三黄泻心汤联合西药治疗脓毒症急性肾损伤(?三焦热盛?)随机平行对照研究

Sanhuang Xiexin Decoction(三黄泻心汤) combined with Western Medicine in the Treatment of Sepsis Acute Kidney Injury(Sanjiao Resheng/三焦热盛) Randomized Parallel Controlled Study

[目的]观察三黄泻心汤联合西药治疗脓毒症急性肾损伤(三焦热盛)疗效。[方法]使用随机平行对照方法,将78例住院患者按病志号抽签方法随机分为两组。对照组40例液体复苏,维持有效血容量;低潮气量通气,6m L/kg;氢化可的松,20~40mg/d,肌注;根据细菌培养结果给予抗生素,达到血液透析指征高通量血液透析,支持、对症治疗。治疗组38例三黄泻心汤(黄连6g,黄芩12g,大黄6g,甘草生12g,肉桂3g,乳香制、没药制各l0g,白及9g,大枣10g),150m L/次,2次/d,口服或鼻饲(昏迷或吞咽困难);西药治疗同对照组。连续治疗8d为1疗程。观测临床症状、急性生理学及慢性健康状况评分Ⅱ、中性粒细胞明胶酶相关脂质运载蛋白含量、尿肾损伤分子-1、血清半胱氨酸蛋白酶抑制剂C、IL-18、不良反应。治疗1疗程(8d),判定疗效。[结果]A-PACHEⅡ评分、NGAL、Kim-1、Cys C、IL-18两组均有改善(P<0.05,P<0.01),治疗组改善优于对照组(P<0.05,P<0.01)。[结论]三黄泻心汤联合西药治疗脓毒症急性肾损伤(三焦热盛),疗效满意,无严重不良反应,值得推广。

[Objective] To observe the curative effect of Sanhuang Xiexin decoction combined with western medicine on sepsis acute kidney injury（Sanjiao Resheng）. [Methods] 78 cases of inpatients were randomly divided into two groups by random parallel control method. The control group had 39 cases of fluid resuscitation, maintaining effective blood volume, low tidal volume ventilation, 6 m L/kg; hydrocortisone, 20～40 mg/d, intramuscular injection; according to the results of bacterial culture, antibiotics were given to the hemodialysis indication high throughput hemodialysis, support and symptomatic treatment. In the treatment group, 39 cases of Sanhuang Xiexin decoction（Huanglian 6 g, Hauqngi 12 g, Dahuang 6 g, Shenggancao 12 g, Rougui 3 g, Zhiruxiang, Zhimoyao each l0 g, Baiji 9 g, Dazao 10 g）, 150 m L/times, 2/d, oral or nasal feeding（coma or dysphagia）, and Western medicine were treated with the control group. The continuous treatment of 8 D was 1 courses. The clinical symptoms, acute physiology and chronic health status score II, neutrophil gelatinase related lipid carrying protein content, urinary kidney damage molecule-1, serum cysteine protease inhibitor C, IL-18, adverse reaction were observed. The 1 course of treatment（8 d） was treated and the curative effect was determined. [Results] A-PACHE II score, NGAL, Kim-1, Cys C and IL-18 were improved in two groups（P〈0.05, P〈0.01）, and the improvement of the treatment group was better than that of the control group（P〈0.05, P〈0.01）. [Conclusion] Sanhuang Xiexin decoction combined with western medicine in treatment of septic acute kidney injury（Sanjiao Resheng） has satisfactory curative effect, no serious adverse reactions, and is worthy of promotion.