通腑理肺汤结肠透析对肺炎合并脓毒症患者血乳酸水平的影响

The Effect of the Tongfulifei Decoction and Colon Dialysis on the Blood Lactate Levels in Patients with the Pneumonia and Sepsis

目的观察通腑理肺汤结肠透析对肺炎合并脓毒症患者动脉血乳酸水平的影响及其可能机制。方法将患者按随机数字表法分为对照组与治疗组各30例,均给予内科常规治疗,治疗组予通腑理肺汤结肠透析机进行清洗灌注和透析治疗;对照组予等量灭菌温水结肠透析治疗,均每日1次,7 d为1疗程,两组均连续治疗2周。于治疗前、治疗后1周、2周末行动脉血乳酸检测。观察两组患者治疗前后中医证候积分、血乳酸(Lac)水平、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的变化,同时记录每个患者的预后情况:观察呼吸机机械通气时间、脱机成功率及ICU住院时间。结果两组治疗后中医证候学积分均有所降低,治疗组与对照组同期差异有统计学意义(P<0.05);两组治疗后Lac水平、APACHEⅡ评分均明显降低,治疗组上述指标的改善程度明显优于对照组(P<0.05);两组治疗后呼吸机使用时间、脱机成功率、ICU住院时间明显缩短,治疗组与对照组同期差异有统计学意义(P<0.05)。结论通腑理肺汤直肠滴入能够显著地改善肺炎合并脓毒症患者血乳酸水平、中医证候积分及APACHEⅡ评分,改善患者预后,缩短呼吸机使用时间、ICU住院时间,增加脱机成功率,提高肺炎合并脓毒症患者治疗有效率。

Objective： To observe the effet and possible mechanism of Tongfulifei Decoction and Colon dialysis on the Blood lactate （Lac） levels in patients with the pneumonia and sepsis. Method： The patients were randomly divided into a control group （30 cases） and treatment group （30 cases） ,conventional treatment were given to the two groups,in treatment group,Tongfulifei Decoction instillation Cleaning infusion and dialysis was applied by the Colon dialysis machine ,while in control group ,the same amount of the injectable warm water was instilled into the Colon by the same method,once a day,Seven days for a course and continuous treatment two weeks in both groups. The levels of Lac in serum were tested before the treatment and one weeks and two weeks after treatment, the changes of traditional Chinese medicine（TCM） symptom scores,The Lac level in serum,acute physiology and chronic health evaluation I1 （APACHE I1 ）score were observed,Meanwhile,the prognosis of each patient was recorded,to observe the duration of mechanical ventilation with ventilator,rate of offline success and length of ICU stays. Results： The TCM symptom scores of the two groups were lower after treatment,the score in treatment group comparedwith that of the same time in control group had statistical significant difference（P〈 0.05）;The Lac level in serum,APACHE I1 score of the two groups were markedly markedly decreased and the improvement de- gree of above indexesin treatment group were obviously better than those in control group;The ventilation time and length of ICU stays were significantly shorter in the treatment group after treatment,was significantly higher success rate oflline compared with the control group,in treatment group comparedwith that of the same time in control group had statistical significant difference （P〈 0.05）. Conclusion： Colon dialysis of Tongfulifei Decoction can significantly reduce blood lactate level, the TCM symptomscores, APACHE IT score in patients with the pneu- monia and sepsis,improve patient outcomes,reduced the ventilation time and length of ICU stays,increase the rate of success offline, significantly increase the therapeutic efficacy of patients with s the pneumonia and sepsis.