解毒理脉汤治疗热毒炽盛型脓毒症的临床研究  

Effect of Jiedu Limai decoction in septic patients with syndrome of heat-toxin exuberance

作　　者：李传磊 谢云[2] 郑志煌 徐可馨 朱楠 臧秀娟[3] 王学敏 包谨芳 于青[1] 王瑞兰[2] 刘军[1] 周志刚[2] Li Chuanlei;Xie Yun;Zheng Zhihuang;Xu Kexin;Zhu Nan;Zang Xiujuan;Wang Xuemin;Bao Jinfang;Yu Qing;Wang Ruilan;Liu Jun;Zhou Zhigang(Department of Nephrology,Shanghai General Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 201620,China;Department of Intensive Care Unit,Shanghai General Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 201620,China;Department of Nephrology,Songjiang Branch of Shanghai General Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 201620,China;Department of Intensive Care Unit,Songjiang Branch of Shanghai General Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 201620,China)

机构地区：[1]上海交通大学附属第一人民医院肾内科,上海201620 [2]上海交通大学附属第一人民医院重症医学科,上海201620 [3]上海交通大学附属第一人民医院松江分院肾内科,上海201620 [4]上海交通大学附属第一人民医院松江分院重症医学科,上海201620

出　　处：《中华危重病急救医学》2021年第7期815-820,共6页Chinese Critical Care Medicine

基　　金：上海市进一步加快中医药事业发展3年行动计划项目(ZY(2018-2020)-FWTX-3008)。

摘　　要：目的探讨解毒理脉汤治疗热毒炽盛型脓毒症患者的临床效果。方法采用前瞻性随机对照研究方法,选择上海交通大学附属第一人民医院重症医学科和松江分院重症医学科2019年3月至2020年4月收治的符合热毒炽盛型脓毒症诊断标准的患者,按照随机数字表法分为常规治疗组和解毒理脉汤组。两组患者均按照指南给予常规治疗;解毒理脉汤组在常规治疗基础上增加解毒理脉汤口服治疗,每日1剂,治疗14 d。记录两组患者入组28 d存活情况,治疗前及治疗7 d的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)、凝血功能指标、感染指标、炎性因子以及器官功能指标变化;同时记录两组患者预后。结果观察期间共收治259例感染或临床诊断感染患者,排除不符合Sepsis-3诊断标准、年龄>80岁或<18岁、恶性肿瘤多处转移、自身免疫系统疾病、重症监护病房(ICU)住院时间<24 h、急性活动性消化道出血及资料不全者,最终共纳入100例患者,常规治疗组和解毒理脉汤组各50例。治疗前两组患者凝血功能指标、感染指标、炎性因子、器官功能指标水平差异均无统计学意义。治疗7 d后,与常规治疗组比较,解毒理脉汤组患者凝血功能、感染指标、炎性因子均明显改善〔D-二聚体(mg/L):2.2(1.8,8.5)比4.0(1.5,8.7),纤维蛋白原(Fib,g/L):3.7(3.4,4.3)比4.2(3.7,4.3),纤维蛋白原降解产物(FDP,mg/L):7.2(5.4,10.2)比13.2(9.2,15.2),降钙素原(PCT,μg/L):0.4(0.2,2.9)比0.5(0.2,0.9),C-反应蛋白(CRP,mg/L):50.1(9.5,116.0)比75.1(23.5,115.2),白细胞介素-6(IL-6,ng/L):31.6(21.6,81.0)比44.1(14.0,71.3),均P<0.05〕,且B型脑钠肽(BNP)和肾损伤因子-1(KIM-1)水平明显降低〔BNP(ng/L):261.1(87.5,360.3)比347.3(128.8,439.4),KIM-1(μg/L):0.86(0.01,1.40)比1.24(1.05,1.57),均P<0.05〕。与常规治疗组相比,解毒理脉汤组治疗后出现新的器官功能衰竭患者比例更低(30.0%比50.0%,P<0.05);�Objective To investigate the clinical effect of Jiedu Limai decoction in septic patients with syndrome of heat-toxin exuberance.Methods A prospective randomized controlled trial was conducted.From March 2019 to April 2020,septic patients with syndrome of heat-toxin exuberance admitted to intensive care unit(ICU)of Shanghai General Hospital and Songjiang Branch of Shanghai General Hospital were enrolled as the research objects,and they were divided into routine treatment group and Jiedu Limai decoction group by the random number table method.Patients in both groups were given standard treatment in accordance with the guidelines,and patients in the Jiedu Limai decoction group were given Jiedu Limai decoction in addition to the standard treatment,once a day for 14 days.The 28-day survival of patients of the two groups were recorded,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,coagulation indexes,infection indexes,inflammatory cytokines and organ function indicators before treatment and 7 days after treatment in both groups were recorded,and the prognosis of the two groups were recorded.Results A total of 259 patients with infection or clinical diagnosis of infection admitted during the experimental observation period were included,and those who did not meet the Sepsis-3 diagnostic criteria,more than 80 years old or less than 18 years old,with multiple tumor metastases,autoimmune system diseases,with length of ICU stay less than 24 hours,with acute active gastrointestinal bleeding and with incomplete data were excluded.One hundred patients were finally enrolled,with 50 patients in the routine treatment group and 50 patients in the Jiedu Limai decoction group.There were no statistically significant differences in coagulation indexes,infection indicators,inflammatory cytokines and organ function indicators before treatment between the two groups.After 7 days of treatment,the coagulation indexes,infection biomarkers and inflammatory cytokines in the

关 键 词：脓毒症 热毒炽盛型 解毒理脉汤 炎性因子 凝血指标 

分 类 号：R459.7[医药卫生—急诊医学]