中西医结合疗法救治毒热动风型重症手足口病

Combined Traditional Chinese and Western Medicine in Treating Syndrome of Terrific Heat and Dynamic Wind in Hand-foot-and-mouth Disease

目的：探讨安宫牛黄丸和风引汤治疗重症手足口病（毒热动风型）的临床疗效及其对血清S-100β蛋白（S-100β）和脑利钠肽（BNP）的影响。方法：142例重型手足口病患儿按入院先后随机分为治疗组和对照组各71例。对照组参照《手足口病诊疗指南（2010年版）》采取常规治疗和对症处理。治疗组在对照组治疗的基础上采取安宫牛黄丸保留灌肠,1丸/次,3岁,1次1/4丸;4-6岁,1次1/2丸;1次/d;同时加服风引汤治疗,1剂/d,常规水煎煮2次;3-5岁患儿,50 m L/次,3岁以下儿童,10-40 m L/次;3-5次/d,口服或鼻饲给药。两组疗程均为10 d。观察两组患儿临床症状、体征,记录住院时间。检测两组患儿动脉血氧分压（Pa O2）,血氧饱和度（SPO2）,血清S-100β和BNP含量。结果：治疗组临床总有效率为88.73%,对照组为73.23%,治疗组优于对照组（P〈0.05）;治疗组皮疹、疱疹消退时间,体温复常时间,易惊、肢体震颤消失时间,住院时间均优于对照组（P〈0.01）;治疗组治疗后患儿Pa O2和SPO2均明显高于对照组（P〈0.01）;治疗组治疗后患儿S-100β和BNP均明显低于对照组,比较差异有统计学意义（P〈0.01）。结论：在西医常规治疗的基础上,采用安宫牛黄丸保留灌肠以及口服风引汤治疗毒热动风型重症手足口病可减轻患儿临床症状体征,提高血氧饱和度和血氧分压,缩短住院时间,其降低患儿血清S-100β和BNP含量可能参与了上述作用的调节。

Objective： To investigate the clinical effect of Angong Niuhuang Wan plus Fengyin decoction in treating severe hand-foot-mouth disease（ terrific heat and dynamic wind type） as well as its influence on serum S-100β protein（ S-100β） and brain batriuretic peptide（ BNP）. Method： One hundred and forty-two patients with severe hand-foot-and-mouth disease were randomly divided into control group and treatment group,with 71 cases in each group according to hospital admission sequence. Control group received routine treatment and symptomatic treatment referring to treatment guide of hand-foot-and-mouth disease（ 2010 year）. Based on the treatment in control group,patients in treatment group also received retention enema of Angong Niuhuang Wan（ 1 wan /time,1 /4 wan /time for child of 3 years old,and 1 /2 wan /time for child of 4-6 years old）,1 time /day;combined with oral administration or nasal feeding of Fengyin decoction（ 1 dose / d and bid in convention decoction form,50 m L / time for child of 3-5 years old,10-40 m L / time for child 〈3 years old,3-5 times / d）. Course of treatment was 10 days in both groups. Clinical symptoms and signs were observed and length of stay was recorded for two groups. Pa O2,SPO2,S-100β,and BNP were detected in both groups. Result： The total efficacy of treatment group was 88. 73%,which was superior to 73. 23% in control group（ P〈 0. 05）. Extinction time of erythra,bleb,skittishness and limb tremor,as well as temperature recovery time and length of stay in treatment group were superior to control group（ P 〈0. 01）. Pa O2 and SPO2of treatment group were significantly higher than those of control group（ P 〈0. 01）. After treatment,serum S-100β and BNP in treatment group were significantly lower than those in control group with statistical difference（ P 〈0. 01）. Conclusion： Based on western medicine conventional therapy,Angong Niuhuang Wan combined with Fengyin decoction could relieve clinical symptoms and signs of severe hand-foot-mouth disease（ terrific heat and dynamic wind type）,improve oxygen saturation of blood and partial pressure of oxygen,and shorten length of stay. Reduction of serum S-100β and BNP levels may be involved in above-mentioned regulation.