麻杏石甘汤治疗痰热壅肺型重症肺炎的临床研究

Clinical study on Maxing-Shigan decoction for severe pneumonia of phlegm-heat obstructing lung type

目的：评价麻杏石甘汤治疗痰热壅肺型重症肺炎患者的疗效。方法收集2013年1－12月大连市中心医院中医科重症肺炎患者60例。按随机数字表随机分为2组各30例。对照组给予抗感染、补液、呼吸机支持等治疗。治疗组在对照组基础上鼻饲麻杏石甘汤。比较2组治疗前后平均动脉压（MAP）、乳酸（Lac）含量、氧合指数（PaO2/FiO2）、临床肺部感染评分（clinical pulmonary infection score, CPIS）、急性生理与慢性健康评分Ⅱ（acute physiology and chronic health evaluation II, APACHEⅡ）。结果治疗组总有效率为80.0%（24/30），对照组为73.3%（16/30），2组比较差异有统计学意义（χ2＝4.800，P＝0.029）。2组MAP[治疗组：（102.4±11.9）mmHg比（70.4±6.4）mmHg，t＝12.972，P＝0.000；对照组：（101.2±12.5）mmHg比（69.8±6.6）mmHg，t＝12.1672，P＝0.000]、PaO2/FiO2[治疗组：（265.4±19.7）mmHg比（78.6±10.5）mmHg，t＝45.833，P＝0.000；对照组：（124.8±13.4）mmHg比（79.1±11.1）mmHg，t＝14.385， P＝0.000]均显著高于治疗前，Lac均显著低于治疗前[治疗组：（1.04±0.42）mmol/L比（6.37±2.27）mmol/L， t＝12.65，P=0.000；对照组：（3.88±1.45）mmol/L比（6.39±2.32）mmol/L，t＝5.025，P=0.000]；治疗组Lac（t＝10.304，P＝0.000）和 PaO2/FiO2（t＝32.323，P＝0.000）改善情况优于对照组。CPIS[治疗组：（2.2±1.5）分比（6.7±1.7）分，t＝10.872，P＝0.000；对照组：（4.5±2.7）分比（6.8±1.8）分，t＝3.882， P＝0.000]和APACHEⅡ[治疗组：（5.3±2.1）分比（13.8±3.8）分，t＝10.723，P＝0.000；对照组：（9.3±3.5）分比（13.7±3.5）分，t＝4.869，P＝0.000]评分均较治疗前显著降低，且治疗组CPIS（t＝4.079， P＝0.000）和APACHEⅡ（t＝5.368，P＝0.000）下降情况优于照组。结论麻杏石甘汤对痰热壅盛型重症肺炎的疗效确切。

Objective To assess the clinical efficacy ofMaxing-Shigan decoction in patients with severe pneumonia due to phlegm-heat obstructing the lung.Methods Sixty patients with severe pneumonia in the TCM Department of Dalian Municipal Central Hospital from January to December 2013 were randomly divided into a control group and a treatment group by random number table method, 30 in each group. The control group was treated with anti-infection, fluid infusion and mechanical ventilation. On the basis of treatment in the control group, the treatment group was also givenMaxing-Shigan decoction through nasogastric gavage. The mean arterial pressure （MAP）, lactic acid （Lac） and PaO2/FiO2 were compared before and after the treatment in both groups. The scores of the Clinical Pulmonary Infection Score （CPIS） and the Acute Physiology and Chronic Health Evaluation II （APACHEⅡ） were compared between the two groups.Results The total effective rate in the treatment group was significantly higher than that in the control group （80.0%vs.73.3%;χ2=4.800,P=0.029）. In both groups, MAP （treatment group： 102.4 ± 11.9 mmHgvs. 70.4 ± 6.4 mmHg, t=12.972,P=0.000; control group： 101.2 ± 12.5 mmHgvs. 69.8 ± 6.6 mmHg,t=12.1672,P=0.000）, PaO2/FiO2 （treatment group： 265.4 ± 19.7 mmHgvs. 78.6 ± 10.5 mmHg,t=45.833,P=0.000; control group： 124.8 ± 13.4 mmHg vs. 79.1 ± 11.1 mmHg;t=14.385,P=0.000） after the treatment were significantly higher than before the treatment, and the Lac level were significantly lower （treatment group： 1.04 ± 0.42 mmol/Lvs. 6.37 ± 2.27 mmol/L,t=12.65, P=0.000; control group： 3.88 ± 1.45 mmol/Lvs. 6.39 ± 2.32 mmol/L,t=5.025,P=0.000）. The improvements in Lac （t=10.304,P=0.000） and PaO2/FiO2 （t=32.323,P=0.000） in the treatment group were superior to the control group. The scores of the CPIS （treatment group： 2.2 ± 1.5vs. 6.7 ± 1.7,t=10.872,P=0.000; control group： 4.5 ± 2.7 vs. 6.8 ± 1.8,t=3.882,P=0.000） and APACHEⅡ（treatment group： 5.3 ± 2.1vs. 13.8 ± 3.8,t=10.723,P=0.000; control group： 9.3±3.5vs. 13.7 ± 3.5,t=4.869,P=0.000） after the treatment were significantly lower than before the treatment in both groups, and the changes of CPIS （t=4.079,P=0.000） and APACHEⅡ（t=5.368,P=0.000） in the treatment group were greater than those in the control group.ConclusionsMaxing-Shigan decoction has definite therapeutic effects for severe pneumonia due to phlegm-heat obstructing the lung..