通腑护脏方干预脓毒症急性肾损伤患者的临床疗效分析

Analysis of clinical therapeutic effect of Tongfu Huzang Recipe on patients with acute kidney injury due to sepsis

目的分析通腑护脏方干预脓毒症急性肾损伤(AKI)患者的临床疗效。方法采用前瞻性研究方法,选择2015年11月至2020年3月江苏省中医院重症监护病房(ICU)收治的脓毒症AKI患者共56例,将入组患者随机分为对照组(19例)和研究组(37例),再根据是否伴有腹腔内高压(IAH)分为IAH亚组和非IAH亚组。对照组给予常规治疗.研究组在常规治疗基础上加用通腑护脏方(组成:大黄、枳实、厚朴、姜黄、桃仁、红花等)进行中药汤剂管饲联合灌肠,浓煎200mL,每日1剂。测定各组患者血肌酐(SCr)、胱抑素C(Cys C)、中性粒细胞明胶酶相关脂质运载蛋白(NCAL)、肾损伤分子-1(KIM-1)水平并计算肌酐清除率(CCr),记录尿量、机械通气(MIV)时间、肠内营养(EN)达标时间、去甲肾上腺素(NE)使用时间、连续性肾脏替代治疗(CRRT)持续时间以及ICU住院时间,采用Kaplan-Meier法分析患者28 d生存情况。结果①医疗相关时间:与对照组比较、研究组MV时间、EN达标时间、CRRT持续时间和ICU住院时间均明显缩短,差异均有统计学意义;NE使用时间亦有所缩短,但差异无统计学意义.②CCr:入组1d,IAH患者人组各时间点CCr均略高于非IAH患者,但差异无统计学意义;人组3d开始。研究组IAH患者的CCr明显高于对照组IAH患者(ml/min:43.8±3.9比36.7±2.8,P<0.05);人组7d开始,研究组非IAH患者的CCr明显高于对照组非IAH患者(ml/min:46.8±4.8比37.1±2.9,P<0.05);人组21 d时,研究组非IAH患者的CCr赶上并明显超过对照组IAH患者(ml/min:107.3±22.1比98.3±18.9.P<0.05)。③肾功能指标:研究组患者Cys C、NGAL、KIM-1水平均较对照组明显降低,且研究组IAH患者SCr水平较对照组IAH患者明显降低(umol/L:91.3±2.5比259.7±2.9.P<0.05).而两组间的尿量比较差异无统计学意义。④28 d病死率:研究组与对照组的28 d病死率比较差异无统计学意义[18.92%(7/37)比21.05%(4/19),P>0.05]。结论通腑护脏方对脓毒症AKI患者的肾功能有保护作用,可通过降低腹腔内压(IAP)改善肾脏灌注压以及其他机制实现,是潜在的可有效保护脓毒症AKI患者肾功能的药物。

Objective To analyze the elinieal eficacy of Tongfu Huzang Recipe of traditional Chinese medicine(TCM)on acute kidney injury(AKI)in patients with sepsis.Methods A prospective research method was used in this study,a total of 56 patients with AKI due to sepsis admited into the intensive care unit(ICU)of Jiangsu Provincial Hopital of TCM from November 2015 to March 2020 were enrolled and they were randomly divided into study group(37 cases)and control group(19 cases).Each group was futher subdivided into itra-abdominal hypetension(IAH)subgroup and non-IAH subgroup according to whether being accompanied by IAH or nol.The control group was given routine Western treatment,while the study group was treated with TCM on the basis of routine W estern therapy.using Tongfu Huzang Recipe(composition:Rhubarb.Citrus aurantium,Magnolia ofcinalis,Turmerie,Peach kermel.Safflower,ete.)to prepare TCM 200 mL concentrated decoction administered by tube feeding combined with enema,I dose per day.Sernum rrainine(SCr),cystain C(Cys C).neutrophil gelatinase associated lipocalin(NCAL),kidney injury molecule-1(KIM-1)were measured,and the ecreatinine clearance rate(CCr)was calculated;urine output,mechanical ventilation(MV)time,enteral nutrition(EN)compliance time,norepinephrine(NE)use time,continuous renal replacement therapy(CRRT)duration,and lengh of ICU stay were recorded in patients of each group.The 28.day survival situation of each group was analyzed by Kaplan-Meier method.Results①Medical therapy related time:compared with the control group,the study group's MV time,EN compliance time,CRRT duration and lengh of ICU stay were signifcantly shortened:the NE use time was also shortened,but the dffrence was not staistically signifieant between the two groups.②CCr:on the first day of the study,the CCr of IAH patients was slightly higher than that of the non-IAH group at each time point,but the diference was not statistically significant;on the third day,in the IAH group.the CCr of IAH patients in the study group was sgnificanly higher than that of IAH patients in the control group(ml/min:43.8±3.9 vs.36.7+2.8.P<0.05);after 7 days,the CCr of non-IAH patients in the study group was signifcanly higher than that of non-IAH patients,in the control group(ml/min:46.8±4.8 vs.37.1±2.9,P<0.05).Furthermore,after investigation for 21 days,the CCr of non-IAH patients in the study group exceded that of IAH patients in the control group(ml/min:107.3±22.1 vs.98.3±18.9,P<0.05).③Kidney injury indicators:afer treatment,the levels of Cys C.NGAL and KIM-1 in the study group were significantly lower than those in the control group.Moreover,the SCr level in the IAH patients of study group was lower than that of IAH patients in the control group(umo/L:91.3±2.5 vs.259.7±2.9,P<0.05).The comparison of the amount of urine belween the Iwo groups had no statistical signifcant difference.④28-day mortality:there was no satistially signifcant difrerence in the 28.day fatality rate between the study group and the control group[18.92%(7/37)vs.21.05%(4/19),P>0.05].Conclusions Tongfu Huzang Recipe has a protective efet on the renal function of patients with sepsis AKI.The prolection can be achieved by reducing intra-abdominal pressure(IAP)to improve renal perfusion pressure and other mechanisms.Tongfu Huzang Recipe could potentially be an ffrctive protective drug for patients with AKI due to sepsis.