健脾益肾活血化痰方治疗全耐药菌感染呼吸机相关性肺炎临床观察

Clinical observation of Jianpi-yishen-huoxue-huayu decoction on pan-drug resistant bacteria infection of ventilator-associated pneumonia

目的观察健脾益肾活血化痰方治疗全耐药菌感染呼吸机相关性肺炎(VAP)的临床疗效。方法将60例全耐药菌感染的VAP患者随机分为2组,2组均停用抗生素,对照组30例采用西医治疗,治疗组30例停用所有静脉药物,加强气道管理同时予健脾益肾活血化痰方和特殊饮食鼻饲。2组均治疗28 d,比较2组治疗前后外周血白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、血清降钙素原(PCT)、中医证候积分、临床肺部感染评分(CPIS),并统计疗效。结果治疗组总有效率86.67%,高于对照组(20.00%,P<0.05);治疗组28 d死亡率13.33%,低于对照组(53.33%,P<0.05)。治疗组治疗后WBC、hs-CRP、PCT较治疗前均下降(P<0.05),且均低于对照组(P<0.05)。治疗组治疗后中医证候积分及CPIS评分较治疗前均下降(P<0.05),且均低于对照组(P<0.05)。对照组治疗后中医证候积分下降(P<0.05),CPIS评分无改善(P>0.05)。结论采用健脾益肾活血化痰方治疗全耐药菌感染VAP疗效显著,为临床治疗此病提供一种新的治疗思路。

Objective To observe the clinical effects of Jianpi-yishen-huoxue-huayu decoction on the treatment of pan-drug resistant bacteria infection of ventilator-associated pneumonia（ VAP）. Methods 60 patients with pan-drug resistant bacteria infection of VAP were randomly divided into 2 groups,and antibiotics were discontinued in both groups. 30 cases in the control group were treated by conventional western medicine. 30 cases in the treatment group were discontinued all intravenous medicine,and treated by Jianpi-yishen-huoxue-huayu decoction and special dietary for nasal feeding,and strengthen airway management at the same time. Both groups were treated for 28 days. The peripheral blood white blood cells（ WBC）,hypersensibility c-reactive protein（ hs-CRP）,procalcitonin（ PCT）,traditional Chinese medicine（ TCM） symptom score and clinical pulmonary infection score（ CPIS） before and after treatment were compared between the two groups,and the curative effects were evaluated. Results The total effective rate in the treatment group（ 86. 67%） was higher than that in the control group（ 20. 0%,P 〈 0. 05）,and the mortality rate at 28 days in the treatment group was 13. 33%,was lower than that in the control group（ 53. 33%,P 〈 0. 05）. The WBC,hs-CRP and PCT after treatment were reduced in treatment group（ P 〈 0. 05）,and which were lower than that in control group（ P 〈 0. 05）. The TCM symptom score and CPIS after treatment were reduced in treatment group（ P 〈 0. 05）,and which were lower than that in control group（ P 〈 0.05）. The TCM symptom score after treatment were reduced in control group（ P 〈 0. 05）,but CPIS was no improvement（ P 〉 0. 05）. Conclusions Jianpi-yishen-huoxue-huayu decoction has significant clinical effects on the treatment of pan-drug resistant bacteria infection VAP,which provides a new thought for clinical treatment of the disease.