中药雾化吸入联合保留灌肠对多重耐药菌所致脓毒症(气分实热证)的临床研究

Clinical Study on Traditional Chinese Medicine for Nebulized Inhalation Combined with Retention Enema in the Treatment of Sepsis( Syndrome of Excessive Heat of Qifen) Caused by Multidrug-Resistant Organisms

目的:探讨中药雾化吸入联合保留灌肠对多重耐药菌所致脓毒症(气分实热证)的临床疗效。方法:选取2019年6月至2020年5月济宁市中医院重症医学科收治的脓毒症(气分实热证)患者90例进行前瞻性研究,采用随机数字表法进行分组,研究组和对照组各45例患者。两组患者均根据《中国严重脓毒症/脓毒性休克治疗指南》进行标准治疗,研究组患者在此基础上行青石合剂雾化吸入联合白虎汤加减保留灌肠治疗,7 d为1个疗程,两组患者均治疗1个疗程,疗程结束后统计疗效。比较两组患者治疗前后中医证候积分变化,急性生理功能和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)变化,血清降钙素原(PCT)、乳酸(Lac)含量变化,记录治疗期间两组患者的安全性情况。结果:经秩和检验,研究组患者的中医证候疗效分级情况优于对照组,研究组患者的总有效率为95.56%(43/45),明显高于对照组的82.22%(37/45),差异有统计学意义(P <0.05)。两组患者治疗后各项中医证候积分、APACHEⅡ评分明显低于治疗前,血清PCT、Lac含量明显低于治疗前,且研究组患者上述评分和血清指标含量明显低于对照组,差异均有统计学意义(P <0.05)。两组患者的治疗安全性均较好。结论:中药雾化吸入联合保留灌肠对多重耐药菌所致脓毒症(气分实热证)的疗效较好,可有效改善患者的临床症状和预后情况,降低患者血清PCT和Lac含量,且治疗安全性较好。

OBJECTIVE: To probe into the clinical efficacy of traditional Chinese medicine for aerosol inhalation combined with retention enema in the treatment of sepsis( syndrome of excessive heat of qifen) caused by multidrugresistant organism( MDRO). METHODS: Totally 90 patients with sepsis( syndrome of excessive heat of qifen) admitted into the ICU department of Jining Hospital of Traditional Chinese Medicine from Jun. 2019 to May 2020 were selected for prospective study,these patients were divided into research group and control group via random number table,with 45 cases in each group. Both groups had received standard treatment according to the "Guidelines for the Treatment of Severe Sepsis/Septic Shock in China",the research group was given bluestone mixture for nebulized inhalation combined with modified Baihu decoction for retention enema,7 days were set as 1 course of treatment,both groups were treated for1 course,and the efficacy was counted at the end of treatment course. Changes of traditional Chinese medicine( TCM)syndrome integral,acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) and serum procalcitonin( PCT) and lactate( Lac) contents were compared between two groups before and after treatment,the safety profile of the two groups was recorded. RESULTS: After rank-sum test,the TCM syndrome efficacy grading of patients in the research group was better than that of the control group,the total effective rate of patients in the research group was 95. 56%( 43/45),which was significantly higher than that of the control group( 82. 22%,37/45),with statistically significant difference( P< 0. 05). After treatment,the TCM syndrome integral and APACHEⅡ scores of both groups had been significantly decreased,the serum PCT and Lac levels were significantly lower than those of before treatment,and the above scores and serum index levels were significantly lower in the research group than those in the control group,with statistically significant differences( P < 0. 05). Both groups were in a good safety profile. CONCLUSIONS: The efficacy of traditional Chinese medicine for aerosol inhalation combined with retention enema in the treatment of sepsis( syndrome of excessive heat of qifen) caused by MDRO is remarkable,which can effectively improve the clinical symptoms and prognosis of patients,reduce serum PCT and Lac levels,with good treatment safety.