清肺降浊方治疗重症肺炎痰热壅肺证患者的临床研究  

Clinical study on Qingfei Jiangzhuo Prescription in treating severe pneumonia of obstruction of phlegm heat in the lung

作　　者：郭健[1] 朱亮[1] 吴祎[1] 钱风华[1] 赵雷[1] 钱义明[1] GUO Jian;ZHU Lang;WU Yi;QIAN Feng-hua;ZHAO Lei;QIAN Yi-ming(Department of Emergency Medicine,Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院急诊医学科,上海200437

出　　处：《北京中医药》2021年第4期355-359,共5页Beijing Journal of Traditional Chinese Medicine

基　　金：上海市高级中西医结合人才培养项目[ZY(2018-2020)-RCPY-2008]。

摘　　要：目的观察清肺降浊方对重症肺炎痰热壅肺证患者炎症反应和器官保护作用的影响。方法选取上海中医药大学附属岳阳中西医结合医院2017年9月—2019年9月收治的重症肺炎痰热壅肺证患者68例,随机分为西医组和中西医组,每组34例。西医组采取西医常规治疗,中西医组在西医常规治疗基础上口服或鼻饲清肺降浊方,1剂/d,7 d为1个疗程。比较治疗前后2组患者临床疗效、肺炎严重指数(PSI)评分、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、炎症指标[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)]、呼吸功能[氧合指数(PaO_(2)/FiO_(2))、动脉血二氧化碳分压(PaCO_(2))]、循环功能[收缩压(SBP)、乳酸(Lac)]、凝血功能[纤维蛋白原(FIB)、D-二聚体(D-D)]。结果治疗后中西医组患者临床有效率高于西医组,但差异无统计学意义(P>0.05)。治疗后2组患者PSI评分、APACHEⅡ评分均较治疗前降低(P<0.05),中西医组低于西医组(P<0.05)。治疗后2组患者CRP、PCT、IL-6、Lac、FIB、D-D水平均较治疗前降低(P<0.05),中西医组患者CRP、PCT、IL-6、Lac水平低于西医组(P<0.05)。治疗后2组患者PaO_(2)/FiO_(2)较治疗前升高(P<0.05),中西医组高于西医组(P<0.05)。治疗前及治疗后,2组患者SBP、PaCO_(2)水平正常。结论清肺降浊方联合西医治疗可改善重症肺炎痰热壅肺证患者病情严重程度,可能与其减轻患者炎症反应,改善呼吸和循环功能有关。Objective To observe the effect of Qingfei Jiangzhuo Prescription on inflammatory response and organ protection in patients with severe pneumonia of obstruction of phlegm heat in the lung.Methods A total of 68 cases of severe pneumonia with phlegm heat obstructing lung syndrome treated in Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from September 2017 to September 2019 were randomly divided into combined Chinese and western medicine treatment group and western medicine treatment group with 34 cases in each group.The western medicine group was treated by routine western medicine.On the basis of the routine treatment,the Chinese and western medicine group was also given Qingfei Jiangzhuo Prescription,one bag each day and for 7 days as one course.The clinical efficacy,pneumonia severity index(PSI),acute physiology and chronic health evaluationⅡ(APACHEⅡ),C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),oxygenation index(PaO_(2)/FiO_(2)),carbon dioxide(PaCO_(2)),systolic blood pressure(SBP),lactic acid(Lac),fibrinogen(FBG)and D-Dimer(D-D)were compared between the two groups before and after the treatment.Results The effective rate of the Chinese and western medicine group was higher than that of the western medicine group,but the difference was not statistically significant(P>0.05).The scores of PSI and APACHEⅡin both two groups were significantly lowered than those before the treatment(P<0.05),and the decline in the Chinese and western medicine group was more pronounced than the western medicine(P<0.05).The same change happened with the levels of CRP,PCT,IL-6,Lac in the two groups.After treatment the oxygenation indexes(PaO_(2)/FiO_(2))in the two groups were higher than those before treatment;And the change was more obliviously in the Chinese and western medicine group(P<0.05).The levels of SBP and PaCO_(2) were normal before and after the treatment.Conclusion Qingfei Jiangzhuo Prescription combined with western medi

关 键 词：重症肺炎 痰热壅肺 清肺降浊方 炎症反应 多器官功能障碍 

分 类 号：R563.1[医药卫生—呼吸系统]