基于电阻抗断层成像(EIT)技术监测加味厚朴大黄汤治疗中重度ARDS患者的疗效评价  

Evaluation of Clinical Efficacy of M odified Houpo Dahuangtang in Moderate and Severe ARDS Patients Based on Electrical Impedance Tomography

作　　者：宋娜[1] 易茜 姚勇刚 周玉玲[1] 罗真春 SONG Na;YI Qian;YAO Yonggang;ZHOU Yuling;LUO Zhenchun(Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]重庆市中医院,重庆400021

出　　处：《中国实验方剂学杂志》2024年第9期108-115,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：重庆市科卫联合医学科研项目(2020FYYX110);国家自然科学基金青年项目(31800983);重庆市科卫联合中医药技术创新与应用发展项目(2021ZY3571)。

摘　　要：目的:评估加味厚朴大黄汤在痰热壅盛型中重度急性呼吸窘迫综合征(ARDS)患者中的临床疗效,并使用电阻抗断层成像(EIT)技术监测两组患者治疗前后肺通气变化。方法:选择重庆市中医院重症医学科2021年9月至2022年6月收治的痰热壅盛型需要机械通气的中重度ARDS患者62例,随机数字法分为观察组和对照组,每组各31例,在常规西医治疗基础上,观察组给予加味厚朴大黄汤鼻饲,对照组给予温开水鼻饲治疗,疗程7 d,记录两组患者治疗前后中医证候疗效、氧合指数[动脉血氧分压(PaO_(2))/吸入氧浓度(FiO2)、乳酸(Lac)、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、顺应性、平台压、EIT监测的气体分布参数(Z1、Z2、Z3、Z4)、炎性指标[白细胞介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)],记录两组患者机械通气时间、重症监护室(ICU)住院时间、28 d死亡率、不良反应发生率(谵妄、腹痛、腹泻)等。结果:两组患者各项基线指标差异均无统计学意义,资料具有可比性。治疗7 d后,观察组中医证候疗效总有效率90.30%(28/31),高于对照组的67.74%(21/31)(Z=-2.415,P<0.05)。与本组治疗前比较,观察组患者平台压及Lac显著降低(P<0.01),顺应性及P/F显著升高(P<0.01),对照组患者Lac下降(P<0.05),P/F增加(P<0.05),顺应性及平台压差异无统计学意义。与对照组治疗后比较,观察组患者平台压、炎症因子均明显降低(P<0.05),顺应性、P/F明显升高(P<0.05),EIT监测的气体分布参数Z1、Z2、Z3、Z4、Z1+Z2、Z3+Z4均明显升高(P<0.05)。机械通气时间、ICU住院时间、28 d死亡率、谵妄及腹痛腹泻等不良反应发生率两组间差异无统计学意义。所有患者研究过程中无临床不良事件发生。结论:加味厚朴大黄汤可显著改善中重度ARDS患者的P/F、重力依赖区域的肺通气、肺顺应性,减少炎症因子释放。且相较于传统方法,EIT技术�Objective:To evaluate the clinical efficacy of modified Houpo Dahuangtang in moderate and severe acute respiratory distress syndrome(ARDS)patients with phlegm-heat accumulation,and monitor the pulmonary ventilation changes of patients before and after treatment by electrical impedance tomography(EIT).M ethod:The 62 cases of moderate and severe ARDS patients with phlegm-heat accumulation who required mechanical ventilation in the department of intensive care unit(ICU)in Chongqing Hospital of Traditional Chinese Medicine from September 2021 to June 2022 were selected,and divided into an experimental group(31 cases)and a control group(31 cases)using a random number table.On the basis of regular Western medicine treatment,the experimental group received modified Houpo Dahuangtang and the control group received warm water by a nasogastric tube for seven days.The changes in the clinical efficacy of traditional Chinese medicine(TCM),the oxygenation index[arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO2),P/F],lactic acid(Lac),acute physiology and chronic health evaluation II(APACHE II)score,compliance,plateau pressure,gas distribution parameters monitored by EIT(Z1,Z2,Z3 and Z4),inflammatory factors[interleukin-6(IL-6),IL-10,tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)]of both groups before and after treatment were recorded.Besides,the mechanical ventilation time,length of stay in ICU,28-day mortality and incidence of adverse reactions(delirium,abdominal pain and diarrhea)in the two groups were also observed.Result:There was no significant difference in the baseline indexes of patients in the two groups,and thus the two groups were comparable.After treatment for one week,the total effective rate for TCM syndromes in the experimental group was 90.30%(28/31),higher than the 67.74%(21/31)in the control group(Z=-2.415,P<0.05).Compared with the same group before treatment,the plateau pressure and Lac decreased(P<0.01)and the compliance and P/F increased(P<0.01)in experimental group,whil

关 键 词：加味厚朴大黄汤 急性呼吸窘迫综合征 电阻抗断层成像技术 炎症因子 痰热壅盛 

分 类 号：R242[医药卫生—中医临床基础] R2-0[医药卫生—中医学] R2-031R825.6R974R256.1