清瘟解毒汤联合机械通气治疗老年重症社区获得性肺炎临床研究

The effect of Qingwen-Jiedu Decoction combined with mechanical ventilation on severe community acquired pneumonia in the elderly

目的评价清瘟解毒汤联合机械通气治疗老年重症社区获得性肺炎(severe community acquired pneumonia,SCAP)的疗效。方法将符合入选标准的2018年11月-2019年5月淮北市中医医院老年SCAP患者66例按随机数字表法分为2组,每组33例。在抗生素、解痉平喘化痰、营养支持等西医常规治疗基础上,对照组配合应用有创呼吸机治疗,治疗组在对照组基础上服用清瘟解毒汤。2组均治疗14 d。分别于治疗前后进行症状、体征评分,采用临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS)评估肺部感染程度;采用免疫荧光分析法检测血清降钙素原(procalcitonin,PCT),采用免疫比浊法检测前白蛋白(prealbumin,PA)水平,采用乳胶凝集法检测D-二聚体、WBC、CRP水平;观察并记录患者通气时间、住院时间、撤机成功率。结果治疗组治疗后CPIS及发热、神昏、气喘、汗出评分均低于对照组(t值分别为6.322、7.231、11.356、9.877、7.233,P值均<0.01)。治疗后,治疗组血清PCT[(0.12±0.03)μg/L比(0.49±0.11)μg/L,t=7.897]、D-二聚体[(0.98±0.23)mg/L比(1.91±0.88)mg/L,t=4.456]水平低于对照组(P<0.01),PA[(178.91±25.32)mg/L比(156.45±20.85)mg/L,t=12.334]水平高于对照组(P<0.01)。治疗组有创通气时间、总通气时间、住院时间均少于对照组(t值分别为4.332,3.931,6.567,P值均<0.05),撤机成功率高于对照组(t=10.232,P<0.01)。结论清瘟解毒汤联合机械通气可有效促进老年SCAP患者炎症吸收,减轻炎症反应和提高呼吸机撤机成功率,协同改善患者的临床症状。

Objective To evaluate the curative effect of Qingwen-Jiedu Decoction combined with mechanical ventilation on elderly patients with severe community acquired pneumonia(SCAP).Methods A total of 66 SCAP patients in Huaibei Hospital of traditional Chinese medicine from November 2018 to May 2019 were randomly divided into two groups,33 in each group.On the basis of conventional western medicine treatment such as antibiotics,antispasmodic,antiasthmatic and expectorant,nutritional support,the control group was treated with invasive ventilator,and the treatment group was given Qingwen-Jiedu Decoction on the basis of the control group.Both groups were treated for 14 days.The Clinical Pulmonary Infection Score(CPIS)was used to evaluate the degree of pulmonary infection,immunofluorescence analysis was used to detect serum procalcitonin(PCT),and immunoturbidimetric method was used to detect prealbumin(PA).The D-dimer,WBC and CRP were detected by latex agglutination method;the ventilation time,hospitalization time and weaning success rate were observed and recorded.Results The CPIS,fever,god faint,asthma,sweat the score of the treatment group were significantly lower than those in the control group(t values were 6.322,7.231,11.356,9.877,7.233,respectively,all Ps<0.01).After treatment,the levels of serum PCT(0.12±0.03μg/L vs.0.49±0.11μg/L,t=7.897),D-dimer(0.98±0.23 mg/L vs.1.91±0.88 mg/L,t=4.456)in the treatment group were significantly lower than those in the control group(P<0.01),and the levels of PA(178.91±25.32 mg/L vs.156.45±20.85 mg/L,t=12.334)in the treatment group were significantly higher than that of the control group(P<0.01).The invasive ventilation time,ventilation time and hospitalization time in the treatment group were significantly less than those in the control group(t values were 4.332,3.931,6.567,respectively,all Ps<0.05),and the weaning success rate was significantly higher than that of the control group(t=10.232,P<0.01).Conclusion Qingwen-Jiedu Decoction combined with mechanical ventilation can promote the absorption of inflammation in SCAP patients,reduce the inflammatory reaction and improve the success rate of weaning machine,and improve the clinical symptoms of patients.