清金化痰汤联合抗生素降阶梯疗法治疗重症肺炎痰热壅肺证临床研究

Clinical Study on Qingjin Huatan Tang Combined with Antibiotic De-Escalation Therapy for Severe Pneumonia with Syndrome of Phlegm-Heat Obstructing Lung

目的:观察清金化痰汤联合抗生素降阶梯疗法治疗重症肺炎痰热壅肺证的临床疗效。方法:选取78例重症肺炎痰热壅肺证患者,按随机数字表法分成治疗组和对照组,每组39例。对照组给予抗生素降阶梯疗法治疗,治疗组在对照组基础上给予清金化痰汤治疗,2组均治疗14 d。比较2组治疗前后临床肺部感染评分(CPIS)及营养指标、血氧指标、炎症因子水平,统计2组机械通气时间。结果:治疗后,2组CPIS及血清白细胞介素-6 (IL-6)、C-反应蛋白(CRP)水平均较治疗前降低(P<0.05),治疗组CPIS及血清IL-6、CRP水平均低于对照组(P<0.05)。治疗后,2组血清血红蛋白(Hb)、白蛋白(Alb)、前白蛋白(PAB)水平及血氧饱和度、氧合指数、血氧分压均较治疗前升高(P<0.05),治疗组血清Hb、Alb、PAB水平及血氧饱和度、氧合指数、血氧分压均高于对照组(P<0.05)。治疗组机械通气时间为(70.75±22.03)h,对照组机械通气时间为(106.61±23.94)h,2组比较,差异有统计学意义(P<0.05)。结论:清金化痰汤联合抗生素降阶梯疗法治疗重症肺炎痰热壅肺证,能有效调节血清Hb、Alb、PAB水平,改善血氧饱和度、氧合指数、血氧分压,减轻炎症反应,缩短机械通气时间。

Objective:To observe the clinical effect of Qingjin Huatan tang combined with antibiotic de-escalation therapy for severe pneumonia with syndrome of phlegm-heat obstructing lung. Methods:A total of 78 cases of patients with severe pneumonia with syndrome of phlegm-heat obstructing lung were selected,and divided into the treatment group and the control group according to the random number table method,39 cases in each group. The control group was given antibiotic de-escalation therapy,and the treatment group was additionally given Qingjin Huatan tang based on the treatment of the control group. Both groups were treated for 14 days. Clinical pulmonary infection score(CPIS), nutrition indexes, blood oxygen indexes,and levels of inflammatory factors before and after treatment were compared between the two groups. The mechanical ventilation time was counted in the two groups. Results:After treatment,CPIS as well as levels of interleukin-6(IL-6) and C-reactive protein(CRP) in the two groups were decreased when compared with those before treatment(P<0.05);CPIS and the two levels above in the treatment group were lower than those in the control group(P<0.05). After treatment,levels of hemoglobin(Hb), albumin(Alb), and prealbumin(PAB) in serum as well as blood oxygen saturation, oxygenation index,and blood partial pressure of oxygen in the two groups were increased when compared with those before treatment(P<0.05);the three levels and the three indexes above in the treatment group were higher than those in the control group(P<0.05). The mechanical ventilation time was(70.75 ±22.03) hours in the treatment group,and(106.61 ±23.94) hours in the control group,the difference being significant(P<0.05). Conclusion:In the treatment of severe pneumonia with syndrome of phlegm-heat obstructing lung, the application of Qingjin Huatan tang combined with antibiotic de-escalation therapy can effectively regulate levels of Hb,AIb,and PAB in serum,improve blood oxygen saturation,oxygenation index,and blood partial pressure of oxygen,as well as relieve inflammatory response and shorten the mechanical ventilation time.