大承气汤联合β-七叶皂苷钠对胸部创伤后急性肺损伤患者肺功能的影响

The effect of Dachengqi decoction combined withβ-aescine on pulmonary function in patients with acute lung injury after chest trauma

目的 观察中药大承气汤联合β-七叶皂苷钠对胸部创伤后急性肺损伤（ALI）患者肺功能的影响.方法 选择2013年4月至2016年5月甘肃省定西市人民医院胸心外科收治的95例胸部创伤后ALI患者,将患者按随机数字表法分为大承气汤组（47例）和对照组（48例）.对照组在常规治疗基础上加用 β-七叶皂苷钠,每日0.4 mg/kg加入10%葡萄糖注射液（250 mL）静脉滴注（静滴）,大承气汤组在对照组治疗基础上给予大承气汤（大黄12 g、厚朴24 g、枳实12 g、芒硝9 g）每日1剂,分早晚2次服用,两组治疗时间均为1周.观察两组患者治疗前后食管压力、呼吸力学、肺功能指标和血气分析指标的变化.结果 与治疗前比较,两组治疗后气道平台压（Pplat）、平均气道压（mPaw）、气道阻力（Raw）和动脉血二氧化碳分压（PaCO2）水平均显著降低,下食管括约肌压力（LESP）、气道峰压（PIP）、1秒用力呼气容积（FEV1）、用力肺活量（FVC）、呼气峰流速（PEF）、平均最大呼气流量（MMEF）、脉搏血氧饱和度（SpO2）、动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）水平均显著升高,且大承气汤组上述指标的变化较对照组更显著〔LESP（mmHg,1 mmHg=0.133 kPa）：18.64±2.79比15.46±3.09,Pplat（cmH2O,1 cmH2O=0.098 kPa）：14.27±1.68比16.00±1.87,PIP（cmH2O）：40.23±5.03比32.19±4.45,mPaw（cmH2O）：8.57±0.67比9.41±1.23,Raw（cmH2O·L-1·s-1）：6.76±1.01比9.31±1.43,FEV1（L）：1.73±0.27比1.46±0.25,FVC：（3.95±0.51）%比（3.30±0.46）%,PEF（L/s）：3.81±0.47比3.11±0.38,MMEF（L/s）：0.93±0.16比0.77±0.12,SpO2：0.96±0.06比0.91±0.05,PaO2（mmHg）：97.82±10.13比74.73±8.02,PaCO2（mmHg）：36.49±4.28比47.13±5.46,PaO2/FiO2（mmHg）：362.47±20.82比259.79±17.61,均P〈0.05〕.结论 大承气汤联合β-七叶皂苷钠治疗可降低胸部创伤后ALI患者的呼吸力学,改善患者肺功能和血氧水平.

Objective To observe the effect of Dachengqi decoction combined with β-aescine on pulmonary function in patients with acute lung injury （ALI） after chest trauma.Methods Ninety-five patients with ALI after chest trauma admitted to the Department of Thoracic Cardiothoracic Surgery of Dingxi People＇s Hospital of Gansu from April 2013 to May 2016 were enrolled, and they were divided into a Dachengqi decoction group （47 patients） and a control group （48 patients） by random number table. The control group patients were treated with conventional therapy and β-aescine 0.4 mg/kg＋ 10% Glucose （250 mL） intravenous drip, while the Dachengqi decoction group patients were additionally treated with Dachengqi decoction on the treatment of the control group （rhubarb 12 g, magnolia officinalis 24 g, fructus aurantii immaturus 12 g, mirabilite 9 g）, one dose daily, taken twice in a day, once in the morning and once in the evening orally, both groups were treated for one week. Before and after treatment, the changes of esophageal pressure, respiratory dynamics, the indexes of pulmonary function and blood gas analysis were observed. Results Compared with those before treatment, the levels of plateau pressure （Pplat）, mean airway pressure （mPaw）, airway resistance （Raw） and arterial partial pressure of carbon dioxide （PaCO2） of the two groups after treatment were significantly reduced, but the levels of lower esophageal sphincter pressure （LESP）, peak airway pressure （PIP）, the first second forced expiratory volume （FEV1）, forced vital capacity （FVC）, peak expiratory flow rate （PEF）, the mean maximum expiratory flow （MMEF）, pulse oxygen saturation （SpO2）, arterial partial pressure of oxygen （PaO2）, oxygenation index （PaO2/FiO2） were all increased significantly; the changes of the above indexes in the Dachengqi decoction group were more significant than those in the control group [LESP （mmHg, 1 mmHg = 0.133 kPa）：18.64±2.79 vs. 15.46±3.09, Pplat （cmH2O, 1 cmH2O = 0.098 kPa）： 14.27±1.68 vs. 16.00±1.87, PIP （cmH2O）： 40.23±5.03 vs. 32.19±4.45, mPaw （cmH2O）： 8.57±0.67 vs. 9.41±1.23, Raw （cmH2O·L-1·s-1）： 6.76±1.01 vs. 9.31±1.43, FEV1 （L）： 1.73±0.27 vs. 1.46±0.25, FVC： （3.95±0.51）% vs. （3.30±0.46）%, PEF （L/s）： 3.81±0.47 vs. 3.11±0.38, MMEF （L/s）： 0.93±0.16 vs. 0.77±0.12, SpO2： 0.96±0.06 vs. 0.91±0.05, PaO2 （mmHg）： 97.82±10.13 vs. 74.73±8.02, PaCO2 （mmHg）： 36.49±4.28 vs. 47.13±5.46, PaO2/FiO2 （mmHg）： 362.47±20.82 vs. 259.79±17.61, allP 〈 0.05]. Conclusion Dachengqi decoction combined with β-aescine can reduce the respiratory intensity of patients with ALI after chest trauma and improve the lung function and blood oxygen level.