贞芪扶正颗粒在抢救重症肺炎呼吸衰竭患者中的作用

Observation on role of Zhenqi Fuzheng granule in rescue treatment of patients with severe pneumonia respiratory failure

目的观察贞芪扶正颗粒在抢救重症肺炎呼吸衰竭(呼衰)中的作用.方法采用回顾性研究方法,选择白银市第一人民医院重症医学科收治的重症肺炎患者96例,按治疗方法不同将患者分为西医常规治疗组(47例)和中西医结合治疗组(49例).西医常规治疗组只给予各种常规抢救措施;中西医结合治疗组在西医常规治疗的同时给予贞芪扶正颗粒5g,用20mL温开水溶化后鼻饲,每日2次,7~10d为1个疗程.3个疗程后评价临床疗效.观察两组患者病死率和治疗前后免疫球蛋白、降钙素原(PCT)、C-反应蛋白(CRP)的变化以及病程、抗菌药物与呼吸机使用时间、肺部渗出的改变、肺间质纤维化发生率.结果中西医结合治疗组病死率较西医常规治疗组明显降低〔14.29%(7/49)比36.17%(17/47),P<0.05〕.两组治疗后免疫球蛋白均较治疗前明显升高,PCT和CRP均较治疗前明显降低,且以中西医结合治疗组治疗后的变化较西医常规治疗组更为显著〔IgG(g/L):12.48±2.36比10.35±3.01,IgA(g/L):4.16±1.08比3.18±1.13,IgM(g/L):5.01±1.15比3.62±1.02,PCT(mg/L):1.48±1.36比2.35±1.01,CRP(mg/L):8.48±2.36比10.35±2.01,均P<0.05〕.中西医结合治疗组病程、抗菌药物和呼吸机使用时间均较西医常规治疗组明显缩短〔病程(d):10.86±2.64比14.38±3.02,抗菌药物使用时间(d):11.29±3.54比13.96±4.21,呼吸机使用时间(d):8.26±2.64比10.25±3.08,均P<0.05〕.中西医结合治疗组肺部渗出明显减少例数、肺部渗出完全吸收例数均较西医常规治疗组明显增多,肺纤维化例数均较西医常规治疗组明显减少(肺部渗出明显减少例数:15例比10例,肺部渗出完全吸收:16例比9例,肺纤维化例数:8例比10例,均P<0.05).结论贞芪扶正颗粒可明显降低重症肺炎患者病死率和炎症因子水平,升高免疫球蛋白,缩短病程和抗菌药物以及呼吸机使用时间,减少肺部渗出,降低肺间质纤维化发生率.

Objective To observe the role of Zhenqi Fuzheng granules in the treatment of patients with severe pneumonia respiratory failure.Methods A retrospective research was conducted,96 patients with severe pneumonia admitted to the Department of Critical Care Medicine of the First People Hospital of Baiyin were enrolled,and they were divided into a western medical conventional treatment group(47 cases)and a combined traditional Chinese and western medicine treatment group(49 cases)according to the different treatment methods.A variety of conventional rescue treatments were carried out in the western medicine routine treatment group(conventional group);while in the combined traditional Chinese and western medicine conventional treatment group(combined group),based on the western medical therapies in the conventional group,at the same time,additionally Zhenqi Fuzheng granules 5 g dissolved in 20 mL warm boiled water were given by nasal feeding to the patients,2 times daily,7-10 days constituting a therapeutic course,and after 3 courses,the clinical therapeutic effects were evaluated.The mortality and changes of pre-and post-treatment levels of immunoglobulin,procalcitonin(PCT),C-reactive protein(CRP),course of disease,times of using antibacterial drug and ventilator,and changes in lung exudation before and after treatment,and incidence of pulmonary fibrosis were observed in the two groups.Results The mortality of combined group was significantly lower than that of the conventional group[14.29%(7/49)vs.36.17%(17/47),P<0.05].After treatment,the levels of immunoglobulins were significantly higher than those before treatment,while the levels of PCT and CRP were significantly lower than those before treatment in both groups,and the changes after treatment in the combined group were more obvious than those in conventional group[IgG(g/L):12.48±2.36 vs.10.35±3.01,IgA(g/L):4.16±1.08 vs.3.18±1.13,IgM(g/L):5.01±1.15 vs.3.62±1.02,PCT(mg/L):1.48±1.36 vs.2.35±1.01,CRP(mg/L):8.48±2.36 vs.10.35±2.01,all P<0.05].Compared with those in conventional group,the patient's disease course,times of using antibacterial drug and ventilator were significantly shorter in combined group[the course of disease(days):10.86±2.64 vs.14.38±3.02,time of using antibacterial drug(days):11.29±3.54 vs.13.96±4.21,time of using ventilator(days):8.26±2.64 vs.10.25±3.08,all P<0.05];Compared with those in the conventional group,the cases with significant reduction of pulmonary exudation and the cases with complete absorption of pulmonary exudation were markedly increased,while the cases of pulmonary fibrosis were obviously decreased in the combined group(cases of reduction of pulmonary exudation:15 cases vs.10 cases,complete absorption of pulmonary exudation:16 cases vs.9 cases;cases of pulmonary fibrosis:8 cases vs.10 cases,all P<0.05).Conclusion Zhenqi Fuzheng granules can significantly reduce the mortality and inflammatory factor levels,raise immunoglobulin,shorten the course of disease and times of using antimicrobial drugs and ventilator,reduce pulmonary exudation and incidence of pulmonary fibrosis obviously in patients with severe pneumonia.