内毒素血症期治疗中加用中药对全身性炎症反应的影响

Influences of Chinese Herbs Added to Treatment of Endotoxemia Stage on Systemic Inflammatory Reaction

目的 :探讨急腹症内毒素血症期治疗中加用中药对全身性炎症反应的影响。 方法 :前瞻性研究 ,将 2 7例急腹症内毒素血症期患者按病种及APACHE -Ⅱ评分分层随机分为综合安慰组及综合中药组 ,再将后者分为综合清胆组和综合承气组。动态观察血内毒素、脂质过氧化物 (LPO)、大便次数、体温及白细胞计数等变化。 结果 :综合中药和综合承气组第 3d内毒素及第 1、3dLPO水平低于综合安慰组 (P <0 0 5 ) ,综合清胆组内毒素及LPO呈降低趋势。第 1d各中药组体温低于综合安慰组 ,第 3d综合中药和综合清胆组增高的体温及白细胞计数均降低 (P <0 0 5 )。各中药组大便次数增多 (P <0 0 1)。时段日均便次 (第 1～ 3d)与第 3d体温、白细胞计数、LPO呈负相关 (r =- 0 6 42 ,P <0 0 1;r =- 0 431,P <0 0 5 ;r =- 0 499,P <0 0 5 )。 结论 :大承气颗粒、清胆灵颗粒通过通里攻下、清热解毒作用 ,降低内毒素血症期循环内毒素和脂质过氧化物水平 ,降低增高的体温和白细胞计数 ,能减轻全身性炎症反应。

To evaluate the influences of Chinese herbs added to the treatment of endotoxemia stage in acute abdominal diseases on systemic inflammatory reaction Methods:In a prospective clinical study 27 patients were classified into combined treatment+placebo(group A)and combined treatment+Chinese herbs(group B)through stratified random according to the kinds of diseases and APACHE Ⅱscore;18 healthy persons served as normal control(group C).Then according to the kinds of illness,group B was further divided into group B1 and group B2m.Qing Dan Ling granules and Da Cheng Qi granules were given respectively.Initially Chinese herbs were taken per os,sometimes by enemata in the postoperative period.Plasma endotoxin,serum LPO,bowel movement,body temperature (BT) and white blood cell determined dynamically.Results:Endotoxin level in group B and group B2 lowered at day 3( P <0 05);LPO content in group B and group B2 lowered at day 1,3( P <0.05).Body temperature raised in group B and group B1 at day 1,3,and fell in group B2 at day 1( P <0.01);Increased white blood cell count(WBC)was found in group B,and in group B1 decreased at day3( P <0.05).The number or bowel movement in each group with Chinese berbs taken increased persistently( P <0.01);average number of times during day 1～day 3correlated negatively with BT,WBC and LPO at day 3( r =-0.642, P = 0.001; r =-0.431, P =0.031; r =-0.499, P =0.035)Conclusion:On the basis of western medicine combined tratement,Da Cheng Qi granules or Qing Dan Ling granules with the effects of purgation and clearing away heat and detoxicating may alleviate systemic inflammatroy reaction through reducing circulating endotoxin,LPO,WBC and BT.