大黄附子汤治疗脓毒症肺损伤的疗效观察

Therapeutic effect of Dahuang Fuzi decoction in treatment of sepsis lung injury

目的观察大黄附子汤治疗脓毒症肺损伤患者的临床疗效。方法选择2018年6月至2020年6月北京中医药大学深圳医院(龙岗)重症监护病房(ICU)收治的60例脓毒症肺损伤患者,采用随机数字表法分为对照组和治疗组,每组30例。所有患者均给予常规治疗。对照组在常规治疗基础上加用枸橼酸莫沙必利片和双歧杆菌三联活性胶囊治疗;治疗组在常规治疗基础上加用大黄附子汤(组成:大黄12 g,制附子15 g,细辛6 g)治疗,每剂煎煮成200 mL,每日1剂,分3次服用;两组疗程均为8 d。观察两组患者治疗前后序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、胃肠功能障碍评分、肺部超声B线评分、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))变化;记录两组患者28 d病死率、机械通气时间、ICU住院时间和总住院时间。结果两组患者治疗3 d肺部超声B线评分较治疗前略降低,治疗5 d和8 d肺部超声B线评分均较治疗前明显降低,以治疗组降低更明显(分:治疗5 d为12.78±2.13比14.32±2.40,治疗8 d为8.59±1.16比9.43±1.35,均P<0.05)。随治疗时间延长,治疗组患者治疗3、5、8 d APACHEⅡ评分、SOFA评分、胃肠功能障碍评分均呈明显降低趋势,PaO_(2)、PaO_(2)/FiO_(2)均呈明显升高趋势,且上述指标与对照组同时间点比较差异均有统计学意义,以治疗8 d变化最明显〔APACHEⅡ评分(分):15.74±3.62比18.21±3.82,SOFA评分(分):3.43±1.22比4.32±1.43,胃肠功能障碍评分(分):6.44±1.49比7.37±1.51,PaO_(2)(mmHg,1 mmHg≈0.133 kPa):86.81±9.87比81.76±9.45,PaO_(2)/FiO_(2)(mmHg):295.88±57.47比265.89±51.64,均P<0.05〕。治疗组患者机械通气时间、ICU住院时间和总住院时间均较对照组明显缩短〔机械通气时间(d):7.35±2.52比9.32±3.31,ICU住院时间(d):9.46±4.23比12.24±5.18,总住院时间(d):14.39±6.72比18.46±7.22,均P<0.05〕;两组患者28 d病死率比较差异无统计学意义〔20.00%(6/30)比33.33%(10/30),P>0.05〕。结论大黄附子汤能促进脓毒症肺损伤患者胃肠功能恢复,减轻肺水肿,改善呼吸功能,缩短住院时间,缓解病情。

Objective To observe the clinical effect of Dahuang Fuzi decoction in the treatment of patients with sepsis lung injury.Methods From June 2018 to June 2020,60 patients with sepsis lung injury treated in the intensive care unit(ICU)of Shenzhen Hospital(Longgang)of Beijing University of Traditional Chinese Medicine(TCM)were randomly divided into treatment group and control group,with 30 cases in each group.Both groups were given conventional treatment.The control group was treated with mosapride citrate tablets and Bifidobacterium triple active capsules on the basis of conventional treatment,while the treatment group was treated with Dahuang Fuzi decoction on the basis of conventional treatment(prescription composition:Rhubarb 12 g,Prepared aconite 15 g,Asarum 6 g),each dose is decocted into 200 mL,take 1 dose daily in 3 times;the course of treatment in the two groups was 8 days.The changes of sequential organ failure score(SOFA),acute physiology and chronic health status scoreⅡ(APACHEⅡ),gastrointestinal dysfunction score,lung ultrasound B-line score,the changes of arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2))and oxygenation index(PaO_(2)/FiO_(2))were observed in both groups.The patients'28-day mortalities,mechanical ventilation times,ICU stay times and total hospitalization times in the two groups were recorded.Results Compared with those before treatment,on the third day of treatment,the B-line scores of pulmonary ultrasound in the two groups were slightly decreased.On the fifth and eighth day of treatment,the B-line scores of pulmonary ultrasound in both groups were decreased significantly,and the decrease was more obvious in the treatment group(the 5th day:12.78±2.13 vs.14.32±2.40,the 8th day:8.59±1.16 vs.9.43±1.35,both P<0.05).With the prolongation of therapeutic time,on the 3rd,5th and 8th day of treatment,APACHEⅡscore,SOFA score and gastrointestinal dysfunction score showed a significant downward trend,while PaO_(2) and PaO_(2)/FiO_(2) showed an obvious upward trend in the treatment group,and the above indexes had statistical significant differences compared with the control group at the same time point and the most obvious change being on the 8th day of treatment[APACHEⅡscore:15.74±3.62 vs.18.21±3.82,SOFA score:3.43±1.22 vs.4.32±1.43,gastrointestinal dysfunction score:6.44±1.49 vs.7.37±1.51,PaO_(2)(mmHg,1 mmHg≈0.133 kPa):86.81±9.87 vs.81.76±9.45,PaO_(2)/FiO_(2)(mmHg):295.88±57.47 vs.265.89±51.64,all P<0.05].The duration of mechanical ventilation,ICU stay and total hospital stay times in the treatment group were significantly shorter than those in the control group[mechanical ventilation time(days):7.35±2.52 vs.9.32±3.31,ICU stay time(days):9.46±4.23 vs.12.24±5.18,total hospitalization time(days):14.39±6.72 vs.18.46±7.22,all P<0.05];there was no significant statistical difference in the 28-day mortality between the two groups[20.00%(6/30)vs.33.33%(10/30),P>0.05].Conclusion Dahuang Fuzi decoction can promote the recovery of gastrointestinal function,reduce pulmonary edema,improve respiratory function,shorten the length of hospital stay and alleviate the suffering of patients with sepsis lung injury.