清瘟败毒饮对毒瘀互结型脓毒血症患者炎症反应和脏器功能的影响

Effect of Qingwen Baidu Decoction on Inflammatory Reaction and Organ Function in Sepsis Patients with Toxic-Stasis Syndrome

目的观察清瘟败毒饮对脓毒血症毒瘀互结证患者炎症反应和脏器功能的影响。方法收集2016年5月—2018年5月的脓毒血症患者80例,随机分为对照组和观察组,每组40例。对照组患者予以补液、抗感染等常规治疗,观察组常规治疗的基础上服用清瘟败毒饮汤剂,随证加减,疗程为7天。预后评价采用急性生理与慢性健康评分(APACHE-Ⅱ)、序贯性器官功能衰竭评分(SOFA);检测感染和炎症指标[包括白细胞(WBC)、中性粒细胞数(NEUT)、中性粒细胞百分比(NEUT%)、降钙素原(PCT)、IL-6、超敏C反应蛋白(hs-CRP)、内毒素];检测肝、肾功能[包括ALT、AST、TBIL、DBIL、IBIL,肌酐(CREA)、尿素(UREA)、尿酸(UA)、肾小球滤过率(GFR)]和肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、肌红蛋白(Mb)、乳酸脱氢酶(LDH)];中医治疗评分采用毒瘀互结证候评分。结果观察组中医证候疗效总有效率75%(29/38),高于对照组的总有效率55%(20/37,χ^2=13.625,P<0.01);与本组治疗前比较,两组治疗后第3、7天,APACHE-Ⅱ和SOFA评分均降低(F对照=6.42,F观察=7.38,P<0.05),WBC、NEUT、NEUT%、PCT、IL-6、hs-CRP、内毒素、ALT、AST、TBIL、DBIL、IBIL、CREA、UREA、UA水平均明显降低(P<0.05),GFR明显增加(P<0.05);与对照组同期比较,观察组治疗第3、7天APACHE-Ⅱ和SOFA评分降低(P<0.05);WBC、NEUT、NEUT%、PCT、IL-6、hs-CRP、内毒素、ALT、AST、TBIL、DBIL、IBIL、CREA、UREA、UA水平均明显降低(P<0.05),GFR明显提高(P<0.05),且第7天较第3天各检测指标改善明显(P<0.05)。结论在西医综合治疗的基础上,合用清瘟败毒饮辨证加减治疗毒瘀互结型脓毒血症患者,能明显降低感染指标和炎症因子的水平,减低APACHE-Ⅱ评分和SOFA评分,改善脏器损害。

Objective To observe the effect of Qingwen Baidu Decoction(QWBDD)on inflammatory reaction and organ function in sepsis patients with toxic-stasis syndrome.Methods Totally 80 sepsis patients received from May 2016 to May 2018,were randomly assigned to the control group and the observation group,40 in each group.Patients in the two groups received routine symptomatic treatment such as fluid infusion and anti-inflammation,and so on.Patients in observation group additionally took QWBDD according to syndrome type,the therapeutic course for all was 7 days.The prognosis was assessed by Acute Physiology and Chronic Health Evaluation(APACHE-Ⅱ)Score and Sequential Organ Failure(SOFA)Score.Infection and inflammation indicators including white blood cell(WBC),neutrophil count(NEUT),neutrophil percentage(NEUT%),procalcitonin(PCT),IL-6,hypersensitive C-reactive protein(hs-CRP),and endotoxin were detected.Liver function and renal function were detected[including ALT,AST,TBIL,DBIL,IBIL,creatinine(CREA),urea(UREA),uric acid(UA),and glomerular filtration rate(GFR)].The level of creatine kinase(CK),creatine kinase isoenzyme(CKMB),myoglobin(Mb),and lactate dehydrogenase(LDH)of myocardial enzyme were detected.The curative effect of Chinese medicine was evaluated by toxic-stasis syndrome scoring system.Results The total effective rate of Chinese medicine syndrome in the observation group was 75%(29/38),higher than the control group which was 55%(20/37,χ2=13.625,P<0.01).Compared with before treatment,the APACHE-Ⅱscore and SOFA score decreased in both groups at the 3rd and 7th day after treatment(Fcontrol=6.42,Fobservation=7.38,P<0.05).The levels of WBC,NEUT,NEUT%,PCT,IL-6,hs-CRP,endotoxin,ALT,AST,TBIL,DBIL,IBIL,CREA,UREA and UA were decreased(P<0.05),GFR was increased(P<0.05).Compared with the control group at same time point,the APACHE-Ⅱscore and SOFA score were decreased in the observation group at the 3rd and 7th day after treatment(P<0.05),the levels of WBC,NEUT,NEUT,PCT,IL-6,hs-CRP,endotoxin,ALT,AST,TBIL,DBIL,IBIL,CREA,UREA,and UA were significantly decreased(P<0.05),and the GFR was significantly increased(P<0.05),and the detection indexes of the 7th day were significantly improved than the 3rd day(P<0.05).Conclusion QWBDD combined with Western medicine could reduce the level of infection and inflammation on patients with toxin-stasis syndrome,reduce APACHE-Ⅱscore and SOFA score,and improve organ injury.