宣白承气汤对急性肺损伤机械通气患者呼吸力学的影响

Effect of Xuanbai Chengqi Decoction on Breathing Mechanics in Acute Lung Injury Patients Receiving Mechanical Ventilation

目的:研究宣白承气汤对急性肺损伤(ALI)机械通气患者呼吸力学的作用及其机制。方法:将符合要求的45例ALI患者随机分为治疗组23例和对照组22例,均给予常规治疗及机械通气,治疗组加用宣白承气汤,比较治疗前后气道峰压(PIP)、平台压(Pplat)、气道阻力(Raw)、氧合指数(PaO2/FiO2)、静态肺顺应性(Cst)及动态肺顺应性(Cdyn)等呼吸力学参数,胸片评分及血清肿瘤坏死因子α(TNF-α)、白介素-1β(IL-1β)和白介素-10(IL-10)等炎性因子。结果:治疗后治疗组患者PIP、Raw、Cdyn及胸片评分等均有改善,与对照组比较,差异均有显著性意义(P<0.05);而Pplat、Cst、PaO2/FiO2等改善更显著,明显优于对照组(P<0.01)。炎性指标方面,治疗后治疗组TNF-α、IL-1β水平较对照组明显下降(P<0.05);而IL-10较对照组明显上升(P<0.05)。结论:宣白承气汤对急性肺损伤患者呼吸力学有较好的改善作用,其机制可能与宣白承气汤调节促炎因子与抑炎因子之间的平衡有关。

Objective: To observe the therapeutic effect of Xuanbai Chengqi Decoction (XCD) on breathing mechanics in acute lung injury (ALI) patients receiving mechanical ventilation,and to explore its mechanism. Methods: Forty-five qualified ALI patients were randomized into the treatment group ( n = 23 ) and the control group ( n = 2 2 ).The two groups received routine western medicine and mechanical ventilation,and the treatment group was given XCD additionally. The changes of breathing mechanics parameters such as pressure of inspiration peak (PIP),platform pressure (Pplat),airway resistance (Raw),oxygenation index (PaO2 / FiO2 ),lung compliance (Cst) and dynamic compliance (Cdyn) were observed. Meanwhile,the chest X-ray score and serum levels of inflammatory factors such as tumor necrosis factor α (TNF-α),interleukin-1β (IL-1β) and interleukin-10 (IL-10 ) were examined. Results: PIP,Raw,Cdyn and chest X-ray score were improved in the treatment group after treatment ( P < 0. 05 compared with those in the control group). The improvement of Pplat,Cst and PaO2 / FiO2 in the treatment group was superior to that in the control group ( P < 0. 01 ). Serum TNF-α and IL-1β levels were decreased and IL-10 level was increased in the treatment group ( P < 0. 05 compared with those in the control group).Conclusion: XCD can improve the breathing mechanics in acute lung injury patients receiving mechanical ventilation,and its possible mechanism is related with the regulation of inflammatory factors.