加味宣白承气汤治疗重症创伤呼吸机相关性肺炎临床观察  

Efficacy and Safety Observation on Modified Xuanbai Chengqi Decoction in the Treatment of Ventilatorassociated Pneumonia with Severe Trauma

作　　者：王知兵 于克静 刘倩倩[1] 李中健 张春霞[1] 韩冬冬 Wang Zhibing;Yu Kejing;Liu Qianqian;Li Zhongjian;Zhang Chunxia;Han Dongdong(Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Hebei,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院,河北沧州061000

出　　处：《中国中医急症》2024年第5期827-830,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：河北省中医药管理局中医药类科研计划课题(2021305)。

摘　　要：目的观察加味宣白承气汤治疗重症创伤合并呼吸机相关性肺炎(痰热壅肺证)患者的疗效及安全性。方法本研究采用前瞻性、随机对照试验方法进行。将患者60例随机分为治疗组与对照组各30例,对照组给予西医基础治疗,治疗组给予加味宣白承气汤联合西医基础治疗,干预周期为7 d。观察两组治疗前后降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、临床肺部感染评分(CPIS)、气道阻力(Raw)、静态顺应性(Cst)、氧合指数(PaO_(2)/FiO_(2))、机械通气时间、腹内压(IAP)、高胃残余量(GRV)发生率、喂养不耐受(FI)发生率及肠内营养达标时间,并评价两组临床综合疗效和安全性指标。结果与对照组相比,治疗后治疗组CPIS评分明显降低(P<0.01),PaO_(2)/FiO_(2)明显上升(P<0.01),Raw明显下降(P<0.01),治疗组机械通气时间明显缩短(P<0.01)。与对照组相比,治疗组治疗后IAP下降更明显(P<0.01),肠内营养达标更快(P<0.05),高GRV发生率、FI发生率更低(P<0.05)。治疗组总有效率90.00%,高于对照组的80.00%(P<0.05)。结论加味宣白承气汤在辅助治疗重症创伤合并呼吸机相关性肺炎临床疗效优于单纯西医治疗,且安全性较好。Objective:To investigate the efficacy and safety of Modified Xuanbai Chengqi Decoction in treating ventilator-associated pneumonia(VAP)patients with severe trauma(syndrome of phlegm-heat obstructing lung).Methods:This study employed a prospective,randomized controlled trial design.60 patients were randomly as⁃signed to either a treatment group or a control group,each consisting of 30 patients.The control group received ba⁃sic western medicine treatment,while the treatment group was combined with Modified Xuanbai Chengqi Decoction on the basis of the control group for a 7-day intervention period.Procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC),clinical pulmonary infection score(CPIS),airway resistance(Raw),static compli⁃ance(Cst),oxygenation index(PaO_(2)/FiO_(2)),duration of mechanical ventilation,intra-abdominal pressure(IAP),inci⁃dence of high gastric residual volume(GRV),incidence of feeding intolerance(FI),and time to reach enteral nutri⁃tion goals were observed.The overall clinical efficacy and safety indicators were evaluated in both groups.Re⁃sults:Compared with the control group,the treatment group showed significantly lower CPIS scores(P<0.01),higher PaO_(2)/FiO_(2)(P<0.01),and significantly decreased Raw(P<0.01)after treatment.The treatment group also exhibited a notably shorter duration of mechanical ventilation(P<0.01).Compared with the control group,the treatment group had more significant reductions in IAP(P<0.01),shorter time to reach enteral nutrition goals(P<0.05),and lower incidences of high GRV(P<0.05)and FI(P<0.05).The total effective rate for the treatment group was 90.00%,which was higher than 80.00%in the control group(P<0.05).Conclusion:Modified Xuanbai Chengqi Decoction demonstrated superior clinical efficacy in assisting the treatment of severe trauma complicated by VAP compared with western medicine alone,and it showed good safety.

关 键 词：呼吸机相关性肺炎 加味宣白承气汤 中西医结合 重症创伤 

分 类 号：R563.1[医药卫生—呼吸系统]