大黄治疗创伤后急性呼吸窘迫综合征的临床观察

目的：观察应用大黄治疗创伤后急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法60例ARDS患者按随机数字表法分为观察组和对照组，每组30例。对照组给予常规治疗方案：积极处理原发病灶、循环和呼吸支持、氧疗、止血、输液、输血、抗感染、营养支持及对症治疗等；观察组在常规治疗基础上加用生大黄粉治疗（大黄15 g加温开水150～300 ml浸泡，50～80ml鼻饲/次，2～4次/d）；两组均治疗5d。采用放射免疫分析试验（RIA）测定血清肿瘤坏死因子-α（TNF-α）的水平；酶联免疫吸附试验（ELISA）测定白细胞介素1β（IL-1β）的水平；观察两组患者治疗前后呼吸频率（RR）、氧合指数（PaO2/FiO2）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分的变化；比较两组住院时间、住重症监护病房（ICU）时间及病死率。结果治疗前两组患者TNF-α（ng/L）、IL-1β（ng/L）、RR （次/min）、PaO2/FiO2（mmHg，1mmHg=0.133kPa）、APACHE Ⅱ评分比较差异无统计学意义（P〉0.05）。治疗3d后，两组患者上述指标明显改善，观察组[（TNF-α：（64±5）；IL-1β：（23±4）；RR：（25.7±1.8）；PaO2/FiO2：（278.3±14.1）；APACHEⅡ评分：（12.2±2.7）]和对照组（TNF-α：[（78±3）；IL-1β：（30±2）；RR：（30.2±2.8）；PaO2/FiO2：（262.3±13.8）；APACHEⅡ评分：（16.3±7.4）]，两组各指标比较差异均有统计学意义（P〈0.05）。观察组住院时间（14.4±2.5）d、住ICU时间（8.4±1.9）d，与对照组比较时间明显缩短（P〈0.05），观察组病死率（6.7%）与对照组病死率（16.7%）相比明显降低（P〈0.05）。结论大黄治疗创伤后ARDS患者能减轻机体炎症及肺损伤，改善患者氧合及预后。

ObjectiveTo investigate the application of Rhubarb for acute respiratory stress syndrome after trauma（ARDS）in patients with clinical effi cacy.Methods60 patients with ARDS were randomly divided into treatment group and control group with30 cases in each,the control group was given conventional treatment, ie. actively treating the primary disease,circulatory and respiratory support,oxygen therapy,hemostasis, infusion,transfusion,combined with hormone and antibiotic resistant infections,nutritional support and symptomatic treatment.;the treatment group in the conventional treatment were treated with combination of rhubarb treatment（rhubarb 15 g heating boiling water soak 150～300 ml, each time 50～80 ml feeding,daily 2～4 times）;the two groups were treated for 5d. Analysis was performed on the tests of radioimmunoassay（RIA）for determination of serum tumor necrosis factor alpha（TNF-α）,enzyme linked immunosorbent assay（ELISA）for determination of interleukin 1β（IL-1β）level,two groups were observed before and after treatment in patients with respiratory rate（RR）,oxygenation index（PaO2/FiO2）,acute physiology and chronic health evaluation systemⅡ（APACHEⅡ）score were compared between the two groups,hospital stay,stay in the intensive care unit（ICU） time,mortality rate.Results of the two groups before treatment（ng/L）of TNF-α,IL-1β（ng/L）,RR（/min）,PaO2/FiO2（mm Hg,1 mm Hg=0.133 kPa）,APACHEⅡ score（score）there was no signifi cant difference（P〉0.05）. 3 d after treatment,the indice in both groups were signifi cantly improved,and the treatment group was improved signifi cantly better than the control group（TNF-α：64±5 vs 78±3,23±4 IL-1β：30±2,RR：25.7±1.8 vs 30.2±2.8,PaO2/FiO2：278.3±14.1 vs 262.3±13.8,APACHEⅡ scores：12.2±2.7 vs 16.3±7.4,P〈0.05）. The treatment group’s hospitalization time（d：14.4±2.5）,length of stay in ICU（d：8.4±1.9）was signifi cantly shortened than in the control group（23.7±3.6,11.5±2.2） （P〈0.05）,signifi cantly reduced mortality（6.7% vs 16.7%,P〈0.05）.Conclusion Rhubarb in the treatment of post-traumatic ARDS can reduce the infl ammation of generation,reduce lung injury,improve oxygenation and prognosis.