大黄在危重症救治中的应用

Application of Dahuang(Rhubarb)in Treatment of Critically ill Patients

西医"危重症"多归属于中医"危候"范畴,是对病情极重,精气将竭,脏腑衰败,濒于死亡的临床征象概括。大黄是一种传统中药,具有攻积导滞,活血化瘀,泻火凉血之功效。药理研究发现大黄具有调节免疫功能、抗感染、胃肠道保护、肺保护、脑保护、减轻脑出血后脑水肿严重程度、缩短血肿吸收时间、止血和神经保护的作用;增加肾脏血流量、降低尿蛋白、血清肌酐和尿素氮水平等作用。查阅近年来的相关文献,就大黄在重症急性胰腺炎、脓毒症、脑卒中、肾功能衰竭等危重症领域中的应用为例,证明在危重症的救治过程中,西医西药配合中药大黄治疗,双管齐下,提高救治的成功率,改善预后、减少并发症的发生,但应用时也要注意其可能存在的不良反应及剂量、炮制等问题。抛砖引玉,期望临床同道树立中西医结合救治危重症患者的医学思维模式。

Western medicine"critical disease"belongs to"critical syndrome"in traditional Chinese medicine and is extremely serious to the patients.The essence Qi would be exhausted and the Zang-fu organs function would be declined,with death clinical signs.Dahuang(Rhubarb)is a traditional Chinese drug and has the effects of purging the mass and eliminating stagnation,promoting blood circulation and removing blood stasis,reducing fire and cooling blood.Pharmacological studies have found that Dahuang(Rhubarb)has the effects of regulating immune function,anti-infection,gastrointestinal protection,lung protection,brain protection,reducing the severity of edema after intracerebral hemorrhage,shortening hematoma absorption time,stopping bleeding and protecting nerve,increasing renal blood flow,reducing levels of urinary protein,serum creatinine and urea nitrogen.In recent years,the author reviewed the literature on Dahuang(Rhubarb)in severe acute pancreas,inflammation,sepsis,stroke,renal failure and other critical areas as an example to prove that in the treatment of critically ill patients,western medicine combined with traditional Chinese medicine Dahuang(Rhubarb)can improve the success rate of treatment,improve the prognosis,reduce the occurrence of complications,but the application should also pay attention to its possible side effects and dosage,processing and other problems.We hope to set up the medical thinking mode of integrated Chinese and western medicine to treat critically ill patients.