大黄联用丹参注射液治疗急性呼吸窘迫综合征疗效观察

A clinical study of therapeutic effect of combination of rubarb and Danshen injection on patients with acute respiratory distress syndrome

目的 观察大黄联用丹参注射液治疗急性呼吸窘迫综合征（ARDS）的临床疗效.方法 60 例 ARDS 患者按随机数字表法分为治疗组和对照组，每组30 例，对照组给予西医常规治疗，治疗组在西医常规治疗 基础上加用丹参注射液和大黄治疗5 d。采用放射免疫分析试验（RIA）测定血清肿瘤坏死因子-α（TNF-α）， 酶联免疫吸附试验（ELISA）测定白细胞介素1β（IL-1β）的水平，观察两组患者治疗前后呼吸频率（RR）、氧 合指数（PaO2/FiO2）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分的变化，比较两组住院时间、住 重症监护病房（ICU）时间、病死率.结果 两组治疗前TNF-α（ng/L）、IL-1β（ng/L）、RR（次/min）、PaO2/FiO2 （mm Hg，1 mm Hg=0.133 kPa）、APACHE Ⅱ评分（分）比较差异均无统计学意义（均P ＞0.05）。两组治疗3 d 后 上述指标即明显改善，且治疗组改善程度明显优于对照组（TNF-α：64±5 比78±3，IL-1β：23±4 比30±2， RR：25.7±1.8比30.2±2.8，PaO2/FiO2：278.3±14.1比262.3±13.8，APACHEⅡ 评分：12.2±2.7比16.3±7.4，均P ＜ 0.05）。治疗组住院时间（d：14.4±2.5）、住ICU时间（d：8.4±1.9）较对照组（23.7±3.6、11.5±2.2）明显缩短（均P ＜ 0.05），病死率明显降低（6.7% 比16.7%，P ＜0.05）.结论 大黄联合丹参注射液治疗ARDS 能减少机体炎症 介质的产生，减轻肺损伤，改善患者氧合及预后.

Objective To investigate the clinical therapeutic effects of combination of rhubarb and Danshen injection on patients with acute respiratory distress syndrome （ARDS）. Methods Sixty patients with ARDS were divided by random numeric table method into two groups ： treatment （30 cases） and control groups （30 cases）. The control group was treated by western routine medicine, and the treatment group was treated by Danshen injection and rhubarb for 5 days on the base of western routine medicine. The serum levels of tumor necrosis factor-α （TNF-α） was determined by radioimmuuoassay （RIA）, the serum level of interleukin-1β （IL-1 β ）was determined by enzymelinked immunosorbent assay （ELISA）, the changes of respiratory rate （RR）, oxgenation index （PaO2/FiO2）, the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score before and after treatment were observed in the two groups. The time of hospitalization, the length of stay in intensive care unit （ICU）, and the mortality were compared between the two groups. Results Before treatment, there were no significant differences in TNF-α （ng/L）, IL-1β （ng/L）,RR（bpm）,PaO2/FiO2（mm Hg, 1 mm Hg：0.133 kPa）,APACHE Ⅱ score between the two groups （allP〉0.05）. After treatment for 3 days, all the above indexes were significantly improved compared to those before treatment, and the degree of improvement in the treatment group was better than that in control group （TNF-α 64±5 vs. 78±3, IL-1β：23±4 vs. 30±2, RR ：25.7±1.8 vs. 30.2±2.8, PaO2/FiO2/278.3±14.1 vs. 262.3±13.8, APAHCE Ⅱ score ： 12.2± 2.7 vs. 16.3 ±7.4, all P〈 0.05 ）. The duration of hospitalization （day ： 14.4± 2.5）, and the stay in ICU （day ： 8.4± 1.9）in treatment group were shorter significantly than those in the control group （23.7±3.6, 11.5± 2.2, both P〈0.05 ）, and the mortality rate in treatment group was lower than that in the control group （6.7% LL 16.7%, P〈 0.05）. Conclusion It is suggested that combination of rhubarb and Danshen injection inhibit the production of inflammatory media of the organism, lessen lung injury, and improve oxygenation and the prognosis in cases with ARDS.