通里攻下法对SIRS/MODS的治疗价值——多中心临床分析

The Therapeutic Evaluation on TongLiGongXiaFa(通里攻下法)in SIRS/MODS——a Multiple Center Clinical Analysis

目的:观察不同病因所致的肠源性内毒素血症、SIRS及MODS的发生、发展规律,评价通里攻下法代表方剂大承气颗粒对肠源性内毒素血症、全身炎性反应综合征(SIRS)/多器官功能障碍综合征(MODS)的治疗作用。方法:前瞻性对照分析2002—2005年来源于4个医疗中心的符合SIRS或MODS标准的202名病人,随机分为西医治疗对照组105例(对照组)和大承气颗粒+西医治疗组97例(治疗组)。比较两组治疗后的器官损害或衰竭数、病死率、并发症发生率、体温(每日最高体温)、白细胞计数、血浆内毒素、血清细胞因子TNFα和IL-6的变化。结果:治疗组的疗效均显著优于对照组。对照组与治疗组病死率分别为15·24%和5·15%,器官受损率对照组105例中发生器官功能障碍215个,平均每例发生器官功能障碍2·05个,治疗组97例中发生器官功能障碍133个,平均每例发生器官功能障碍1·27个,两组相比较有显著性差异,P<0·05。其他指标治疗组显著优于对照组。结论:通里攻下法代表方剂大承气颗粒可以明显改善SIRS/MODS患者的临床症状,降低病死率、并发症发生率,促进脏器功能恢复,预防或减少MODS/MOF的发生,改善预后,降低病死率。

Objective To observe the pathogenesis of enterogenous endotoxemia and SIRS/MODS from different diseases and evaluate the therapeutic effect of TongLiGongXiaFa（通里攻下法） - Dachengqi（大承气） granules on them Methods Prospective control analysis of 202 patients with SIRS/MODS from 4 medical centers in 2002 - 2005 was done. Patients were divided randomly into the conventional treatment control group and Dachengqi granules treatment group in addition to conventional treatment measures. The mortalities, morbidities, white blood cell count, LPS, IL--6 and TNFαchanges after treatment were compared. Results The results of the therapeutic group was significantly better than those of the control group with statistically differences. The morbidity rates of the therapeutic and control group were15.24% and 5.15% separately.There were 215organs experiencing dysfunction in therapeutic group with 133 cases and the average number was 2.05per case; on the contrary, there were 133 organs experiencing dysfunction in control group with 97 cases and the average number was 1.27 per case; the differences between them were significant. And other items have the same changes that the therapeutic group was better than the control group. Condusion Clinical results revealed marked improvement of clinical manifestations with reduction of morbidity and mortality, improvements of visceral functions and the prognosis, prevention of MODS/MOF.