凉血解毒法辅助治疗毒热内盛证脓毒症患者的临床疗效及对其炎性因子、可溶性CD14、高迁移蛋白1的影响  

Clinical Efficacy of Blood-cooling and Toxin-removing Therapy in Adjunctive Treatment of Sepsis with Internal Exuberance of Toxin Heat Syndrome and Its In⁃fluence on Inflammatory Factors,sCD14,and HMGB1

作　　者：廖金明 曾志威[1] 丘文凤 LIAO Jin-ming;ZENG Zhi-wei;QIU Wen-feng(Department of Traditional Chinese Medicine of Meizhou People′s Hospital,Meizhou Guangdong 514000;Department of Intensive Care Medicine III of Meizhou People′s Hospital,Meizhou Guangdong 514000)

机构地区：[1]梅州市人民医院中医科,广东梅州514000 [2]梅州市人民医院重症医学三科,广东梅州514000

出　　处：《世界中西医结合杂志》2025年第1期147-152,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：广东省中医药局科研项目(20202207)。

摘　　要：目的探讨凉血解毒法辅助治疗毒热内盛证脓毒症患者的临床疗效及对其炎性因子、可溶性CD14(soluble CD14,sCD14)及高迁移蛋白1(High mobility group box 1,HMGB1)的影响。方法选取2020年1月—2022年12月期间在梅州市人民医院就诊的脓毒症患者100例,按随机抽签法分为对照组和观察组,每组各50例。对照组患者接受西医综合治疗,观察组在上述基础上加用凉血解毒法。两组患者疗程均为7 d。观察比较两组患者临床疗效、安全性,治疗前后中医证候评分(中医证候高热、喘息气短、神昏、烦躁、口渴,大便秘结、小便赤短、面红目赤、总积分),炎性因子指标和乳酸[白细胞(White blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)、白介素-6(Interleukin-6,IL-6)、乳酸(Lactate,LAC)]、血清指标(sCD14、HMGB1)、凝血功能指标[活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)、D-二聚体(D-Dimer,D-D)],病情严重程度评分[急性生理与慢性健康评分Ⅱ(Acute physiology and chron⁃ic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(Sequential organ failure assessment,SOFA)]。结果治疗后观察组临床总有效率92.00%(46/50)明显高于对照组76.00%(38/50),差异有统计学意义(P<0.05)。治疗后两组患者中医证候高热、喘息气短、神昏、烦躁、口渴,大便秘结、小便赤短、面红目赤、总积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候高热、喘息气短、神昏、烦躁、口渴,大便秘结、小便赤短、面红目赤、总积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者WBC、CRP、PCT、IL-6、LAC水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组WBC、CRP、PCT、IL-6、LAC水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清sCD14、HMGB1水平均较治疗�Objective To investigate the clinical efficacy of the blood-cooling and toxin-removing therapy as an adjunctive treatment for sepsis patients with internal exuberance of toxin heat syndrome,and its effect on inflammatory factors,soluble CD14(sCD14),and high mobility group box 1(HMGB1).Methods A total of 100 sepsis patients treated at Meizhou People′s Hospital from January 2020 to December 2022 were selected and randomly divided into a control group and an observation group according to random sortition method,with 50 patients in each group.The control group received conventional Western medicine treatment,while the observation group received the blood-cooling and toxin-removing therapy in addition to the treatment in the control group.Both groups were treated for 7 days.The clinical efficacy,safety,traditional Chinese medicine(TCM)syndrome scores(including high fever,wheezing,shortness of breath,confusion,irrita⁃bility,thirst,constipation,dark and scanty urination,red face and eyes,and total score),inflammatory markers and lactate levels[white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),lactate(LAC)],serum markers(sCD14,HMGB1),coagulation function indicators[activated partial thromboplastin time(APTT),prothrombin time(PT),D-dimer(D-D)],and severity of illness scores[Acute Physiology and Chronic Health Evalua⁃tion(APACHEⅡ),Sequential Organ Failure Assessment(SOFA)]were compared between the two groups before and af⁃ter treatment.Results After treatment,the total clinical effective rate in the observation group was 92.00%(46/50),sig⁃nificantly higher than 76.00%(38/50)in the control group(P<0.05).After treatment,both groups showed a significant reduction in TCM syndrome scores(including high fever,wheezing,shortness of breath,confusion,irritability,thirst,consti⁃pation,dark and scanty urination,red face and eyes,and total score)compared to those before treatment(P<0.05),with the observation group showing significantly lower TCM syndrome scores than the control g

关 键 词：凉血解毒法 毒热内盛证 脓毒症 血瘀 

分 类 号：R826.3[医药卫生—临床医学]