清肺消炎汤联合抗感染机械通气治疗老年重症肺炎临床研究

Clinical study on Qingfei-Xiaoyan Decoction combined with anti infective mechanical ventilation in the treatment of senile severe pneumonia

目的评价清肺消炎汤联合抗感染机械通气治疗老年重症肺炎的临床疗效。方法将符合入选标准的2018年6月-2021年5月本院重症肺炎患者102例,采用随机数字表法分为2组,每组51例。对照组给予抗感染机械通气治疗,研究组在对照组基础上加服清肺消炎汤治疗。2组均治疗2周。分别于治疗前后进行中医证候积分,采用临床肺部感染评分(CPIS)评估感染严重程度,采用肺功能仪检测患者FVC、FEV1及最高呼气流速(PEF),采用ELISA法检测血清TNF-α、高迁移率族蛋白B1(high mobility group box 1,HMGB1)及CRP水平,记录不良反应,评价临床疗效。结果研究组总有效率为94.1%(48/51)、对照组为80.4%(41/51),2组比较差异有统计学意义(χ^(2)=4.320,P=0.038)。治疗后,研究组中医证候积分、CPIS评分低于对照组(t值分别为14.203、11.403,P值均<0.01),FVC、FEV1、PEF高于对照组(t值分别为4.663、3.451、13.220,P值均<0.01),血清CRP、TNF-α、HMGB1水平低于对照组(t值分别为14.672、10.277、24.453,P值均<0.01)。治疗期间,2组均未发生严重不良反应。结论清肺消炎汤联合抗感染机械通气可明显缓解老年重症肺炎患者的临床症状,改善肺功能,减轻炎症反应,提高疗效,且安全性较好。

Objective To evaluate the clinical efficacy of Qingfei-Xiaoyan Decoction combined with anti infective mechanical ventilation in the treatment of senile severe pneumonia.Methods A total of 102 patients with severe pneumonia in our hospital from June 2018 to May 2021 who met the inclusion criteria were randomly divided into two groups by random number table method,with 51 in each group.The control group was treated with anti-infection mechanical ventilation,and the study group was treated with Qingfei-Xiaoyan Decoction on the basis of the control group.Both groups were treated for 2 weeks.TCM syndrome scores were performed before and after treatment.The severity of infection was evaluated by clinical pulmonary infection score(CPIS),FVC,FEV1 and peak expiratory flow(PEF)were detected by pulmonary function meter,and the levels of TNF-α,high mobility group box 1(HMGB1)and CRP were detected by enzyme-linked immunosorbent assay,adverse events were recorded and clinical efficacy was evaluated.Results The total effective rate was 94.1%(48/51)in the study group and 80.4%(41/51)in the control group,and there was significant difference between the two groups(χ^(2)=4.320,P=0.038).After treatment,the TCM syndrome score and CPIS score of the study group were significantly lower than those of the control group(t values were 14.203 and 11.403,respectively,all Ps<0.01),FVC,FEV1 and PEF in the study group were significantly higher than those in the control group(t values were 4.663,3.451 and 13.220,respectively,all Ps<0.01),and the levels of serum CRP,TNF-αand HMGB1 in the study group were significantly lower than those in the control group(t values were 14.672,10.277 and 24.453,respectively,all Ps<0.01).During the treatment,no serious adverse reactions occurred in both groups.Conclusions Qingfei-Xiaoyan Decoction combined with anti-infective mechanical ventilation has a significant effect in the treatment of senile severe pneumonia.It can alleviate clinical symptoms,improve lung function,reduce inflammatory reaction with safety.