凉膈散对急性呼吸窘迫综合征的治疗作用

Therapeutic effect of Lianggesan for treatment of patients with acute respiratory distress syndrome

目的 探讨中药方剂凉膈散对急性呼吸窘迫综合征（ARDS）患者临床疗效的影响.方法 选择2015年5月1日至2016年4月30日入住天津市天津医院和天津市第一中心医院重症医学科（ICU）、符合柏林诊断标准的ARDS患者52例,按抽签法分为中药组24例和对照组28例.两组均给予抗感染、化痰、机械通气及对症支持等常规治疗;中药组在常规治疗基础上联用凉膈散配方颗粒（连翘30 g、黄芩10 g、栀子 10 g、竹叶10 g、大黄10 g、薄荷6 g、芒硝6 g、甘草15 g）,加水冲至50 mL,早、晚鼻饲或口服.比较两组治疗前后氧合指数、肿瘤坏死因子-α（TNF-α）及呼气末正压（PEEP）水平的差异.结果 两组治疗后氧合指数较治疗前明显升高,TNF-α、PEEP较治疗前明显降低,且中药组治疗后的变化较对照组更显著〔氧合指数（mmHg, 1 mmHg=0.133 kPa）：267.45±38.67比235.26±30.62,TNF-α（mg/L）：24.37±5.46比28.31±5.41,PEEP （cmH2O,1 cmH2O=0.098 kPa）：4.58±1.61比5.93±1.61,均P〈0.05〕.结论 凉膈散可有效清除ARDS患者体内的炎症介质,改善呼吸功能,促进病情恢复.

Objective To observe the effect of prescription of traditional Chinese medicine （TCM） Lianggesan on clinical efficacy for treatment of patients with acute respiratory distress syndrome （ARDS）. Methods Fifty-two patients consistent with the Berlin diagnostic criteria of ARDS admitted to the departments of intensive care unit （ICU） of Tianjin Hospital and of the First Tianjin Center Hospital from May 1, 2015 to April 30, 2016 were enrolled, and they were divided into a Chinese medicine group （24 cases） and a control group （28 cases） by lottery. The anti-infection, reduction of phlegm, mechanical ventilation and symptomatic support treatment were given to the two groups, additionally Chinese medicine group received TCM Lianggesan （particles） including ingredients： fructus forsythiae 30 g, radix scutellariae 10 g, fructus gardeniae 10 g, henon bamboo leaf 10 g, rhubarb 10 g, herba menthae 6 g, natrii sulfas 6 g, radix glycyrrhizae 15 g, adding water to punch the particles in 50 mL liquid, taken by nasal feeding or orally drinking, in the morning and in the evening, twice a day. Before and after treatment, the differences in levels of oxygenation index, tumor necrosis factor-α （TNF-α） and positive end expiratory pressure （PEEP） were compared between the two groups. Results After treatment, the oxygenation indexes of the two groups were significantly higher than those before treatment, the levels of TNF-α and PEEP of the two groups were significantly lower than those before treatment, and the degrees of changing in the Chinese medicine group were more significant than those of the control group [oxygenation index （mmHg, 1 mmHg = 0.133 kPa）： 267.45±38.67 vs. 235.26±30.62, TNF-α （mg/L）：24.37±5.46 vs. 28.31±5.41, PEEP （cmH2O, 1 cmH2O = 0.098 kPa）： 4.58±1.61 vs. 5.93±1.61, all P 〈 0.05]. Conclusion TCM Lianggesan can effectively eliminate the inflammatory mediators of patients with ARDS, improve the respiratory function and promote the recovery of the disease.