通腑泻肺汤对脓毒症患者呼吸及肠道功能影响的临床研究

Clinical Study of Tongfu Xiefei Decoction on Respiratory and Intestinal Function of Sepsis Patients

目的观察通腑泻肺汤对脓毒症患者呼吸功能及肠道功能的影响,并探讨其可能作用机制。方法60例患者随机分为对照组和治疗组两组各30例。对照组予以常规西医治疗,治疗组在对照组治疗基础上加用中药通腑泻肺汤剂,疗程为14 d。观察并比较两组患者治疗前、治疗后第7、14天的炎症指标、呼吸功能及肠道功能等指标改善情况。结果两组治疗后第7日与第14日的TNF-α、IL-6、PCT水平均比本组治疗前降低(均P<0.05),且治疗组治疗后TNF-α、IL-6、PCT水平均明显低于同期对照组(P<0.05)。治疗组治疗后第7日与第14日的氧合指数均高于本组治疗前水平(P<0.05),而LIS评分则比治疗前降低(P<0.05);对照组治疗后第7日氧合指数与LIS评分与治疗前相比较差异无统计学意义(均P>0.05),但其治疗后的第14日氧合指数高于治疗前(P<0.05),且LIS评分比治疗前降低(P<0.05)。两组在治疗后第7日与第14日机械通气人数与本组治疗前相比较差异无统计学意义(均P>0.05)。治疗组在治疗后第7日与第14日的氧合指数均高于同期对照组(P<0.05),且机械通气人数及LIP评分均较同期对照组降低(P<0.05)。治疗组治疗后第7日与第14日的DAO、D-Lac水平以及GIF评分均比治疗前均降低(均P<0.05);对照组治疗后第7日与第14日的D-Lac水平比治疗前降低(P<0.05),但第7日与第14日DAO水平和GIF评分与治疗前相比较差异无统计学意义(均P>0.05)。治疗组在治疗后第7日与第14日的DAO、D-Lac水平以及GIF评分均低于同期对照组(P<0.05)。对照组与治疗组28 d死亡人数分别为3例与2例,差异不明显(P>0.05)。治疗组在观察期间未出现明显药物不耐受或过敏等不良反应。结论通腑泻肺汤可有效改善脓毒症患者的呼吸功能及肠道功能,其机制可能与其调控脓毒症时的全身炎症反应有关。

Objective:To observe the effect of Tongfu Xiefei Decoction on respiratory function and intestinal function of sepsis patients and its possible mechanism.Methods:60 patients were randomly divided into the control group and the treatment group,30 cases in each.The control group was treated with routine Western medicine,while the experimental group was treated with Tongfu Xiefei Decoction on that basis.The treatment course last for 14 days.The improvement of inflammation,respiratory function and intestinal function were observed and compared before treatment,7 and 14 days after treatment in the two groups.Results:TNF-α,IL-6 and PCT levels decreased in both groups after treatment and the decline was more obvious in the treatment group compared to the control group(all P<0.05).There was no significant difference in oxygenation index,number of mechanical ventilation and lung injury score between the two groups before treatment(all P>0.05).Respiratory function and oxygenation level were improved in both groups after treatment.The number of mechanical ventilation patients in the experimental group decreased significantly,and PaO2/FiO2 and LIS improved most significantly on the 14 th day after treatment in the experimental group(all P<0.05).DAO,D-Lac and GIF scores of the two groups showed a downward trend after treatment,but it was more obvious in the treatment group especially on the14 th day(all P<0.05).Conclusion:Tongfu Xiefei Decoction can effectively improve the respiratory and intestinal functions of sepsis patients,whose mechanism may be related to its regulation of systemic inflammatory response in sepsis.