二中医院黄埔分院,广东广州510700

出　　处：《中医药导报》2020年第14期55-59,共5页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：2018年度广东省中医药局科研项目(20181219)。

摘　　要：目的:探讨通腑泻下活血法治疗肺热腑实型脓毒症肺损伤的临床疗效。方法:将39例肺热腑实型脓毒症肺损伤患者随机分成治疗组和对照组,对照组给予西医常规治疗,治疗组在对照组治疗基础上加用通腑泻下活血法(桃核承气汤)。两组患者连续治疗7 d,观察两组患者治疗前后中医证候积分、急性生理和慢性健康评分(APACHEⅡ)、肺损伤相关指标[PO2/FiO2、P(A-a)O2]、炎性指标(白细胞计数、血清C-反应蛋白、降钙素原、IL-1β、IL-18)及外周血单核细胞NLRP3 mRNA表达水平。结果:(1)治疗后两组患者中医证候积分、APACHEⅡ评分均较治疗前下降(P<0.05);治疗组患者中医证候积分、APACHEⅡ评分均较对照组下降更明显(P<0.05)。(2)治疗后两组患者PO2/FiO2、P(A-a)O2均较治疗前改善(P<0.05);但治疗组与对照组同期比较,差异均无统计学意义(P>0.05)。(3)治疗后两组患者白细胞计数、血清C-反应蛋白、降钙素原、IL-18均低于治疗前(P<0.05);治疗组治疗后降钙素原、IL-18均低于对照组(P<0.05)。治疗组患者治疗后IL-1β水平低于治疗前(P<0.05);与对照组同期比较,低于对照组(P<0.05)。对照组治疗前后IL-1β比较,差异无统计学意义(P>0.05)。(4)治疗后两组患者NLRP3 mRNA表达水平均低于治疗前(P<0.05);治疗组治疗后NLRP3 mRNA表达水平低于对照组(P<0.05)。结论:通腑泻下活血法治疗肺热腑实型脓毒症肺损伤具有较好的疗效,其部分潜在的机制可能通过下调NLRP3 mRNA的表达,调控下游炎症产物的合成。Objective:To explore the clinical efficacy of the method of Fu-organs-purging and blood-activating in the treatment of lung injury in sepsis with syndrome of lung heat and bowel excess.Methods:A total of 39 patients with lung injury in sepsis of syndrome of lung heat and bowel excess were randomly divided into treatment group and control group.The control group was given conventional Western medicine treatment.The treatment group was treated with the method of Fu-organs-purging and blood-activating[Taohe Chengqi decoction(桃核承气汤)]on the basis of the control group.The two groups of patients were continuously treated for 7 days.The scores of TCM syndromes,acute physiology and chronic health scores(APACHEⅡ),lung injury-related indicators[PO2/FiO2,P(Aa)O2],and inflammatory indicators(White blood cell count,serum C-reactive protein,procalcitonin,IL-1β,IL-18)and the expression of NLRP3 mRNA in peripheral blood mononuclear cells were observed before and after treatment.Results:(1)After treatment,the scores of TCM syndromes and APACHEⅡ of the two groups of patients decreased compared with those before treatment(P<0.05).The scores of TCM syndromes and APACHEⅡ of the treatment group decreased more significantly than those of the control group(P<0.05).(2)After treatment,PO2/FiO2 and P(A-a)O2 of the two groups were improved compared with that before treatment(P<0.05).However,there was no statistically significant difference between the treatment group and the control group during the same period(P>0.05).(3)After treatment,the white blood cell count,serum C-reactive protein,procalcitonin,and IL-18 of the two groups were lower than before treatment(P<0.05),and the procalcitonin and IL-18 in the treatment group were lower than those in the control group(P<0.05).After treatment,the level of IL-1β in the treatment group was lower than before treatment(P<0.05);Compared with the control group over the same period,it was lower than the control group(P<0.05).There was no statistically significant difference in IL-1β

关 键 词：脓毒症 肺损伤 肺热腑实型 桃核承气汤 临床观察 

分 类 号：R259[医药卫生—中西医结合]