基于“瘀热”理论观察凉血散瘀法治疗重症肺炎的临床疗效

Clinical efficacy of the method of Liangxuesanyu stasis on patients with severe pneumonia based on the theory of"Yure"

目的:探讨凉血散瘀法对重症肺炎患者的临床疗效,并探讨其作用机制。方法:选择2018年3月~2019年10月南京中医药大学附属医院重症医学科收治符合重症肺炎诊断标准患者60例,随机分成中药组30例和对照组30例。两组均给予抗感染、化痰、营养支持、呼吸支持等西医常规治疗,中药组患者在西医常规治疗基础上加用凉血散瘀颗粒剂(水牛角20 g、制大黄10 g、桃仁10 g、生地黄20 g、牡丹皮10 g、赤芍药15 g、丹参20 g),温开水冲至200 mL,分早、晚口服或鼻饲各100 mL,疗程为14 d。比较两组治疗前及治疗后第7天、第14天的呼吸功能、炎症反应、28 d病死率之间的差异。结果:治疗后第7天中药组氧合指数(PO2/FiO2)明显高于同期对照组(P<0.01),气管插管率、Murray肺损伤评分(LIS)、白细胞计数(WBC)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)均低于同期对照组(P<0.05);治疗后第14天中药组氧合指数(PO2/FiO2)高于同期对照组(P<0.05),TNF-α低于同期对照组(P<0.05),Murray评分明显低于同期对照组(P<0.01);中药组机械通气时间低于对照组(P<0.05),住院时间及28 d病死率同对照组比较,差异无统计学意义(P>0.05)。结论:凉血散瘀法干预治疗重症肺炎可有效减轻患者机体的炎症反应,改善氧合水平,减少机械通气时间。

Objective To explore the clinical effect of the method of Liangxuesanyu stasis on the patients with severe pneumonia and its mechanism.Methods From March 2018 to October 2019,60 patients who met the diagnosis criteria of severe pneumonia were selected from the Department of Critical Medicine,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine.They were divided into the Chinese medicine group(n=30)and the control group(n=30)according to the random number table method.Patients in both groups were given conventional Western medicine treatment such as anti-infection,phlegm elimination,nutritional support,and respiratory support.On the basis of conventional Western medicine treatment,patients in the Chinese medicine group were given Liangxuesanyu granules(shuiniujiao 20 g,zhidahuang 10 g,taoren 10 g,shengdi 20 g,mudanpi 10 g,chishao 15 g,danshen 20 g);Liangxuesanyu granules were dissolved in 200 mL warm water and then were given to patients orally or nasally each morning and evening with 100 mL per time,for 14 days.The respiratory function and inflammatory response of the two groups were compared before the treatment and on day 7 and day 14 after treatment.And the 28-day mortality rate was compared between two groups.Results The oxygenation index(PO2/FiO2)of the Chinese medicine group was significantly higher than that of the control group on day 7 after treatment(P<0.01).The tracheal intubation rate,Murray score,white blood cell count,tumor necrosis factor(TNF)-α,and procalcitonin were all lower than those of the control group(P<0.05).On day 14 after treatment,the oxygenation index(PO2/FiO2)of the Chinese medicine group was higher than that of the control group(P<0.05),the TNF-αwas lower than that of the control group(P<0.05),and the Murray score was significantly lower than that of the control group(P<0.01).The mechanical ventilation time of the Chinese medicine group was lower than that of the control group(P<0.05),and the length of hospital stay and 28-day mortality were not significantly different from those of the control group(P>0.05).Conclusion The intervention of Liangxuesanyu method in the treatment of severe pneumonia can effectively reduce the inflammatory response of patients,improve the oxygenation level and reduce the time of mechanical ventilation.