益气通腑泻热法治疗脓毒症致急性肺损伤/急性呼吸窘迫综合征的临床研究  

Effect of Tonifying Qi,Relaxing Bowels and Purging Heat on Acute Lung Injury/Acute Respiratory Distress Syndrome Induced by Sepsis

作　　者：赖芳 曾瑞峰 张燕 覃晓莲 刘文婷 麦舒桃 翁燕娜 谢东平 杜炯栋 韩云 LAI Fang;ZENG Rui-feng;ZHANG Yan;QIN Xiao-lian;UU Wen-ting;MAI Shu-tao;WENG Yan-na;XIE Dong-ping;DU Jiong-dong;HAN Yun(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Chinese Medicine/The Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou Guangdong 510120,China;Guangdong Provincial Key Laboratory of Research on Emergency in TCM,Guangzhou Guangdong 510120,China;CHAO En-xiang Famous Chinese Medicine Expert Inheritance Studio,Guangzhou Guangdong 510120,China;Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou Guangdong 510095,China;Guixi Hospital of Traditional Chinese Medicinef Yingtan Jiangxi 335400,China)

机构地区：[1]广州中医药大学第二附属医院/广东省中医院/广州中医药大学第二临床医学院,广东广州510120 [2]广东省中医急症研究重点实验室,广东广州510120 [3]晁恩祥名中医药专家传承工作室,广东广州510120 [4]广东省第二中医院,广东广州510095 [5]贵溪市中医院,江西鹰潭335400

出　　处：《中医药导报》2021年第8期75-80,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：广东省科技厅项目(2011B031700033,2016A020215196,2017B030314176);广东省中医院“优势病种”突破专项(脓毒症优势病种)。

摘　　要：目的:探讨益气通腑泻热法对脓毒症致急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者的呼吸功能、炎症指标的影响,探讨其安全性及疗效。方法:选取脓毒症致ALI/ARDS患者70例,中医辨证为肺热腑实证,将患者按随机原则分为治疗组及对照组各35例。对照组患者予西医常规治疗,治疗组患者在对照组治疗基础上予益气通腑泻热法治疗,疗程5~7 d。两组患者均在治疗前及治疗后检测血气分析、炎症指标、血乳酸水平,同时观察患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、28 d生存率和卫生经济学指标。结果:治疗组患者治疗后动脉血pH值、PaO_(2)/FiO_(2)较治疗前升高(P<0.05);对照组患者治疗后PaCO_(2)较治疗前升高(P<0.05)。治疗组患者治疗后的PaO_(2)/FiO_(2)高于对照组(P<0.05)。治疗组患者治疗后CRP、PCT、IL-6水平均较治疗前明显下降(P<0.05)。对照组患者治疗后CRP、PCT、IL-10水平均较治疗前明显下降(P<0.05)。两组患者治疗后CRP、PCT、IL-6、IL-10比较,差异均无统计学意义(P>0.05)。治疗后,两组患者APACHEⅡ评分、LAC水平均较治疗前明显改善(P<0.05);两组治疗后APACHEⅡ评分、LAC水平比较,差异均无统计学意义(P>0.05)。治疗组患者28 d生存率为97.14%(34/35),对照组患者28 d生存率为93.94%(31/33)。两组患者28 d生存率、累积机械通气时间、住院时间、ICU住院时间、住院日均费用比较,差异均无统计学意义(P>0.05)。试验过程无药物相关不良事件。结论:益气通腑泻热法治疗脓毒症致ALI/ARDS患者,无负性结果,在呼吸功能的改善上有阳性意义。Objective:To investigate the effects of tonifying Qi,relaxing bowels and purging heat on the respiratory function and inflammatory indexes in patients with sepsis-induced acute lung injury(ALI)/acute respiratory distress syndrome(ARDS),and to explore its safety and efficacy.Method:Totally 70 patients with sepsis-induced ALI/ARDS,diagnosed as lung-heat and bowel excess syndrome based on TCM differentiation,were randomly divided into treatment group and control group,35 cases in each group.The control group was given conventional Western medicine treatment,and the treatment group was assigned the method of tonifying Qi,relaxing bowels and purging heat on the basis treatment of the control group,once a day.The course of treatment was 5-7 days.Blood gas analysis,inflammation indicators and blood lactic acid levels were tested in two groups before and after treatment.Simultaneously,the acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)score,28-day survival rate and health economic indicators were observed.Results:The p H value and oxygenation index(PaO_(2)/FiO_(2))increased in treatment group(P<0.05),and PaCO_(2)increased in control group after treatment(P<0.05).The treatment group showed higher PaO_(2)/FiO_(2)than control group after treatment(P<0.05).The CRP,PCT and IL-6 decreased in treatment group(P<0.05),and CRP,PCT and IL-10 decreased in control group after treatment(P<0.05).There was no significant difference in CRP,PCT,IL-6 and IL-10 between the two groups(P>0.05).The APACHEⅡscores and lactic acid(LAC)were improved in two groups after treatment(P<0.05).There was no statistical difference in APACHEⅡscores and LAC between the two groups after treatment(P>0.05).The 28-day survival rate was 97.14%(34/35)in treatment group and 93.94%(31/33)in control group.There were no significant difference in 28-day survival rate,cumulative ventilation time,length of stay,length of ICU stay and average daily hospitalization expenses between the two groups(P>0.05).There was no drug-related adverse event d

关 键 词：脓毒症 急性肺损伤 急性呼吸窘迫综合征 肺热腑实证 益气通腑泻热法 呼吸功能 炎症 

分 类 号：R278[医药卫生—中医学]