中药固表辟邪方预防老年院内感染的疗效观察

Prevention of traditional Chinese medicine Gubiao Pixie prescription for nosocomial infection in elderly population

目的观察中药固表辟邪方预防住院老年易感患者发生院内感染的疗效。方法采用前瞻性观察性研究方法，选择天津市第一中心医院中西医结合科2015年3月至2016年3月收治的年龄〉70岁的老年住院患者，采用随机数字表法分为试验组和对照组。对照组给予常规治疗，不进行特殊干预；试验组在常规治疗基础上加用中药固表辟邪方颗粒（组成：生黄芪30g、麸炒苍术20g、防风12g、黄芩10g、草果6g），温水300mL冲服，早晚各1次，饭后半小时服用，并随证加减。观察两组患者治疗前后免疫功能指标的变化及治疗10d院内感染发生率，体温、白细胞计数（WBC）、C-反应蛋白（CRP）异常升高率。结果研究期间共收治110例老年住院患者，剔除服药后呕吐、腹胀及未能按试验要求服药、住院时间不足10d的患者后，最终共100例患者纳入分析，对照组50例、试验组50例。两组治疗前免疫功能指标免疫球蛋白IgA、IgG、IgM差异均无统计学意义。治疗10d后，对照组各项免疫功能指标均无明显改善；而试验组免疫功能指标均较治疗前明显改善，且IgA（g／L：1．59±0．32比1．29±0．29）、IgG（g／L：12．07±2．37比10．23±1．91）、IgM（g／L：1．01±0．29比0．88±0．24）均明显高于对照组（均P〈0．01）。与对照组比较，试验组治疗10d后院内感染发生率（20％比38％）以及体温（24％比44％）、WBC（28％比52％）、CRP（28％比50％）异常升高率均明显降低（均P〈0．05）。结论中药同表辟邪方具有增强免疫功能以及抑菌、杀菌的作用，对住院老年易感人群院内感染有一定预防作用。

Objective To observe the curative effect of traditional Chinese medicine （TCM） Gubiao Pixie prescription on the prevention of nosocomial infection in elderly patients with susceptible factors. Methods A prospective observational study was conducted. The elderly patients aged over 70 years admitted to the Department of Integrated TCM and Western Medicine of Tianjin First Center Hospital from March 2015 to March 2016 were enrolled. The patients were divided into experiment group and control group by random number table. The patients in control group were given conventional treatment without special intervention; and those in experimental group were given Gubiao Pixie prescription particles （prescription composition： Radix Astragali 30 g, Bran fried Rhizoma Atracylodis 20 g, Raidix Saposhnikoviae 12 g, Radix ScuteUariae 10 g, Fructus Tsaoko 6 g） on the basis of conventional treatment. The Gubiao Pixie prescription particles were taken in warm water 300 mL, twice a day in morning and evening respectively, taking half an hour after meals, and were increased or decreased according to the disease condition. The changes in immune function parameters before and after treatment, as well as the incidence of nosocomial infection, the abnormal increase rate of body temperature, white blood cell （WBC）, and C-reactive protein （CRP） after 10 days of treatment in the two groups were observed. Results A total of 110 elderly patients with susceptible factors during hospitalization were included. After the exclusion of vomiting, abdominal distension and failure to conform the trial requirements, hospitalization time less than 10 days of patients, a total of 100 patients were enrolled in the analysis finally, with 50 patients in control group and in experimental group respectively. There were no significant differences in immune function parameters including IgA, IgG, IgM before treatment between the two groups. After 10 days of treatment, the immune function parameters showed no significant improvement in control group, and those in experiment group were improved significantly, and IgA （g/L： 1.59± 0.32 vs. 1.29 ± 0.29）, IgG （g/L： 12.07 ± 2.37 vs. 10.23± 1.91）, and IgM （g/L： 1.01 ±0.29 vs. 0.88±0.24） were significantly increased as compared with those of control group （all P 〈 0.01）. Compared with the control group, the incidence of nosocomial infection （20% vs. 38%） and the abnormal increase rate of body temperature （24% vs. 44%）, WBC （28% vs. 52%）, and CRP （28% vs. 50%） 10 days after treatment in experimental group were significantly decreased （all P 〈 0.05）. Conclusions TCM Gubiao Pixie prescription has a role in enhancing immune function and antibacterial and bactericidal effect. It has certain preventive effect on nosoeomial infection in susceptible people.