生脉散联合多黏菌素B治疗脓毒症合并重度急性呼吸窘迫综合征的临床观察  

Clinical Observation of Shengmaisan Combined with Polymyxin B in Treatment of Sepsis Complicated with Severe Acute Respiratory Distress Syndrome

作　　者：张宇 陈清峰 尹曦[1] 王晓越 邓兆岿 石姗 卢笑晖[1] ZHANG Yu;CHEN Qingfeng;YIN Xi;WANG Xiaoyue;DENG Zhaokui;SHI Shan;LU Xiaohui(Shandong University of Chinese Medicine Affiliated Hospital,Jinan 250014,China;Health Supervision Institute of Huaiyin District,Jinan 250022,China)

机构地区：[1]山东中医药大学附属医院,济南250014 [2]济南市槐荫区卫生监督所,济南250022

出　　处：《中国实验方剂学杂志》2024年第12期129-135,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：中医药事业传承与发展中央补助资金项目(YWC2022ZYYSY001);山东病理生理学会专项科研基金项目(2021BS006);卢氏内科流派传承工作室建设项目(lp2022-01)。

摘　　要：目的:观察生脉散联合多黏菌素B治疗耐碳青霉烯类革兰阴性杆菌感染脓毒症合并重度急性呼吸窘迫综合征的临床疗效。方法:将90例耐碳青霉烯类革兰阴性杆菌感染脓毒症合并重度急性呼吸窘迫综合征患者随机分为对照组和观察组,各45例,对照组予多黏菌素B治疗,观察组予生脉散联合多黏菌素B治疗,两组疗程均为7 d。观察治疗前后感染相关指标[白细胞(WBC)计数、降钙素原(PCT)、中性粒细胞载脂蛋白(HNL)]、炎症因子[白细胞介素-6(IL-6)、血清趋化因子配体2(CXCL2)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、急性生理与慢性健康Ⅱ(APACHEⅡ)评分和治疗结束后的细菌清除率、28 d生存率。结果:①最终完成试验并纳入统计81例,其中观察组41例,对照组40例,两组患者一般资料具有可比性。②观察组、对照组细菌清除率分别为75.6%(31/41)、52.5%(21/40),组间比较观察组高于对照组(χ2=4.7,P<0.05)。③与本组治疗前比较,治疗后观察组和对照组的WBC计数、PCT、HNL、IL-6、CXCL2、APACHEⅡ评分均明显下降(P<0.05),组间比较观察组除WBC计数外,PCT、HNL、IL-6、CXCL2、APACHEⅡ评分均明显低于对照组(P<0.05)。④与本组治疗前比较,治疗后观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)明显升高(P<0.05),CD8^(+)明显降低(P<0.05);对照组仅CD3^(+)明显升高(P<0.05)。组间比较观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)明显高于对照组,CD8^(+)低于对照组(P<0.05)。⑤两组在治疗结束后28 d的生存率比较观察组高于对照组(χ2=4.3,P<0.05)。结论:生脉散联合多黏菌素B治疗耐碳青霉烯类革兰阴性杆菌感染脓毒症合并重度急性呼吸窘迫综合征,可更好地清除致病菌,控制感染,降低炎症因子水平,调节机体免疫状态,改善短期预后。Objective:To observe the clinical efficacy of Shengmaisan combined with polymyxin B in the treatment of carbapenem-resistant gram-negative bacillus infection with sepsis complicated with severe acute respiratory distress syndrome.Method:A total of 90 patients suffering from carbapenem-resistant gramnegative bacillus infection with sepsis complicated with severe acute respiratory distress syndrome were randomly divided into a control group and an observation group,with 45 cases in each group.The control group was treated with polymyxin B,and the observation group was treated with Shengmaisan combined with polymyxin B.The treatment course of both groups was seven days.The infection-related indicators[white blood cell(WBC)count,procalcitonin(PCT),neutrophil apolipoprotein(HNL)],inflammatory factors[interleukin-6(IL-6),serum chemokine ligand 2(CXCL2)],and T lymphocyte subpopulations(CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)value),acute physiological and chronic healthⅡ(APACHEⅡ)score before and after treatment,as well as bacterial clearance rate and 28-day survival rate after treatment were observed.Result:①The experiment was completed,and 81 cases were included,including 41 cases in the observation group and 40 cases in the control group.The general data of the two groups were comparable.②The bacterial clearance rate of the observation group and the control group was 75.6%(31/41)and 52.5%(21/40),respectively,and the observation group was higher than the control group(χ2=4.7,P<0.05).③The WBC count,PCT,HNL,IL-6,CXCL2,and APACHEⅡscores of the observation group and the control group all decreased after treatment(P<0.05).Except for the WBC count,the PCT,HNL,IL-6,CXCL2,and APACHEⅡscores of the observation group were lower than those of the control group(P<0.05).④The values of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the observation group were increased after treatment(P<0.05),and CD8^(+)was decreased(P<0.05).In the control group,only CD3^(+)value was increased(P<0.05).The values of CD3^(+),CD4^(+),and CD4^(

关 键 词：脓毒症 重度呼吸窘迫综合征 耐碳青霉烯类革兰阴性杆菌 生脉散 多黏菌素B 临床随机对照试验 

分 类 号：R2-0[医药卫生—中医学] R22R242R287